HCW union launches state-by-state campaign for safe needle legislation

Union president says federal standard would be the ultimate solution’

Vowing to do "whatever it takes" to force hospitals to switch to safer needle devices, the president of the nation’s largest health care worker labor union has launched a grass-roots campaign that will sweep the nation state by state, attempting to duplicate the success of legislation requiring California health care facilities to evaluate and purchase new needle technology.

The Washington, DC-based Service Employees International Union (SEIU), which represents about 650,000 HCWs nationwide, announced plans to introduce legislation based on the successful California model in 18 states and the District of Columbia this year. Legislation already has been introduced in Maryland, Florida, New Jersey, Massachusetts, Montana, Indiana, Illinois, and Washington state. Other states targeted are Connecticut, Iowa, Georgia, Maine, Missouri, New York, Oregon, Pennsylvania, Texas, and Wisconsin.

The union also will continue to lobby Congress for a national law and ask the U.S. Occupational Safety and Health Administration (OSHA) for revisions to the bloodborne pathogens standard that would require safer devices as an engineering control to prevent needlesticks, "but we can’t wait," says Andrew Stern, SEIU president. "This is an issue of immense importance to everyone who works in a health care facility today."

Speaking to the media recently via a national teleconference, Stern acknowledged that a federal standard is "the ultimate solution." He called upon other members of the health care community to join in campaigning for a national standard or federal legislation.

"Every year, more than a million health care workers are accidentally stuck by a needle," he says. "It used to be a red badge of courage for many, but now it’s often a death sentence. State by state or nationally, we’ll do whatever it takes to stop this tragedy."

Stern says 1,000 HCWs contract hepatitis B or C or HIV from needlesticks every year, and 100 workers die each year — "the equivalent of a plane load of health care workers" — from occupational transmission of those diseases.

"The tragedy and scandal of all of this is that there is now technology that can prevent at least 75% of all of these injuries, and if hospitals would just stop buying conventional and hazardous needles and start using safer needles, this situation could change immediately and dramatically," he adds.

Safer needles have been available since 1991, Stern notes, but the federal government does not require their use. He defines safer needles as those equipped with a protective shield over the needle or a mechanism that automatically retracts the needle into the barrel after use.

Hospital officials often cite as prohibitive the increased cost of safer devices over conventional versions, but Stern refers to an internal report by the California OSHA (CalOSHA) Standards Board prepared as part of the cost analysis for rulemaking, which found that safer needles cost an average of 23 cents to 24 cents more than their conventional counterparts. On the other hand, the cost to a hospital of each needlestick is estimated to be between $2,234 and $3,832, according to CalOSHA.

Standards board staff estimate that the new law will cost California health care facilities about $104 million a year for safer needle technology and $81 million a year for increased record-keeping costs related to sharps injury logs. However, CalOSHA also estimates the savings on screening and treatment for sharps injuries at $291 million, for a net savings of $106 million per year.

If all states were required to use safer devices, those savings could translate to billions of dollars annually, says Stern, but "more importantly, it’s about saving health care workers’ lives. Hospitals would rather pay workers’ comp payments than pay a little more for life-saving devices. These [safer] needles aren’t getting to health care workers. We have continued to appeal for too long to OSHA and the FDA [Food and Drug Administra tion] to ban unsafe needles."

A ban is unlikely, but federal agencies have pledged to take other action this year on needlestick prevention issues. (See Hospital Employee Health, March 1998, pp. 25-28.) The SEIU hopes OSHA’s recent request for information on nee dlesticks will result in a stronger bloodborne patho gens standard, but agency officials remain noncommittal about that possibility.

OSHA remains noncommittal

While the California law ultimately may lead to federal action, union officials aren’t taking a wait-and-see approach. Legislation already introduced in Maryland is sponsored by every representative with a medical background, Stern says. In each state, the grassroots campaign is led by nurses with firsthand knowledge of the dangers of needlesticks, he adds.

Lorraine Thiebaud, RN, a nurse for more than 25 years, most of them at San Francisco General Hospital (SFGH), actively campaigned for the California legislation. She became an activist for safer needles in 1991 after a medical student at SFGH acquired HIV from a needlestick with a device for which a safer version was available but was not in use because the hospital considered it too expensive.

"The law in California will drastically reduce the number of needlestick injuries, so California health care workers can go to work without fearing coming home with a deadly disease," she says. "This legislation needs to be passed in every state. Safer needles will not be in workers’ hands if it is left up to hospital administrators and needle manufacturers."

