Sharps prevention progress slower than expected?

Keynote: Lives are being lost every day’

Participants in a recent health care worker safety conference agreed that preventing potentially deadly needlestick injuries among U.S. health care workers must become a top priority for hospitals, government, and medical device manufacturers. However, opinion was divided on how to accomplish that goal and whether enough progress has been made in recent years.

The 1998 Frontline Healthcare Workers Conference, held in Washington, DC, is the third such event presented in the last six years. Like its predecessors, the conference’s focus was on preventing sharps injuries and bloodborne exposures to HIV and other pathogens such as hepatitis B and C. In another similarity to past conferences, some participants accused federal agencies of merely paying lip service to needlestick prevention instead of taking direct action to eliminate the conventional needles implicated in high-risk injuries. Those critics also say progress since the previous conference in 1995 has been too slow, allowing workers to contract infections and die from needlesticks.

HIV-positive nurse calls for safer devices

"Lives are being lost every day," says Lynda M. Arnold, RN, founder and president of the Norristown, PA-based National Campaign for Health Care Worker Safety and a keynote speaker at the conference. "The message is, we need to do something. There needs to be specific effort and action designed toward implementation of safety devices in health care facilities to help reduce exposures."

Arnold, who contracted HIV from a needlestick injury in 1992, launched her safety campaign three years ago by appealing to the nation’s hospitals to use safer intravenous catheters and blood-drawing devices, both of which pose an especially high risk for HIV transmission in percutaneous injuries.

"Now that we have statistical information on the types of devices particularly associated with HIV, we can make significant progress in the use of safety devices, and it’s time we do that," she says.

One way to do that is through a national safety alert to warn health care facilities and HCWs of the dangers associated with the use of hollow-bore needles. Arnold says she would like to see the Food and Drug Administration (FDA), a co-sponsor of the Frontline conference, issue an alert promptly.

"That would go a long way in this entire process," she states.

In 1992, the FDA issued a safety alert warning against using hypodermic needles to access intravenous lines, a move intended to prevent injuries related to the practice of "piggybacking" IV lines with needles. Several participants at the 1995 Frontline conference reported that the safety alert had accomplished that goal at their hospitals, but the FDA has issued no subsequent alerts related to other conventional needle devices or sharps and apparently has no current plans to do so.

Nevertheless, a spokeswoman for the FDA maintains that the agency has been "proactive" in helping prevent needlesticks since the 1980s "when transmission of AIDS became a known risk to health care workers."

The FDA has worked with device manufacturers to encourage development of safer products that provide barriers to bloodborne pathogen transmission and has cleared about 250 products with safety features since the mid-1980s, she says.

But officials of the Washington, DC-based Service Employees International Union (SEIU), which represents 600,000 HCWs nationwide, also insist that additional safety alerts are needed to reduce needlesticks.

Do they not work for the taxpayers?’

"Do they work only for the manufacturers? Do they not work for the taxpayers? They’ve spent all their time approving products, but they can’t put out a one-page alert to the nation’s health care workers to let them know these products even exist," says William K. Borwegen, MPH, SEIU’s occupational safety and health director.

A conference participant, Borwegen says the event was "like deja vu all over again. It’s not clear to me whether you can measure any difference since the last one."

Speaking at the conference, SEIU’s secretary-treasurer Betty Bednarcyzk says one HCW per week eventually will die from HIV exposures occurring today. "In one hospital alone where SEIU represents the workers, five workers have occupationally contracted HIV from needlestick injuries," she says.

Safer needle technology that could prevent such injuries exists today, "but we have big corporations that make needles that won’t aggressively market their safer products or develop the best designs, hospitals that won’t buy or even evaluate them, and regulatory agencies that — to be blunt — basically look the other way," Bednarcyzk says.

OSHA to gather needlestick information

However, an official with the U.S. Occupational Safety and Health Administration (OSHA), another conference co-sponsor, announced plans to publish a formal request for information (RFI) on needlestick prevention in the Federal Register. Indeed, several weeks after the conference, OSHA made good on its promise with a notice asking for information on successful strategies for minimizing sharps injuries, particularly related to the use of safer needle devices. (See cover story, p. 129.)

Charles N. Jeffress, the agency’s assistant secretary of labor for occupational safety and health, put it to conference attendees this way: "What works? This is a chance for you to tell us. Which strategies are making a difference at your hospital, your nursing home, your clinic? I am committed to finding ways to reduce needlesticks among health care workers."

Responses to the RFI will determine whether OSHA might revise the bloodborne pathogens standard to include requirements for using newer, safer needle technology in health care institutions, a move Arnold would like to see.

"Over the past few years, there has been an enormous interest in looking at high-risk types of injuries and what we can do to prevent them, but unfortunately there is still a lot more work to be done," she says.

Much of that work needs to be done by individual HCWs, says Murray Cohen, PhD, MPH, CIH, chairman of the Atlanta-based Frontline Healthcare Workers Safety Foundation Ltd., an education and research group that organized and sponsored the conference.

"Health care workers need to be much more directly involved both in recognition of the hazards and the risks, and in efforts to prevent needlestick injuries," he says.

At the 1995 conference, participants said workers knew about their exposure risks but lacked access to safety devices, Cohen explains. However, now the problem more often is that when safety devices are available, HCWs don’t want to use them due to the need to change technique or for other reasons.

Cohen says occupational health and infection control managers now understand sharps injury risks and prevention strategies, but two other groups must be targeted in education programs. One is frontline HCWs, and the other is top management.

Good people doing bad things

"One barrier to hospital managers’ awareness is that with the way health care is being centralized, many times top managers not only are far removed from the hospitals they own but they also are far removed from health care," Cohen states.

"Hospital management is often too far removed from the front line. We have to find the top people and educate them," he says. "Some people allege they’re bad people doing bad things, but I think they’re probably good people who have no idea they’re doing bad things. They have no idea of the good things they can do instead. It’s our obligation to try to find them and educate them."

The time has come to stop finger-pointing and blaming, he adds. "Our theme was: I always wondered why somebody doesn’t do something about this; then I realized I am somebody.’ Everybody in health care needs to be aware that they have a role in fixing the problem. We have the ability, in this problem of percutaneous injuries to health care workers and exposures to bloodborne pathogens, to apply solutions with the efficacy of the best strategies we have in public health, so what are we arguing about? Let’s get out there, roll up our sleeves, and do it."