Needlestick law stirs debate in California

Move could prompt similar laws in other states

California legislators are considering a state law that would create a state-wide surveillance system for needlesticks to health care workers and encourage hospitals to sharps safety designs.

The proposed law has the stated aim of reducing "exposures of health care personnel to deadly, bloodborne diseases by encouraging the development and use of medical devices that are designed to assure worker safety, the safety of patients, and the efficacy of the device."

The law which may foreshadow similar actions in other states, would require the California Department of Health Services to review and analyze existing studies, data, and other information on safety-enhanced product design of medical devices that place health care workers at risk of exposure to bloodborne diseases, including syringes and intravenous tubing. The department would collect and evaluate information from health facilities that are using medical devices that have been redesigned to enhance worker safety.

Plans call for establishment of a 10-member advisory committee, which would include representatives of government, health care employers, labor organizations, researchers, and health care workers. The advisory committee would decide how to implement a statewide sharps exposure surveillance system that would include device and procedure-specific incidents of needlesticks and other sharps injuries. All licensed health care and home care institutions would be required to participate in the surveillance system by reporting all needlesticks and other sharps injuries to the program.

The bill has been approved by the state Senate, but the fiscal impact on hospitals trying to comply was still an issue as the bill awaited approval by the full legislature.

Sponsored by state Sen. Mike Thompson, D-NAPA, chair of the Senate Budget Committee, the legislation has drawn support from state chapters of the Service Employees International Union (SEIU) and the American Nurses Association (ANA), both based in Washington, D.C. It was opposed as initially drafted by the California Healthcare Association -- which represents the hospital industry.

As approved by the Senate, the bill would be funded by state appropriations not to exceed $145,000 annually and grants solicited from public and private contributions. Hospital representatives, however, argued that the lion's share of the funding of the proposed surveillance system would fall to their institutions.

"[The law] will cost the health care industry millions of dollars by requiring a statewide sharps exposure surveillance system," stated Donna M. Kaylor, JD, legislative advocate for the hospital association in Sacramento, in comments submitted opposing the bill. "At this time, only large health care facilities have the staff resources to manage and interpret the results of such a system. It is questionable if small hospitals and some home health programs can find qualified personnel to conduct a meaningful sharps exposure surveillance system."

In opposing the legislation, the hospital group argued that the 1991 federal bloodborne pathogens standard by the Occupational Safety and Health Administration in Washington, D.C., has significantly reduced bloodborne infections. While commending the attempt to protect health care workers, Kaylor noted that even if such a system was implemented, it would not eliminate exposures to bloodborne pathogens for health care workers "due to mistakes which occur due to human nature and actions of patients who move, swing, and kick while being treated."

Bill endorsed by ANA

On the other hand, the bill received strong endorsement from the Los Angeles-based state chapter of the ANA.

"As the professional association representing registered nurses in California, we are increasingly concerned about needle-related injuries in all health care settings," stated comments submitted by Judy Martin-Holland, RN, MS, president of the state ANA group. "It is essential that a unified reporting and surveillance system . . . be established so that accessible and reliable information is available to develop interventions for high-risk procedures."

Currently there is a lack of statistical information about the extent and the nature of needlestick injuries in medical settings in California, argued representatives for the SEIU.

"There are only a few employers conducting objective, comprehensive pilot projects to determine the efficacy of market-available devices to prevent needle stick and other sharp instrument injuries," read an SEIU statement submitted to the legislative record. "The results of these pilot projects are not readily available to other employers, necessitating costly duplication and slowing the process of safer device selection. Finally, there is presently no agency in this country which puts the results of these pilots into the form of recommendations to employers as a whole." *