Pre-packaged kits, trays may violate OSHA rule
Hospitals must ask for safety devices
Violations of the bloodborne pathogen standard are occurring regularly in operating rooms and procedure rooms across the country. The culprit: pre-packaged kits and trays.
A hospital may have carefully selected safety devices, garnering the feedback of frontline health care workers and providing proper training, but despite those careful steps, many pre-packaged kits and trays are purchased without safety features — even on basic items such as syringes.
Hospitals must ask for safety devices in the kits and trays, even if it requires paying more for customized versions, says Dionne Williams, MPH, senior industrial hygienist for the U.S. Occupational Safety and Health Administration (OSHA).
OSHA issued a letter of interpretation on this issue on Feb. 20, 2005, stating, "If, during surgical procedures… physician specialists or other healthcare personnel are using medical instruments supplied in pre-packaged kits, those packages must include engineering controls appropriate for the specific procedures being performed. Employees using these devices must have the opportunity to provide feedback on appropriate and effective, safer devices."
"The employers need to impress upon distributors who are packaging these kits that this is what [their] needs are," Williams says. "If they're accepting these kits just based on costs, they're eliminating the right of the employee to evaluate the device they're going to be using. We would just look at it as a violation if they're not using the device that's selected [by the hospital with frontline worker input]."
In fact, under the Multi-Employer Citation Policy, physicians could be cited along with the hospital, the interpretation letter noted.
Some hospitals may place safety syringes and other safety devices on top of the kits, but that is time-consuming and inefficient for OR teams, says June Fisher, MD, director of the TDICT (Training for the Development of Innovative Control Technologies) Project and associate clinical professor of medicine at the University of California at San Francisco. It may be tempting for OR teams to simply use the conventional devices rather than seek out the safety devices, she says.
Fisher suggests that employee health professionals look at the kits and trays to inventory the devices they contain. TDICT has created a short "trigger" film to spur discussion of the safety issues related to pre-packaged kits and trays. The film is funded by the National Institute for Occupational Safety and Health (NIOSH) and will be available later this year, Fisher says.
Kit packers will respond to customer demand if hospitals begin to ask for safety devices in the kits, she says.
For example, Baxter Medical, a major kit packer based in Deerfield, IL, offers both conventional and safety-engineered devices, says Erin M. Gardiner, senior manager of external communications. "The variety of packaged kits and trays we offer is made based on customer requests," she says.
Kits with safety-engineered devices are typically more expensive than the conventional versions. Cost has always been an obstacle to the adoption of safer sharps technology, but that can't stop the progress toward a safer workplace, says Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville.
"We'll never stop hearing about cost objections and we just have to forge ahead if it's an important measure," she says.
Violations of the bloodborne pathogen standard are occurring regularly in operating rooms and procedure rooms across the country. The culprit: pre-packaged kits and trays.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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