OSHA gets mixed message on needle mandate

But nearly all report safety devices reduce injuries

The Occupational Safety and Health Admi ni stration (OSHA) received 396 responses to its request for information (RFI) on needle safety devices, with some respondents urging broad implementation of the devices and others cautioning against blanket mandates, the agency reports.1

"While health care facilities did not generally comment on an appropriate course of action for the agency to take, a number of other respondents supported OSHA’s interest in making safer medical devices available to employees," the report concludes. "Some respondents, however, expressed reservations about any broad mandate requiring the use of safer medical devices, maintaining that the distinctive situations and needs of particular areas of practice (e.g., dentistry, anesthesiology) must be taken into account, and that device efficacy and effects on patient care should be established prior to device adoption."

Comments were submitted by more than 300 individual health care facilities, including nursing homes, clinics, and acute care, tertiary care, rehabilitation, and pediatric hospitals. Several organizations submitted combined responses on behalf of members representing more than 130 additional health care facilities. Also responding were individual health care workers, researchers, unions, educational institutions, professional and industry associations, and manufacturers of medical devices. The OSHA findings are summarized as follows:

• The OSHA 200 log, as it is currently being maintained, does not accurately reflect injuries that may involve exposure to bloodborne pathogens in health care facilities. The criteria established for recording occupational bloodborne pathogen exposures do not require recording of all injuries that pose a potential risk of disease transmission. Only those exposure incidents resulting in loss of consciousness, transfer to another job, restriction of work or motion, recommendation for medical treatment beyond first aid, or serocon version are currently required to be recorded. Many facilities also apparently do not correctly interpret the established recording criteria.

• Those health care facilities that responded to the RFI have almost universally adopted surveillance systems in addition to the OSHA 200 log. These alternate systems commonly record all reported percutaneous injuries involving exposure to blood or other potentially infectious materials. Information is generally recorded on the circumstances under which injuries occurred, although this information appears to vary in content and level of detail.

• Although confounding factors exist, data submitted to the docket appear to indicate that the rate of percutaneous exposure incidents is declining. An estimated 590,000 needlesticks occur annually.

• Use of safer devices appears to be increasing in limited applications. Responses indicate that most IV line access is now accomplished using safer devices. However, safer devices appear to be used much less frequently in other applications. Responses indicate that safer medical devices are an effective and feasible method of hazard control in many instances. Nearly every health care facility responding to the RFI noted that a reduction in injuries had occurred after the introduction of a safer medical device.

• Training and education in the use of safer medical devices and safer work practices were repeatedly cited by respondents as effective means of preventing percutaneous exposure incidents. In addition, anecdotal responses indicate that staff involvement in the device selection and evaluation process can play an important role in achieving a reduction in injuries. Use of safer medical devices was generally not reported to have substantially affected the delivery of patient care.

• Increased costs and staff resistance to change were the most frequently reported obstacles to adopting safer medical devices. Other barriers encountered include equipment compatibility problems, facility purchasing agreement limitations, and the unavailability of effective safer medical devices for certain applications. Safer medical devices in general are more expensive than conventional devices. The total additional cost per facility, however, appears to be a small fraction of total health care costs, and reductions in the number of these injuries may result in substantial financial benefits from reduced costs for postexposure testing and treatment as well as health benefits from a decrease in disease transmission.

(Editor’s note: The report is available on OSHA’s Web page at http:/www.osha-slc.gov/html/ndlreport052099. html.)

Reference

1. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens: Request for information. 63 Fed Reg 48,250-48,252 (Sept. 9, 1998).