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12/14/2000

Needlestick Prevention Measures Become Law

Nancy Tarleton Landis

A new law to strengthen protections of health care workers from exposure to bloodborne pathogens will take effect in 2001. The Needlestick Safety and Prevention Act, signed by President Clinton on November 6, gives the force of law to a guidance document, or compliance directive, published by the Occupational Safety and Health Administration (OSHA) in 1999.

The law requires health care facilities regulated by OSHA to identify, evaluate, and use "safer" medical devices—such as needleless systems and sharps with built-in safety features or mechanisms that reduce the risk of exposure—for the following purposes:

  • Withdrawing body fluids,   
  • Accessing a vein or artery,   
  • Administering medications or other fluids, or   
  • Any other procedure involving potential exposure through percutaneous injury from contaminated sharps.

Health care facilities are already required, under the Occupational Safety and Health Act of 1970, to have exposure control plans for preventing injuries to workers. The new law says these plans must reflect consideration and implementation of commercially available devices for reducing exposure. Nonmanagerial employees responsible for direct patient care are to be involved in evaluating and selecting "effective engineering and work practice controls"—such as safer devices. The employer must keep a "sharps injury log" that contains the type and brand of device involved, the department or work area where the injury occurred, and an explanation of how the incident occurred. The log is to be maintained in a manner that protects the privacy of the injured employee.

Groups Ask FDA to Ban Unsafe NeedlesThe American Nurses Association (ANA) and the Services Employees International Union were major backers of the legislation, which had broad bipartisan support in Congress. The American Hospital Association also supported the legislation.

The Centers for Disease Control and Prevention (CDC) estimates that 380,000 percutaneous injuries from contaminated sharps occur annually among hospital workers. In all health care settings, an estimated 600,000 to 800,000 percutaneous injuries occur. Depending on the type of device and the procedure, CDC estimates that 62–88% of sharps injuries can be prevented through use of safer devices.

In a statement to Congress, an ANA representative said at least 1000 of the workers injured each year contract infections "like HIV and hepatitis C." Further, said the ANA spokeswoman, studies indicate "needlestick underreporting rates" of 40–90%.

OSHA's 1999 guidance document (see January 1, 2000, AJHP News) directs inspectors to cite employers for failing to evaluate, purchase, and implement safer devices. ANA argued that the new law was needed because OSHA lacks funding to strengthen enforcement, because frontline workers need to be routinely involved in device selection, and because OSHA has not required the collection of specific data that could be used to improve prevention programs and products. ANA emphasized that the involvement of frontline personnel in device selection would increase workers' acceptance of new, safer devices.

According to the National Surveillance System for Hospital Health Care Workers (NaSH), which tracks exposures and infections, nurses and physicians are the hospital workers most likely to be exposed to blood or body fluids. NaSH data show that, from June 1995 to October 1999, 43% of such exposures were in nurses and 29% in physicians. "Technicians" accounted for 13%, housekeeping and maintenance workers 3%, students 4%, and "other" 8%. Percutaneous exposures accounted for more than 80% of all exposures to blood or body fluids.

Although pharmacists may be less affected by the new law than some other members of the health care team, those who participate in "codes," assist with various invasive procedures, draw blood, or administer drugs or vaccines will likely be using new, safer devices. "If pharmacists are practicing progressive pharmacy, then they are exposed to patients and are very much at risk," said Burnis D. Breland, director of pharmacy and clinical research for the Columbus Regional Healthcare System, Columbus, Georgia.

The new provisions on bloodborne pathogens are to be published in the Federal Register within six months of the November 6 enactment and take effect 90 days thereafter. Potential challenges in complying with the law were discussed in a November 13 Modern Healthcare article: a shortage of safety devices, the potential need for hospitals to maintain two separate inventories until an adequate supply of the safer devices is available, and higher cost of the safer devices.