Sharps come into focus outside hospitals

BBP under scrutiny in outpatient care

The push for sharps safety has moved out of the hospital into outpatient facilities. Safety experts are urging physician offices, urgent care clinics, ambulatory surgery centers and others to boost their compliance with the Bloodborne Pathogens Standard. And in some states, the U.S. Occupational Safety and Health Administration is backing that up with random inspections.

"There is really a disconnect between the level of safety that's provided in hospital settings versus non-hospital settings," says Janine Jagger, PhD, director of the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville, who spoke at a recent webinar sponsored by the center and Becton Dickinson and Company in Franklin Lakes, NJ.

"These settings are very difficult to reach in terms of enforcement, documentation and surveillance. It's a situation we refer to as 'no data, no problem,'" she says. While non-hospital facilities may say, 'We don't have a problem here,' they may not know much about the injuries occurring, she says. "It's difficult to define and document what's going on in these settings."

Yet market data reveals higher use of safety devices in hospitals compared with alternate settings, says Jagger. The gap in safety is especially apparent in syringe use, which overall has a lower adoption rate of safety-engineered devices, she says. Alternate settings include private doctors' offices, primary care physicians, urgent care clinics, long-term care, dental clinics, dialysis, ambulatory surgery centers, and freestanding laboratories.

"The devices are what determine risk level," says Jagger. "We really need to have the same level of compliance and the same level of safety [at non-hospital facilities]."

Random inspections in some states

Typically, it's uncommon for an inspector from the U.S. Occupational Safety and Health Administration to visit a doctor's office or urgent care clinic. But with a regional emphasis program that began in Florida, Georgia, Alabama and Mississippi in June, even small employers will be part of the random inspection program. It also will include outpatient facilities that are owned by hospitals or health care systems.

Although employers with fewer than 10 employees do not need to maintain an OSHA 300 log, they are still subject to the Bloodborne Pathogens Standard, notes Benjamin Ross, assistant regional administrator for enforcement programs in OSHA Region 4 in Atlanta.

That means they must involve frontline workers in evaluating safer sharps devices, update exposure control plans annually, and maintain a needlestick log, he says. Employers can get compliance assistance from OSHA, he says.

It is too early to know how outpatient facilities will fare in the inspections. "Hopefully because of this and the outreach we will be doing in this region, we believe people will become more mindful of their duties and responsibilities and become more compliant," he says.

OSHA's enforcement efforts complement the recent attention on safe injection practices. The Centers for Disease Control and Prevention and the Safe Injection Practices Coalition launched the One & Only Campaign to emphasize the importance of using needles only one time. Outbreaks of hepatitis B or C in ambulatory care centers have been linked to the reuse of needles with multiple patients or the insertion of a contaminated needle into a multi-dose vial.

Patients aren't the only ones at risk from unsafe injection practices, says Ross. "We in OSHA believe that a focus on employee and patient safety should go hand-in-hand. It is paramount that the workers be protected also," he says.

Train employees every year

When outpatient facilities fail to comply with the Bloodborne Pathogens Standard, often it's because they misinterpret the standard or they aren't knowledgeable about it, says Pamela Dembski Hart, CHSP BS MT (ASCP), principal with Healthcare Accreditation Resources, a consulting firm based in Holliston, MA.

"The first barrier to compliance has to do with a misconception about the annual training requirement," Hart said in the webinar. "Annual training really does mean annual. Every year.

Credentials do not absolve anyone from attending the training. This applies to all the nurses, doctors, medical technologists, [and others who are at risk of blood or body fluid exposure]."

The training may include a video, but there still needs to be a "live" instructor who can answer questions, she says.

Employers also often fail to comply with requirements related to evaluations of sharps devices, Hart says. If a vendor comes by and shows some samples, that is not a formal evaluation, she says. Instead, you need to look at lists of safety devices available for a specific use, determine what features you need, and use a standardized evaluation form to document your review.

"The evaluation of available devices must be conducted with frontline workers," she says. "It doesn't mean the nurse manager can be the only one involved."

The greatest barrier to compliance with the Bloodborne Pathogens Standard, especially for small employers, is cost, says Hart. Yet cost is not a justification for failing to use safety devices, she says. And it's a misconception that safety is cost-prohibitive, she says.

Post-exposure follow-up and lost workdays due to post-exposure prophylaxis can be costly, she says. And that pales in comparison to the cost of treating a seroconversion. "Prevention is cost-effective," she says.