Reviews to look at 10 years of needle safety
Reviews to look at 10 years of needle safety
OSHA rule effective, but gaps remain
Ten years after the Needlestick Safety and Prevention Act was signed into law, the mandate for safer sharps devices is under review – both legally and academically.
The U.S. Occupational Safety and Health Administration (OSHA) announced a regulatory review of the Bloodborne Pathogens Standard, in which the agency will consider the effectiveness and the continued need for the regulation. And in November, sharps safety experts will gather at the University of Virginia in Charlottesville to focus on "Mapping Progress, Charting a Future Path."
The reviews will find much to laud about the landmark law and standard that transformed safety practices at hospitals and other health care facilities.
"We've been able to document that [the standard] has had an enormous impact on health care worker safety," says Jane Perry, MA, associate director of the International Healthcare Worker Safety Center at the University of Virginia.
Sharps injuries in non-surgical settings declined by about 32% after the federal mandate required the use of safety devices. However, adoption of blunt suture needles and other sharps safety measures in the operating room has lagged. Injury rates in the OR actually increased by 6.5% from 1993 to 2006.1
Other weak areas remain, as well. "We want to look at gaps in safety-engineered devices," says Perry, noting that some less-common devices still do not have a safety-engineered version. Underreporting of sharps injuries remains a problem, as does the continued use of conventional devices. The International Healthcare Worker Safety Center's EPINet surveillance found that 58% of the sharps injuries occurred with non-safety devices.
The November conference also will consider sharps safety globally and the impact that U.S. legislation and regulation has on safety measures in other countries.
Enforcement is the key
Maintaining progress in sharps safety will depend in part on continued vigilance, says Perry. "[Enforcement] has been key in the improvements we have seen in injury rate reduction," she says.
The Bloodborne Pathogens Standard remains the most frequently cited standard in OSHA inspections of hospitals. Inspectors were most likely to cite hospitals for failing to have an adequate exposure control plan or failing to update the plan to reflect changes in technology. The standard requires employers to review their exposure control plans annually.
Hospitals also were cited for failing to provide safety-engineered devices or failing to document that employees had been offered the hepatitis B vaccine.
Despite that enforcement, June M. Fisher, MD, director of the TDICT (Training for Development of Innovative Control Technologies) Project in San Francisco, worries about backsliding that puts health care workers at risk. For example, too often, she says, "health care workers aren't involved in evaluation of devices."
The Bloodborne Pathogens Standard requires the involvement of frontline workers in the selection of devices.
When health care workers fail to activate safety devices, that may indicate insufficient training in the use of the device or that health care workers don't feel comfortable with the device, she says. The EPINet data indicated that in 70.8% of sharps injuries that occurred with safety devices, the user had not activated the safety mechanism.
A recent French study also underscores the importance of selecting the best safety device. An analysis of 435 sharps injuries at 61 hospitals in France found that passive devices which are activated in use without additional steps by the health care worker were involved in the fewest injuries. Self-blunting needles would be one type of passive device.
"Semi-automatic" devices, in which the user must apply extra pressure to activate the safety mechanism – such as some retractable syringes – were associated with the next fewest injuries. Those with a "toppling shield" that requires one-handed activation to cover the needle were more effective than sliding shields, which often require two-handed action and were the least effective, the authors said.2
Overall, the use of safety-engineered devices resulted in a 74% decrease in injuries in phlebotomy, the authors reported.
OSHA cites non-hospital settings
In the announcement of its review of the Bloodborne Pathogens Standard, OSHA said it would consider both the effectiveness and the burden of the rule. Specifically, OSHA said it would look at:
Exposures in non-hospital settings;
Recent technological advances in needlestick prevention;
Effectiveness of needlestick prevention programs;
New, emerging health risks from bloodborne pathogens; and
Any other experiences related to compliance with the standard.
Hospitals are not the only focus of its enforcement efforts. According to OSHA enforcement data, from October 2008 to September 2009, there were more bloodborne pathogens citations at skilled nursing facilities (long-term care) than any other workplace. Ambulance services, doctors' offices, and dental clinics also had more citations under the standard than hospitals.
The provisions requiring safety devices, an updated exposure control plan, employee training, hepatitis B vaccination, and proper sharps disposal "have all been extremely important and extremely effective in reducing risk in the workplace," says Perry.
[Editor's note: The International Healthcare Worker Safety Center at the University of Virginia is sponsoring a conference marking the 10th anniversary of the Needlestick Safety and Prevention Act, Nov. 5-6 at the Omni Hotel in Charlottesville. Online registration is available at www.cmevillage.com. For more information, contact Jane Perry at [email protected].]
1. Jagger J, et al. Increase in sharps injuries in surgical settings versus non-surgical settings after passage of national needlestick legislation. J Am Coll Surg. 2010;210:496-502.
2. Tosini W, et al. Needlestick injury rates according to different types of safety-engineered devices: results of a French multicenter study. Infect Control Hosp Epidemiol. 2010;31:402-407.Ten years after the Needlestick Safety and Prevention Act was signed into law, the mandate for safer sharps devices is under review both legally and academically.
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