Congress, OSHA finally join fight to mandate needle safety precautions
Legislation would implement a federal standard on needle safety
With legislation in the works in some 20 states to require health care providers to implement the use of needle safety devices, Congress and the Washington, DC-based Occupational Safety and Health Administration (OSHA) are jumping on the bandwagon with legislation and new regulations aimed at reducing the risk of bloodborne diseases such as HIV and hepatitis from accidental needlesticks.
In May, U.S. Representatives Pete Stark (D-CA) and Marge Roukema (R-NJ) introduced the Health Care Worker Needlestick Prevention Act of 1999 to combat the estimated 590,000 health care worker needlesticks from sharps products each year.
The legislation is modeled after a California law to protect health care workers from accidental needlestick injuries, which goes into effect on July 1. California was the first state to pass this type of law, although 20 other states are expected to adopt similar measures.
Frustrated by years of apparent foot-dragging on the part of OSHA and Congress, the Washington, DC-based Service Employees Interna tional Union (SEIU) recently launched a state-by-state grass-roots effort to implement needle safety legislation. "We totally agree that a federal standard is the ultimate solution," says Andrew Stern, SEIU president. "We have called upon the producers of needles and other members of the health care community to join with us both in either getting OSHA to establish a national standard or [to] pass federal legislation."
The proposed federal law would amend OSHA regulations to require that employers utilize needleless systems or other engineered safety mechanisms to prevent the spread of bloodborne pathogens. The bill also includes an exception process, because these products may not be appropriate for all medical care settings.
In other provisions, the bill enhances current needlestick reporting requirements and establishes a national clearinghouse to collect data on safe technologies.
"Health care workers shouldn’t have to risk their lives while saving the lives of their patients," Stark says. "Safe needle devices are used in some facilities across the country, but our bill would make use of safe technology the norm rather than the exception."
Although HIV transmission from needlestick injuries is rare, better protective technologies could help eliminate the risk of HIV and other more easily transmitted inflections such as hepatitis, according to Daniel Zingale, director of Washington, DC-based AIDS Action, which supports the measure. (See related story on HIV transmission, p. 74.)
"I think the Stark bill is primarily driven by the availability of technology that for the first time is recognized as foolproof," Zingale says. "This bill can move us from where HIV infection in a medical setting is highly unlikely to where it’s not heard of."
In the meantime, OSHA has announced its three-point plan to reduce the risk of occupational exposure to bloodborne diseases due to sharps injuries. Although the details have not yet been made available, OSHA will make the following general areas a priority:
• The agency has proposed a requirement in the revised Recordkeeping Rule that all injuries from contaminated needles and sharps be recorded on OSHA logs. Officials say they’ll take final action on this proposal in the fall.
• OSHA will revise the bloodborne pathogens compliance directive later this year, including newer and safer technologies in the standard.
• OSHA will amend the bloodborne pathogens standard and place needlestick and sharps injuries on the fall regulatory agenda.
OSHA has reviewed nearly 400 comments from hospitals and other providers about needlestick safety, and the agency’s decision to change standards is in response to these comments, says Charles N. Jeffress, OSHA administrator.
Jeffress says OSHA welcomes the Stark/ Roukema legislation. "I share their goal of wanting to reduce these types of injuries, and welcome the opportunity to work with all members of Congress on how to better protect health care workers from these potentially deadly problems," he adds.
OSHA’s report on its analysis of needlestick safety as practiced across the country discusses various devices and their costs to medical facilities. But Jeffress and other OSHA officials refuse to speculate on whether the new standards will list or require any specific types of devices.
Here are the devices mentioned in the report:
• Vacuum tube phlebotomy needle for venous blood draw: The conventional device costs 10 cents and the safer device costs 33 cents. OSHA estimates that switching to the safer device would cost a 250- to 300-bed hospital an additional $15,500 per year.
• Butterfly needle for venous blood draw: The conventional device costs 65 cents and the safer device costs 90 cents. A 250- to 300-bed hospital would pay an additional $4,000 per year.
• IV catheter for IV access: The conventional unit costs 75 cents and the safer catheter costs $1.75. This would result in a 250- to 300-bed hospital spending an extra $33,500 a year.
• Hypodermic needle/syringe: The conventional item costs 5 cents, while the safer device costs 25 cents. A switch to the safer product could cost a 250- to 300-bed hospital $67,000 more per year.
However, health care facilities are not uniformly sold on the idea of these safer devices, according to the OSHA report.
Hospitals responding to OSHA’s survey said they haven’t introduced these devices because of the increased cost and staff resistance to the changes. Plus, some hospitals cited problems with equipment incompatibility and contractual purchasing agreements in which they are limited in their choices of safer alternatives.
(Editor’s note: To review OSHA’s record summary of the agency’s request for information on needlestick injuries, visit the OSHA Web site at www.osha.gov and click on "Needlestick Safety.")
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