OSHA targeting ambulatory care

Surprise inspections in four states

Outpatient centers have historically attracted little attention from the Occupational Safety and Health Administration, although needle market data shows they have lagged in sharps safety. But that hands-off approach is ending with a regional emphasis program in four states.

In Alabama, Florida, Georgia and Mississippi, inspectors will pay unannounced visits to ambulatory surgery and urgent care centers and medical clinics to gauge compliance with the Bloodborne Pathogen Standard. Those centers are not required to maintain OSHA 300 logs, so little is known about their sharps injury protection, says Billy Kizer, MPH, CSP, team leader for enforcement programs in OSHA's Region IV.

They also are not the focus of sharps safety surveillance efforts, which mostly have collected data from hospitals. Yet there is evidence that "alternate care" sites have much lower uptake of safety devices. In 2010, GHX, a healthcare supply chain management company based in Louisville, CO, reported that about one in five blood collection needles and blood collection sets in alternate sites were conventional devices, and about half (52%) of hypodermic needles were not safety-engineered.

The special emphasis program "is a great way to determine how many sharps injuries they're really having [in alternate sites] as well as making sure they're following the Bloodborne Pathogen Standard and they're providing the protection for sharps," says Kizer. "It's time that we reach out and ensure they are protecting their employees."

The attention from OSHA will send a message that outpatient centers need to get into compliance, says Bruce Cunha, RN, MS, COHN-S, manager of employee health and safety at the Marshfield (WI) Clinic and a surveyor for the American Association for Accreditation of Ambulatory Surgery Facilities.

Cunha was surprised to find facilities that had essentially ignored the Bloodborne Pathogens Standard. "I went in the ORs and they had absolutely no safety needles," he says.

Surgeon or physician preference alone is not a sufficient reason to use conventional needles, says Cunha. The facilities must provide documentation of an exemption from sharps safety for medical reasons, he says.

OSHA's random inspections will include freestanding facilities that are owned by hospitals. However, it will not include physicians' offices, Kizer says. The regional special emphasis program will run through Sept. 30, 2012, and involves states that are under federal OSHA jurisdiction. State-plan states in the region, including Tennessee, Kentucky, North Carolina and South Carolina, may do a similar program but are not required to do so.

OSHA inspectors rarely go into outpatient centers unless there is a complaint from an employee, Kizer notes. But outpatient centers have been the focus of a different national awareness program to improve injection safety. The One & Only Campaign of the Centers for Disease Control and Prevention and the Safe Injection Practices Coalition is emphasizing the importance of using a needle and syringe only one time. Reuse of needles or syringes with multi-dose vials has led to recurrent outbreaks of hepatitis C in a variety of ambulatory care sites.

The OSHA program extends that safe injection message to worker safety. "Our hope is that we'll find that employers are doing what they're supposed to do, that employees are being protected," says Kizer. "If they're not, we can help to bring them into compliance."