If you’re a healthcare professional, staying on top of the latest research findings and survey data is an important part of your profession. This is especially true when it comes to sharps incidents and blood and bodily fluid exposure. These types of accidents in healthcare settings can pose serious health consequences to staff. The Association of Occupational Health Professionals in Healthcare has been committed to tracking the experiences of hospital staff in the US for years, and recently released their 2019-2023 EXPO-S.T.O.P "Fill the Gap" survey. Let’s explore the results.

TOPICS WE WILL COVER: 

1 / What is the EXPO-S.T.O.P. "Fill the Gap" Survey? 

2 / What’s unique about the EXPO-S.T.O.P. “Fill the Gap” Survey? 

3 / What does the survey cover? 

4 / Survey results

5 / The puzzling parts

6 / Conclusions of the Fill the Gap survey  

What is the EXPO-S.T.O.P. "Fill the Gap" survey?

The Association of Occupational Health Professionals in Healthcare (AOHP) has conducted their annual Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.) in US hospitals since 2011. The survey reviews blood and body fluid exposures (BBFE) and was consistently conducted each year until the COVID-19 pandemic prevented researchers from conducting the survey in 2020 and 2021 due to the high workload demands on healthcare professionals. 

What’s unique about the EXPO-S.T.O.P. “Fill the Gap” Survey

Prior to COVID-19, the 2018 EXPO-S.T.O.P. revealed the rising incidents of BBFE nationally had stopped and there was optimism that in 2019 the incidence rate would continue to slow down. Being unable to capture data for several years made it extremely important to regroup and attain data. In 2022, another survey was launched, but with the industry still under workload pressures, response rates were low and it was ultimately necessary to cancel this survey.  An AOHP member focus group determined it was necessary to reduce the number of survey questions by half and this information was gathered together to create the EXPO-S.T.O.P. “Fill the Gap” 2019-2023 survey. 

What does the survey cover?

The “Fill the Gap” report covers BBFE incidence data from hospitals throughout the US for the years 2019 to 2023. The survey comprised a reduced eight-item questionnaire distributed electronically to AOHP members to be completed voluntarily and anonymously. Beyond basic information and the total number of sharps injuries (SI), the survey collected answers on the following optional topics:

• Mucocutaneous exposures (MCE) for all staff
• Total SI for nurses
• Total hours worked by nurses (as full-time equivalent staff was the focus of the survey)

A total of 369 hospitals across 34 states participated (non-hospital healthcare locations were excluded from this survey), making this the largest EXPO-S.T.O.P. study to date and representing about 6% of the total number of hospitals in the country. 

Survey results

To put the results of the “Fill the Gap” survey into context, it’s helpful to contrast it with previous years’ data. In 2011, the first year of the study, sharps injuries for full-time equivalent (FTE) staff were reported at 1.9 incidents per 100 FTE. This rose to a high of 2.5 in 2017 and between 2021 and 2023 remained at a rate of 2.0. However, nurse SI incidence was markedly higher compared to “all staff” SI incidence in the five years of the “gap” survey at 2.9 per 100 in 2018 rising to 3.9 in 2019 and 2020 and 3.6 in 2023.

Mucocutaneous exposures

The report notes that the MCE incidence for each 100 FTE in 2019 and 2023 were in a similar range as those prior to COVID-19. However, the COVID-19 years of 2020-2022, which are all similar, were significantly lower than 2023. Researchers note that this may have been due to the additional Personal Protective Equipment being used during the COVID-19 years. MCE incidences ultimately rebounded to pre-COVID levels in 2023.

The puzzling parts

As with many things in the COVID-19 era, the Fill the Gap survey has some outlier data that gave the researchers of the follow-up report pause. For instance, SI incidence in 2020-2023 was significantly less than the previous four years. The percentage of SI which involved nurses in previous years amounted to around 40%, yet in the most recent survey it was ranged between 14.7% to 21.4% in the “gap” years. In addition only 32% of surveyed hospitals supplied MCE data, yet that range was significantly higher pre-COVID. 74 hospitals did not supply staff FTE data; however, it was noted in the report that this information is mandatory on OSHA 300A forms, thus readily accessible. 

These inconsistencies compared with previous years raise a concern that reporting of SI and BBFE are perhaps not being reported and/or recorded as accurately in a post-COVID-19 hospital landscape as they had been prior to 2019. 

Conclusions of the Fill the Gap survey report

The researchers of the survey report summarize findings with the observation that any BBFE incidences in hospitals should be viewed as unacceptable and that successful strategies for eliminating such exposures should be shared to increase staff safety across the board. They suggest hospitals need to collect more data on SI trends and causes and create a “No Shame, No Blame culture.” Non-hospitals will also need to be studied to gain a more comprehensive view of the issue along with additional occupational health resources being available on a national level.

The findings of the Fill the Gap survey reveal that SI remains an issue for healthcare professionals, particularly nurses. As a new year approaches, hospitals and all healthcare facilities will need to take further steps to ensure the safety of their staff and patients. Zero incidents should always be the goal and one SI is too many. 

Daniels Health is proud to be the exclusive sponsor of the 2019-2023 Fill the Gap Survey and remains committed to sharing information and resources that support safer healthcare environments. Learn more about our Sharpsmart technology and how its innovative design has been shown to minimize the most common risks associated with SI injuries during disposal. 

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