It’s official: Safety devices will be mandatory for California providers

Ever the trendsetter, state passes law to protect health care workers

California always has been a trendsetter, and this time the state may be paving the way to create a safer environment for health care workers. Gov. Pete Wilson recently signed into law legislation that requires the use of safety needles to protect medical workers. The law, developed by the San Francisco-based California Occupational Safety and Health Administration (Cal-OSHA), has an effective date of Jan. 15, 1999.

Although the use of safety devices clearly puts patient and health care worker safety at the forefront, home infusion providers who discussed the new law with Home Infusion Therapy Management wondered if such a law was really necessary.

"Is that something they have to force anyone to do?" asks Ross Domke, RPh, and director of operations for OptionCare’s Redding, CA, office. "It’s more government regulation, and they’re not really going to be able to enforce it unless there is a problem."

Domke notes that common sense dictates the use of safety devices, but not in all cases. He points out that the law does not require the use of safety devices in every instance. For example, a standard cannula or syringe can be used if a provider can show that currently available safety-device technology does not promote patient or employee safety or interferes with a medical procedure.

David Schuetz, PharmD, home infusion pharmacist for Sacramento, CA-based Sutter Health Home Infusion Services, says many providers will need to take advantage of the provision.

"We use needleless systems with the exception of any time there are subcutaneous or IM [intramuscular] doses," he says.

But that’s not the only problem. "In the home, safety needles and syringes sometimes present more educational and usage problems for patients that have limited capabilities to begin with," according to Schuetz. "Using safety devices is often more difficult."

Then there’s the cost issue. Not only are safety devices usually more expensive than standard syringes; reimbursement often is difficult due to the numerous parts that usually make up the safety devices.

"I’m not sure whether Medicaid will reimburse for this, because sometimes when there is something that has a lot of pieces, it is hard to get paid for," says Domke.

The legislation also will require greater inventory for providers.

"We do not use safety-type syringes in sterile preparation because they are very difficult to use in compounding," says Schuetz.

Both Sutter Health Home Infusion and OptionCare are already using safety devices in patient homes. And with the provision allowing for some leeway regarding the use of safety devices, both agree that the law is a step in the right direction.

(Editor’s note: For previous coverage of the Cal-OSHA regulation, see HITM, October 1998, p. 109.)