Be vigilant: Sharps safety still tops OSHA citations

Injuries occur with safety devices

Despite widespread conversion to sharps safety devices, hospitals are more likely to be cited for violations of the bloodborne pathogens standard than any other standard.

The U.S. Occupational Safety and Health Administration (OSHA) issued 136 citations to hospitals in FY2006. Sharps injuries also contributed to the overall high rate of injury among hospitals.

In 2006, OSHA sent letters to 105 hospitals, cautioning them about their rate of six or more injuries or illnesses resulting in days away from work, restricted activity, or job transfer. The average rate for hospitals is 3.4, and the average for all industries is 2.5.

"What we're seeing there is not only the non-use of engineering controls, but also [problems with] work practice," says Dionne Williams, MPH, senior industrial hygienist.

For example, in one case, a facility was cited for a needlestick that occurred when an employee put an unprotected sharp in her pocket. She needed to carry it to a sharps container down the hall because no container was available in the patient care area. As she pulled it out of her pocket, she accidentally stuck another employee.

The hospital needed to have sharps containers available for immediate disposal, says Williams. But the hospital also is responsible for monitoring work practices to make sure safety devices are being used properly, she says.

Safety rounds, in which employee health or safety professionals observe everyday activities, can identify problems with work practice, she says. You also can evaluate the incidents on your sharps injury log, she says.

Hospitals should develop a safety culture that encourages employees to discuss potential problems in a nonpunitive environment and "to be vigilant about things they see," says Williams.

More than half (57%) of sharps injuries occur with the use of safety devices, and about 70% of those were not activated, according to the EPINet data compiled from about 48 hospitals by the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville.

With the rapid growth in the use of safety devices, it's not surprising that they would be involved in a higher proportion of needlesticks, says Jane Perry, MA, associate director of the center. Hospitals should evaluate injuries to determine whether better training is needed or perhaps a switch to a device with a different safety mechanism, she says.

"There are always new devices coming on the market," Perry says. "They need to be continually evaluated to see if there's a new technology that would be better accepted by the staff."

Other standards frequently cited by OSHA include personal protective equipment (PPE), hazard communication, and respiratory protection. For example, in the past year, hospitals have been cited for failing to have an available eye wash station.

"Everything in the health care facility isn't going to fall under the bloodborne [pathogens standard]," says Williams. "It's important for hospitals to make sure they're ensuring PPE for other types of hazards."

Although OSHA has been prohibited from enforcing the annual fit-testing requirement related to tuberculosis and N95-filtering facepiece respirators, hospitals must follow the other requirements of the respiratory protection standard, such as annual training.

Hospitals also have significant hazards in non-clinical areas, particularly related to facility and equipment maintenance. Among the top 10 most-cited standards involve lockout/tagout, woodworking, and cadmium.

One type of violation is missing from the list. The general duty clause of the Occupational Safety and Health Act has not been used to enforce ergonomics-related hazards, despite the high number of musculoskeletal disorder injuries in health care due to patient handling.

"Because there's no standard, it makes it incredibly difficult for us to be able to cite," says Williams. "We do inspect hospitals when we get complaints, but the bar is raised very high as far as documenting for citations. We do issue hazard alert letters, which is the next best thing to get some action."