How to better protect healthcare workers from splash exposures

Healthcare workers can be exposed to infectious diseases and pathogens from patients while going about a normal day on the job — and it is their employer's responsibility to help mitigate the risks of exposure.

Usually, these efforts revolve around limiting needlesticks, a common cause of healthcare worker exposure. However, there is one source of exposure that's not often mentioned: splashes.

Splashes, or mucocutaneous pathogen exposures, occur during workers' daily activities like emptying suction cups, spraying bedpans or changing fecal tubes of catheters. These activities can send patients' bodily fluid accidently into workers' eyes or open cuts.

Though splashes aren't often talked about, they are common: A 2003 study showed 43 percent of physicians, 39 percent of registered nurses, 27 percent of licensed practical nurses and 25 percent of medical techs experienced at least one mucocutaneous blood exposure in the previous three months.

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Perhaps mucocutaneous exposures aren't mentioned as often as percutaneous injuries like needlesticks because they go underreported. The same 2003 study revealed just 12 percent of survey respondents reported their mucocutaneous blood exposure.

Those who do report their exposure must go through the time and cost associated with reporting to employee health, taking baseline tests and, if needed, going through a round of prophylaxis.

How to prevent splashes

Now that splashes are back in the spotlight, hospitals should get serious on cutting down on these types of exposures.

"It's been a pretty big enigma for all of the hospitals I've been in for how to prevent this from happening and get healthcare workers to protect themselves," says Jacie Volkman, MPH, an infection prevention consultant for MEIKO and member of the Association for Professionals in Infection Control and Epidemiology.

Here, she offers two tips for hospitals to get splash exposures under control:

1. Provide improved PPE. Splash exposures usually happen when bodily fluids get in healthcare workers' eyes, so some hospitals opt to provide masks with clear plastic shields to protect workers' eyes. That way, the worker's nose, mouth and eyes are protected. Ms. Volkman acknowledges there are some shortcomings to this approach. "This requires healthcare workers to remember to put them on," she says.

With those shortcomings in mind, hospitals can help by storing PPE more prominently to serve as a visual reminder and to keep it well stocked.

Hospitals can also make PPE more festive. Ms. Volkman gives the example of having a contest where hospital units "bedazzle" a pair of safety goggles for a display as a campaign to raise awareness that splashes happen and to remind nurses and other workers to wear their glasses. This way, workers are more likely to remember to put their PPE on and be better protected.

2. Get rid of the hopper. A common source of splashes is rinsing bedpans, which, in most U.S. hospitals, happens in a hopper. When a worker rinses out the bedpan, its contents can splash up from the force of the water.

To rid the hospital of this splash risk, organizations can add a new piece of equipment: a disinfection appliance, otherwise known as a bedpan washer. Similar to a dish sanitizer in a restaurant kitchen, a bedpan washer — a common tool in Canadian and European hospitals but still relatively new in the U.S. — will wash and sanitize bedpans, suction canisters, catheters and urine bottles without putting workers at risk of splash exposure.

An additional perk of using a washer is that when waste is processed through the machine, it it does not need to go into red bag waste, which can save hospitals money.

"Hospitals can pay $80 a bag for red bag waste," says Tom Jedlowski, from MEIKO, a manufacturer of disinfection appliances. "And floor nurses often err on the side of caution and put all waste in red bags. But now they know if it has been processed, it can go into the regular trash."

So, by taking two relatively simple actions — providing more protective PPE and encouraging healthcare workers to wear it and investing in new equipment like a bedpan washer — hospitals can help protect their workers from splash exposures.

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