No reuse of tube holders allowed
The Occupational Safety and Health Administration (OSHA) is hanging tough on enforcement of safer needle devices, with a new information bulletin that clearly restates its prohibition against reuse of blood tube holders. OSHA also has continued to issue citations and fines, including the $102,000 fine of a Pennsylvania nursing home for failing to provide needle safety devices to protect its employees.
In the fiscal year ending Sept. 30, 2002, OSHA issued 183 citations to hospitals, 29 to clinics and doctors’ offices, and 703 to nursing and personal care facilities related to the bloodborne pathogen standard. "Employees are more and more aware of their ability to file a complaint [related to needle safety]. They are more aware of the requirements of the standard," says Amber Hogan, MPH, an industrial hygienist in OSHA’s office of compliance assistance. "There’s been an influx of complaints."
Hospitals have made a dramatic shift to safety devices since the Needlestick Safety and Prevention Act went into effect in 2001. However, smaller facilities such as nursing homes and physicians offices have been slower to convert, she reports.
One area of controversy involves the reuse of blood tube holders. That practice leaves health care workers vulnerable to a needlestick from the back end of the needle, Hogan adds. "[OSHA’s bulletin] re-emphasizes the requirements of the standard, which state that needle removal is prohibited unless it’s required by a medical procedure," she says. "The safest practice is to not remove the needle but to throw away the whole unit."
Clinical labs fight rule
Clinical laboratories have hotly contested that rule, arguing that the long-standing practice of reusing blood tube holders does not pose a workplace hazard. When OSHA cited corporate laboratory giants Laboratory Corp. of America and Quest earlier this year for failing to comply, the companies vowed to fight.
OSHA withdrew the citations, but it has not backed down from its position, Hogan explains. The prohibition is included in the 1991 bloodborne pathogen standard, the 1999 compliance directive, the revised bloodborne pathogen standard and 2001 compliance directive, and a letter of clarification in 2002. After pulling back on the citations, OSHA officials met with manufacturers, clinical laboratory representatives, and union officials. "We felt it was unfair to go forward until we had time to meet with everyone and come up with a comprehensive policy," Hogan says. However, OSHA now will move forward "because we’ve given due notice to the public."
Data reveal back-end injuries
Clinical laboratories and laboratory associations argue that single use of blood tube holders would not be practical because the high-use volume would create an overwhelming burden of biohazardous waste and increased costs. They also assert that reuse is safe when the health care worker uses a mechanical device to remove the tube holder, and thus it doesn’t violate the standard. Yet a review of nine years of data by the International Health Care Worker Safety Center at the University of Virginia in Charlottesville found evidence of injuries from the back end of needles.1
About one-fourth of needlesticks (28%) from phlebotomy needles occurred after use but before disposal, a higher proportion than for all other devices (22%). About one in 10 of the phlebotomy injuries occurred during disassembly of the device, and 17% of injuries occurred while putting the sharp in a disposal container.
Some injured health care workers offered details of their injuries that describe a needlestick by the back end of the needle. It is likely that other health care workers had similar experiences that they did not describe — or even report, says Jane Perry, the center’s director of communications. "It is a real hazard. The data show that," she says. "We would assume that the workers who do put down that their injury was from the back end [of a needle] are only a portion."
1. Perry J, Jagger J. EPINet data report: Injuries from phlebotomy needles. Advances in Exposure Prevention 2003; 6:43-45.