OSHA needle safety citations hit record high
Agency sends message: It’s not optional!
Hospitals have received more citations for failure to use safer sharps devices in the past year than they have since the bloodborne pathogens standard was first issued in 1989, according to data from the U.S. Occupational Safety and Health Administration (OSHA).
The message is clear. OSHA inspectors are focusing on needle safety, and so should you.
"It should tell anybody regulated by us that we are definitely citing this, we are looking for [compliance with the bloodborne pathogens standard]," says Melody Sands, MS, director of OSHA’s office of health compliance assistance. "The knowledge [level] of compliance officers is raised, and they are paying attention to this."
The new provisions in the revised bloodborne pathogen standard became effective April 18, 2001, but OSHA delayed enforcement action until July 2001. As of May 2002, the agency had issued 1,876 citations to hospitals with penalties totaling about $1.3 million. Only 369, or 20%, were generated from inspections related to a complaint.
OSHA issued 142 citations for failure to use engineering and work practice controls — including safer devices. By contrast, in a 16-month period after the 1999 compliance directive on bloodborne pathogens was released, OSHA issued a total of 144 citations to hospitals related to the standard; just 18 of those involved lack of engineering controls or safer devices.
Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville and a driving force behind tougher standards for needle safety, says she’s impressed with OSHA’s compliance efforts. "OSHA has really taken this issue seriously," she says.
Jane Perry, editor of the center’s publication, Advances in Exposure Prevention, notes that OSHA has communicated clearly, "[that] safety devices are not optional. The increase in citations backs up that message and gives it real teeth," she says.
"And it’s definitely having an impact. There has been a shift in perspective among those responsible for converting to safety in health care facilities: fewer complaints about cost and other hurdles, and more acceptance that this is a task that has to be accomplished. There’s no other choice. Now they’re trying to figure out the best way to get it done."
OSHA’s tough enforcement approach is necessary to ensure that facilities buy the safer devices, obtain employee input, and provide proper training, says Katherine West, MSEd, CIC, an infection control consultant based in Manassas, VA.
"As I’ve traveled around the country, I haven’t seen, in many respects, that it’s been given the priority it deserves," she says. "Many hospitals aren’t following the mandate."
"OSHA’s taking it seriously, and rightfully so," West says. "We’ve identified where risk is, and we know what we have to do to reduce it."
Needle safety has been in the national spotlight since 2000 when Congress passed the Needlestick Safety and Prevention Act. The law directed OSHA to revise its standard to require employers to update exposure control plans annually and consider new technologies. They must involve frontline workers in the evaluation of products and maintain a detailed sharps injury log.
OSHA didn’t direct its educational efforts just at employers. Inspectors received extensive training, and each regional office has a bloodborne pathogens coordinator to provide assistance.
"Compliance officers are told, This is an important document; you need to be aware of it,’" Sands says.
The stepped-up enforcement has put some hospitals on edge, as employee health professionals worry about how an OSHA inspector will regard their efforts to find suitable devices. Documentation is critical, says Amber Hogan, MPH, an industrial hygienist in OSHA’s office of compliance assistance. But how hospitals choose to document their process is up to them, she says.
"Because of the performance-oriented nature of the standard, the employee has a lot of leeway in how [to] document something like device review," she says.
"[For example], they can reference in the exposure control plan minutes of the meeting in which they discussed these devices." OSHA will not dictate which safety device a facility should use, Hogan stresses. "It’s completely up to an employer and their employees to decide what device is best for them."
What if none of the devices are deemed acceptable? Cindy Fine, RN, MSN, CIC, infection control practitioner at John Muir Medical Center in Walnut Creek, CA, who has consulted with hospitals on needle safety, notes that some dialysis clinics have rejected the available devices. "I talked to a couple of facilities that had tried some of the devices," she says. "They all require two hands to activate or discontinue the device. One had a loop that kept pulling the venous access out."
According to the OSHA compliance directive, "Employers must implement the safer medical devices that are appropriate, commercially available, and effective." But facilities may have a tough time making the case that there is no adequate device if dialysis clinics down the street are using them effectively, Fine notes.
Employers shouldn’t hesitate calling their regional OSHA office to ask for clarification on such issues, Hogan says. Each office has a regional bloodborne pathogen coordinator who is an expert on the standard, and a phone call won’t trigger an OSHA inspection, she says. "There’s just a lot of room for interpretation. If people want good, balanced information, all they have to do is ask us. Each state has a free consultation program. They can get assistance for free."
Here are some major issues that arose from inspections and citations, Hogan and Sands say:
• Make sure you update your exposure control plan annually. The exposure control plan is the area that elicited the most citations, and it is one of the most easily observable items. "One of the first things [compliance officers] ask for is the written program," Hogan says. "That is something compliance officers are going to see upfront, on the first day of the inspection. They will be able to tell if it is updated annually because of the date of the document."
In the past year, OSHA issued 165 citations for failure to have a written exposure control plan and 170 citations for failure to update the exposure control plan annually. The agency issued another 25 citations for failing to reflect changes in technology in the exposure control plan and failure to document annual consideration and implementation of safer devices.
You might start with a template for an exposure control plan, such as the one provided on the OSHA web site (www.osha.gov/OshDoc/Directive_pdf/CPL_2-2_69_APPD.pdf). However, it won’t be adequate unless it is customized for your facility and updated at least annually, Hogan says. "You find these blanket exposure control plans that are simply not good enough," she says.
• Include a true representation of frontline health care workers in evaluation and selection of devices. If your hospital is part of a corporate chain, the selection decisions can’t be made solely at the corporate office, Hogan says. "They really need to have a representative sample of employees from the different departments that are using the devices [and] from the different geographic regions." If the sample of health care workers is representative, the hospitals can use a centralized selection process. "They can do that as long as input from the facilities is included and as long as there is some feedback from the facilities," she says.
OSHA inspectors interview employees to find out if they had input into the selection of devices and whether they had adequate training. Again, that is an easy way for inspectors to check for compliance.
"It’s pretty hard to make it up if you haven’t had any input," Sands says.
• Keep up with changes in technology. OSHA issued 25 citations last year for failing to reflect changes in technology in the exposure control plan and failure to document annual consideration and implementation of safer devices. The safety device market is in flux, with new devices emerging that may be easier to use and thus more acceptable to health care workers. Employers are required to consider the new technology and to document that in the exposure control plan.
Thanks to additional training, OSHA inspectors are becoming knowledgeable about the changes in the safety device features.
"We’re having hands-on experience with new devices," Sands says. "The awareness of compliance officers should again be raised up a little more, which should allow them to make informed decisions when they look at devices."
Hogan predicts that as the technology and information improve, hospitals and health care workers increasingly will accept safety devices as a basic part of the work environment. "It just kind of has to marinate itself in the professional world as a standard of good, safe care," she says.
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