OSHA cites hospital’s exposure control plan

While the state-by-state approach may or may not pressure the federal government to establish a national law, some have charged that OSHA could enforce the present version of the bloodborne pathogens standard to require hospitals to evaluate and implement safer needle devices right now. HEH has learned that one hospital recently has been cited under the standard for not addressing the use of safer needle devices in its exposure control plan, and that revisions to OSHA’s compliance directive for standard enforcement could lead to similar citations for other hospitals.

Presbyterian St. Luke’s Hospital in Denver was cited for a "serious" violation because its bloodborne pathogens exposure control plan "did not address the selection, evaluation, and implementation of engineering controls to eliminate or minimize employee exposure. Such controls consist of, but are not limited to, needleless IV systems, blunt suture needles, and self-sheathing needles," the citation states.

Steve Yellstrom, the OSHA compliance officer who inspected and cited the hospital, says a $1,625 fine was levied for an exposure control plan that failed to include a schedule and/or methods of implementation for complying with the standard’s engineering controls requirement to prevent bloodborne pathogens exposures. Engineering controls include safer needle technology, Yellstrom says.

Interestingly, although the employee complaints that precipitated the inspection were related to bloodborne pathogens, OSHA found those complaints unsubstantiated. The citation was issued for other problems discovered during the visit.

"When investigating allegations, we have to look at the entire program," Yellstrom explains. "Whenever we look at a facility that involves [the] bloodborne [pathogens standard], we also look at their written program and make sure it contains all the elements required by the standard."

In talking with workers, it appeared that the hospital had instituted some safer devices, but there was no list, no written plan for selecting or evaluating devices, and no systematic method documented for implementing them. Therefore, the hospital had no proof of compliance with the exposure control plan provisions of the standard. (See editor’s note at end of article.)

"Unless you have a system, there’s no way you can really grasp what’s out there, what’s working, and why you selected one device over another," Yellstrom says.

He suggests that when employee health nurses meet periodically with infection control and safety officers, one person should be assigned to maintain a binder of information on devices currently in use compared with new devices on the market.

"They should have an organized plan to test newer devices and see if they’re better. Combined with that, if they have an exposure incident such as a needlestick, they need to really examine the cause and see if it could have been mitigated by a better device," he adds. "If it’s not systematic and it’s not documented, we can’t tell how effective their program is."

In fact, St. Luke’s exposure control plan included no mention at all of safer needle devices as an engineering control, Yellstrom states. The hospital has since abated the citation, which was reclassified to "other than serious" — meaning a violation is not likely to result in serious injury or illness — following an informal conference.

St. Luke’s officials refused to respond to repeated requests for information about how they abated the citation and improved their exposure control plan.

More strict enforcement ahead?

The citation has drawn attention for two reasons. One is that it apparently is the first one known to be related specifically to safer needle devices. Also, it could signal stricter enforcement of the engineering controls provision of the standard now that preventing needlestick injuries among HCWs has become an OSHA priority.

The first reason is difficult to verify, however. Wanda Bissell, an industrial hygienist with OSHA’s office of health compliance assistance, says the agency’s database shows that the engineering and work practice controls provision of the standard has been cited 110 times since 1992, but recorded data are not specific enough to indicate whether those citations involved safer needle devices.

OSHA’s recent request for information (RFI) regarding needlesticks signals an important first step in addressing the problem; still, observers are questioning the need for and eventual use of the data acquired. (See HEH, November 1998, pp. 129-132.) Bissell says the RFI could result in a revised final rule, and that information obtained might also be incorporated into the standard’s compliance directive she is charged with updating.

"I anticipate using part of the RFI in a new directive specifically related to the use of safer devices," Bissell says. "We’re planning to make it more specific; the marketplace is booming with new needle devices we had never dreamed of in 1992 when [the current compliance directive] was written. There wasn’t a market then for the stuff. OSHA standards are often the mother of invention, and that’s what has happened."

Bissell says the "modernized" directive, pending approval, will be modeled after materials used in California, which requires safer device use.

"Hopefully, the RFI will show us what devices we can support, and [we might] list some actual devices we would like employers to use," she adds.

(Editor’s note: The OSHA Web site includes a current sample of the bloodborne pathogens exposure control plan. Go to: www.osha-slc.gov:80/OshDoc/Interp_data/I19920325.html.)