Many hospitals may lag in needle safety compliance
Phase-in should be complete by now, OSHA says
The step-by-step process of phasing in safer sharps may leave many hospitals out of compliance with the Occupational Safety and Health Administration’s (OSHA) bloodborne pathogen standard. "We expect employers to have utilized sharps with engineered injury protection every time they can," says Melody Sands, director of OSHA’s office of health compliance assistance. "Whenever there’s a control that will reduce or eliminate the chance for cutaneous injuries, we expect them to utilize it."
Somehow, that’s a message that hasn’t completed penetrated, despite publicity about the Needlestick Safety and Prevention Act and OSHA’s outreach and education program on the new standard. A compliance directive detailing how the revised standard will be implemented was recently released. (See "New OSHA directive will cite hospitals for reuse of blood tube holders" in this issue.)
An on-line survey of nurses by the Washington, DC-based American Nurses Association found that about 20% worked in facilities that did not provide safer sharps devices. (See Hospital Employee Health, January 2002, "Hospitals don’t have enough safety devices.") Early last year, surveyors with the Joint Commission on Accreditation of Healthcare Organizations were finding that fewer than half of hospitals visited had switched to the safer devices, says Carole Patterson, MN, RN, health care consultant with Joint Commission Resources, a Joint Commission subsidiary in Oakbrook Terrace, IL.
However, by the end of the year, the picture had changed dramatically, Patterson says. "Every hospital I have been in since has said that they’re done. Two of them have actually said they’ve had a month without any needlestick injuries at all since they’ve converted. I thought, Wow! I hope this is happening all over the country.’"
Even hospitals that have tried to comply with the new rules may not be doing enough to pass muster with OSHA inspectors. Here are some possible lapses:
• Phase-in of safer devices. You analyzed your needlestick data and pinpointed which sharps lead to the most injuries. After you evaluated devices and implemented them, your needlestick rates dropped significantly. Now you will move to another category of sharps. Great job! There’s just one problem. The phase-in of safer devices already should have occurred, OSHA officials say. An inspector will expect to see the conversion in every area. "OSHA looks at what hazard is presented to employees," Sands says. "We expect protection for all workers irrespective of the phase-in." After all, OSHA began enforcing the use of "engineering controls," or safer sharps, to reduce needlesticks with the issuance of a compliance directive in 1999.
Getting input from people who use devices
• Input from frontline workers. You formed an evaluation committee that includes several frontline health care workers. You’ve conducted a trial of devices in certain units. Do you have to choose the first choice of those workers, or can you consider their preference as just one factor along with price and other issues? Cost alone is not a valid reason to reject a safer device, Sands says. But OSHA inspectors would look at the evaluation process on a case-by-case basis, she says. If a hospital rejects a choice made by frontline workers, "they should definitely document it in the exposure control plan," Sands says.
There may be a medical justification or some other reason. "If they have totally overridden what the employees said and not considered it, that would be a violation," she says. In other words, input of workers cannot simply be discarded by materials managers or other administrators. The requirement is to solicit the input of employees in deciding which device to use, say OSHA officials.
Last year, Oregon became the first state to up the ante by requiring hospitals to document reasons for not adopting the employees’ choice. "If a device is purchased without the consent of the employees who evaluated it, the employer must document the employees’ concerns, as well as the employers’ justification for purchasing that device," the Oregon rule states.
• Physicians who won’t use safety devices. At one hospital, a physician insisted that he wasn’t covered by the OSHA rule or the federal law because he wasn’t an employee of the hospital. He wanted to continue using a conventional device. Is that OK?
OSHA’s new compliance directive outlines how the rule impacts a multi-employer work site. In a hospital setting, the physician may be one employer and the hospital is another. "Physicians who are unincorporated sole proprietors or partners in a bona fide partnership are employers for purposes of the OSHA act and may be cited if they employ at least one employee [such as a technician or secretary]," the directive states. "Such physician-employers may be cited if they create or control bloodborne pathogens hazards that expose employees at hospitals or other sites where they have staff privileges in accordance with the multi-employer work site guidelines of CPL 2-0.124, Multi-Employer Citation Policy. "Because physicians in these situations are not themselves employees, citations may not be based on the exposure of such physicians to the hazards of bloodborne diseases."
Beyond those intricacies, the hospital has an obligation to protect its employees even from the actions of a contract worker. "The hospital then takes a risk for the physician imposing unsafe work practices," Sands says. "It is not a positive defense for a doctor to say, I’m a physician; I’m not covered by the standard,’ and then go and expose a handful of other workers."
• Safer sharps in the operating room (OR). You use needleless IV systems, and you have converted all your blood collection devices to safer sharps. Your needlesticks have declined dramatically. The only place resistant to change is the OR. Are you still in compliance? Not until you’ve addressed the hazards in the OR, OSHA officials say.
Beyond the obvious issue of safer sutures and scalpels, the OR has other exposure hazards. For example, the suctioning and disposal of blood during surgery can lead to significant exposures. Manufacturers have developed new containers and other products to reduce that exposure, OSHA officials note. (For more information on preventing OR exposures, see HEH, September 2001, "Hospitals get realistic about explosure risk in OR.")
• New technology and other issues. If you’ve implemented safer sharps throughout the hospital, your job isn’t done. The OSHA regulation requires employers to update the exposure control plan annually, a process that should include a review of new technology. In other words, you need to consider newer devices and whether they may provide more protection than the ones you’re using, says Sands. OSHA expects you to make "a proactive search for what’s available to see if it can be applied to [the] work environment," she says.
Meanwhile, as with other federal OSHA regulations, it doesn’t apply to public hospitals, whether local, state, or federal. However, all 26 state-plan states cover state and local hospitals, and 10 states have passed laws that include the public sector. Three others have state OSHA plans just for public employees. This year, several other state legislatures will be considering expanding needle safety to public employees.
(To see OSHA’s sample sharps injury log and its questionnaire for evaluating sharps disposal container performance, click here.)
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content