OSHA needlestick RFI reveals pertinent data

Safer devices work, but are underutilized

Safer needle devices are an effective means of injury reduction for health care workers, but are used infrequently in all applications except for intravenous line access, according to results of the Occupational Safety and Health Administra tion’s (OSHA) recent request for information (RFI) on preventing needlesticks.

OSHA got 396 responses to its RFI, published late last year. It asked for information on engineering and work practice controls used to eliminate or minimize the risk of occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps.1 (See Hospital Employee Health, November 1998, pp. 129-132.)

More than 300 individual health care facilities responded. Several health care organizations submitted combined responses on behalf of members. Comments also were sent by individual HCWs, researchers, unions, educational institutions, professional and industry associations, and medical device manufacturers.

Respondents’ answers to questions posed in the RFI apparently helped convince OSHA officials to formulate specific plans to help reduce the risk of occupational exposure to bloodborne diseases due to needlestick injuries. (See cover story.)

Based on responses, OSHA officials observed:

• Safer medical devices are an effective and feasible method of hazard control in many instances. Nearly every responding health care facility noted injury reductions after safer medical devices were introduced.

• Most IV line access is now accomplished using safer devices. However, safer devices are used much less frequently in other applications.

• The rate of percutaneous exposure incidents is declining. The best and most current national estimate available was submitted by the Interna tional Health Care Worker Safety Center in Charlottesville, VA, based on surveillance system data. It estimates that approximately 590,000 percutaneous exposure incidents occur annually.

• Training and education in using safer needle devices and work practices are an effective means of preventing needlesticks. Staff involvement in device selection and evaluation plays an important part in achieving injury reduction.

• The OSHA 200 log does not accurately reflect injuries involving bloodborne pathogen exposures. Criteria for recording those exposures (loss of consciousness, transfer to another job, work or motion restriction, medical treatment beyond first aid, or seroconversion) do not require recording all injuries with the potential for disease transmission. Also, many facilities do not correctly interpret established recording criteria.

• Responding health care facilities have almost all adopted surveillance systems in addition to the OSHA 200 log. They commonly record all reported percutaneous injuries involving exposures to blood and other potentially infectious materials.

• Increased costs and staff resistance to change were the most frequently reported obstacles to adopting safer needle devices. Other barriers included equipment compatibility problems, facility purchasing agreement limitations, and unavailability of effective safer devices for certain applications.

• Use of safer devices did not substantially affect patient care delivery.

• Safer devices generally are more expensive than conventional devices. However, total additional cost per facility appears to be a small fraction of total health care costs, and reductions in number of injuries may result in substantial financial benefits from reduced postexposure testing and treatment costs, as well as health benefits from decreased disease transmission.

• Many respondents consider a comprehensive safety and health program to be the most effective means of reducing bloodborne disease transmission risks.

• Some respondents support OSHA’s interest in making safer devices more available to employees. Others expressed reservations about any broad mandate requiring safer device use, citing that needs of particular areas of practice must be considered and that device efficacy and effects on patient care should be established prior to device adoption.

(Editor’s note: To see the entire RFI report, go to OSHA’s Internet Web site at: http://www.osha-slc. gov/html/ndlreport052099.html.)

Reference

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