Warning to AHA: Expect to receive more complaints on needle safety

Medical residents, Public Citizen vow action nationwide

Hospitals that fail to use safer needle devices wherever possible — including the operating room — may find themselves the target of employee complaints or Occupational Safety and Health Administration (OSHA) citations.

That is the message medical residents and the Washington, DC-based advocacy group Public Citizen intend to send after recent OSHA citations of Montefiore Medical Center in New York City.

Among the deficiencies cited: failure to use safety syringes and catheter securement devices, retractable scalpels, and blunt suture needles; lack of sufficient information on needlestick logs; and failure to update the exposure control plan. (Montefiore has contested the citations.)

"The point is not that Montefiore is bad. It’s that Montefiore is common," says Stephen Cha, MD, chief resident in the Montefiore department of internal medicine and a complainant. "We feel what happens here happens a lot of places."

In fact, the hospital asserts that it has made significant efforts to prevent needlesticks. "Montefiore Medical Center has had a long-standing and exceptional program to protect its employees from occupational exposure to bloodborne pathogens and has been and continues to be committed to providing a safe work environment for all of its employees," the hospital said in a statement.

Other hospitals may soon face scrutiny as a result of complaints by medical residents or students. Cha, along with Joseph Ross, MD, a medical resident at Montefiore, and Peter Lurie, MD, MPH, deputy director of Public Citizen’s Health Research Group asked the American Hospital Association (AHA) to issue an alert to hospitals regarding the citations of Montefiore. "In the alternative, medical students and residents stand ready to file institution-by-institution complaints against violating hospitals," they said in a letter.

"We think the violations described in the citation are not particularly unusual in American hospitals," Lurie says. "We suspect that a very large fraction of American hospitals are guilty of exactly the same thing."

AHA president Richard Davidson noted that the AHA has issued "multiple advisories" on needle safety. "We’ll continue to remind our members of its importance," he responded to Public Citizen.

Challenges remain in needle safety

The Montefiore case highlights the challenges that remain in integrating safer devices and changing long-standing practices.

Market data from Becton-Dickinson, the world’s largest manufacturer of needle devices, indicates that 90% of hospitals use needleless IV systems, says Jane Perry, MA, director of communications for the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville. Blood collection devices with safety features, likewise have widespread acceptance.

About half of the syringes sold have safety features; syringes used in the pharmacy or other areas with no direct patient contact would not need the safety device. But safety devices have low acceptance in some areas, such as the operating room.

"I don’t think hospitals have much of an excuse any more," Perry says. "They should be fully converted to safety in the major device categories and they should be making a lot of progress in terms of safety in the specialty products."

June M. Fisher , MD, director of the Training for Development of Innovative Control Technologies (TDICT) Project at the Trauma Foundation at San Francisco General Hospital and a needle safety expert, also expresses concern about how well hospitals have integrated safety devices throughout their units.

"As far as I know, there’s no good surveillance of how it’s implemented," she says.

Complaint arose after union effort

Cha says he became concerned about safe needle devices at Montefiore after he rotated through another hospital where an array of such devices was available. For example, he used a needless system to access central lines and adhesives instead of sutures to secure central venous catheter lines.

Meanwhile, working with the Committee of Interns and Residents, an affiliate of the Service Employees International Union, Montefiore interns and residents began a union organizing effort. They eventually abandoned that effort, but they had gathered information on the bloodborne pathogen standard and the hospital’s injury log.

An OSHA complaint, signed by more than 20 interns and residents, noted a rise in needlesticks from syringes in 2002 and in overall sharps injuries over a three-year period. An average of 89 employees reported being stuck with a hypodermic needle each year, the complaint stated.

Several of the medical residents who signed the OSHA complaint had suffered needlesticks, Cha says.

Cha recalls emergency situations in which he and other physicians might use dozens of syringes. "We would start jamming them into the bed as opposed to having a simple locking mechanism to keep the needle safe," he says.

Since the complaint was filed, Montefiore has improved the availability of safety devices, Cha explains. Now he says he hopes to influence change at other hospitals, as well.

"Needlesticks are still a huge problem. Trans-mission of bloodborne pathogens is still a big problem," says Nicholas Rudikoff, a research analyst with the Committee of Interns and Residents.

"I think there has to be constant vigilance because the enforcement agencies don’t have the time or resources to constantly be checking on this," he adds.