Unions press complaints to enforce needle rules
Inspectors look at logs, exposure control plan
Union-backed employee complaints have led to citations of hospitals in Ohio and California for failing to fully implement safer needle devices.
Those hospitals may be just the first to face fines and remedial action as unions vow to use the complaint process to ensure compliance with the California needlestick prevention law and the new bloodborne pathogens directive issued by the U.S. Occupational Safety and Health Administration (OSHA).
The University Hospital in Cincinnati reached an amicable settlement with OSHA, including $7,500 in fines and an agreement to implement additional safeguards, after an anonymous complaint by nurses. In California, Seton Medical Center in Daly City faced fines of $5,100 for failure to implement an adequate exposure control plan, sharps injury log, and transition to safer devices by July 1, 1999, as required by law. The hospital has appealed the citation.
In California, more complaints are pending. The Washington, DC-based Service Employees International Union (SEIU) is targeting hospitals that fail to have a "constructive dialogue" with the union about implementing safer devices or to include front-line health care workers in the evaluation process, as required by California’s law, says John Borsos, director of SEIU Local 250’s hospital division in Oakland.
"There are a million needlesticks that take place each year across health care settings in the United States," he says. "It’s our folks who are getting stuck, it’s our folks who are getting HIV, it’s our folks who are dying because of this. We need to create a sense of urgency in the industry."
While communication about safety device implementation is important, the effort to protect health care workers should not become politicized, says Cynthia Fine, RN, MSN, CIC, infection control and employee health program consultant for Catholic Healthcare West (CHW) in San Francisco, the corporate parent of Seton and 47 other hospitals.
Fine says while Seton moved more slowly than some hospitals in its implementation, the hospital is now in compliance. The corporate-based selection process included "very broad front-line health care worker input," but not necessarily union representatives, she says.
"The unions are using the safe sharps issue as a campaign issue to try to unionize hospitals," Fine laments. "They tend to be more interested in that than they are in actually working with us, which is our concern."
In the case of University Hospital, the complaint actually led to positive feelings on all sides about the creation of a safer environment.
The teaching hospital had relied on an accident and injury log to target high-risk areas for safer devices and practices, says Michael Grodi, MBA, vice president of hospital services. That approach led to a successful reduction in needlestick injuries, he says.
But OSHA wants hospitals to review, evaluate, and, if necessary, implement safer devices every year — a requirement that is spelled out in the updated bloodborne pathogens directive that was issued in November. (See cover story, p. 1.) "They required a very specific time-cycled review," says Grodi. "We fell short of the letter of the regulation. We were trying to meet the intent. So they cited us for that. Now we’re engaged in a comprehensive review of what we have and what’s on the market."
By conducting a yearly review, the hospital may be able to further reduce needlestick injuries, he says. "I think this change in focus is going to be beneficial," he says.
Grodi says he found OSHA inspectors were willing to listen to the hospital’s point of view, and citations were withdrawn in a couple of cases when he corrected a misunderstanding. "They recognized we weren’t sitting around doing absolutely nothing. We just hadn’t gone all the way. We appreciated the attitude," he says.
Throwing used sharps on the floor
In another case, an OSHA citation prompted the hospital to discover a product that could help make the environment safer. In the emergency department, rather than reaching toward a sharps container and possibly endangering co-workers, employees were accustomed to dropping sharps on the floor beneath a gurney during a trauma case. Someone would later collect the sharps and dispose of them properly.
"OSHA prompted us to go out on the market and look for a better idea," says Grodi. "We did find some needle disposal boxes that attached to the gurney. We didn’t know they existed."
For their part, OSHA officials lauded the positive attitude at University Hospital. "It was a situation where we felt they were very open and honest with us and they were willing to go to state-of-the-art," says Richard Gilgrist, CIH, assistant area director of OSHA in the southwest Ohio area. "We were pleased with their attitude toward compliance."
Other situations may not be resolved quite so amicably, particularly if relations between a union and a hospital are strained. In northern California, SEIU Local 250 sought to meet with hospitals to discuss compliance with the new law. In some cases, union representatives became members of committees that conducted the device evaluation process. (For more information on selection processes, see related article on p. 6.)
"Kaiser Permanente agreed to meet with us and set up a process to begin to select the devices that collectively we think are the best to be used. That was a model of how it should be done," says Borsos.
Other hospitals and hospital corporations were not as responsive. In some cases, the union request went unanswered, says Borsos. "Technical compliance with the law doesn’t mean the safest needles are being used," he says. "We wanted to have a constructive dialogue with them about what are the safest needles that people were comfortable with."
Catholic Healthcare West was one corporation that failed to respond and didn’t invite union representatives to sit on its main committee, says Borsos. "You have to be inclusive of all viewpoints," he says. "The fact that they excluded labor representatives from the discussion is problematic."
Meanwhile, CHW’s evaluation process gained recognition as a model by the California Healthcare Association, notes Fine. In the centralized process, 10 of the 48 hospitals volunteered to conduct pilot projects of safer devices.
After an initial screening, employees used and evaluated devices. A small corporate committee then made final selections, in most cases providing at least two choices to hospitals. "We always had front-line health care workers involved in our process," she says.
Only one hospital from the Bay Area volunteered to conduct a pilot, and that hospital isn’t unionized, notes Fine. Of CHW’s 48 hospitals, only four are unionized, she says.
"I did make offers to make every effort to make sure we included more SEIU representatives in the future," she says. SEIU has requested representation on the CHW corporate committee, and Fine says the corporation felt that would not be appropriate.
Borsos notes that the union has experts on safe needle devices and has offered to assist with training. At the least, the union should receive information about how hospitals plan to comply with the law, and their voice should be heard in the evaluation of safer devices, he says.
"The best place to start would be a dialogue to include the diversity of viewpoints at CHW when they evaluate products," he says.
Responds Fine: "Certainly there was no attempt to close them out of the process. . . . We’re doing our best to involve them even more in the future. We care just as much about the safety of our employees as they do."
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