Congress demands action on safer needle devices

Federal agencies charged with protecting workers

Growing national concerns regarding the hazards of needlestick injuries to health care workers have received a boost from Congress, which has called upon federal agencies to "make reduction of accidental needlesticks a priority by . . . taking all necessary actions to address this serious public health problem."

In language added to the Omnibus Appropriations Act of 1999, a major federal spending bill recently signed into law, Congress urges a requirement for the use of safer needle devices and more accurate needlestick reporting in U.S. health care institutions. Although the directive is not mandatory, the new law specifically charges the Occupational Safety and Health Administra tion, the Centers for Disease Control and Prevention, and the Food and Drug Administra tion with responsibility for protecting HCWs from needlestick injuries that can transmit lethal viruses such as HIV, hepatitis B, and hepatitis C, as well as other bloodborne pathogens.

The bill’s needlestick provisions were added by Sen. Barbara Boxer (D-CA), who wanted to "raise the profile" of the issue, says Danielle Drissel, a spokeswoman in Boxer’s Washington, DC, office.

"Those agencies have been promising to move on the issue but still haven’t," Drissel states. "We want to reassert the fact that they have the authority to make the changes necessary to protect health care workers, who shouldn’t be losing their lives when there are protections that could very easily be put into place."

Several months ago, OSHA published a request for information on engineering and work practice controls that successfully eliminate or minimize sharps injuries. While OSHA says its action is a first step toward directly addressing the problem of disease-transmitting needlesticks among HCWs, other worker safety advocates maintain that OSHA already has all the information it needs to act on protecting workers. (See Hospital Employee Health, November 1998, pp. 129-132.) In fact, critics say OSHA could be enforcing the use of safer needle devices now through the bloodborne pathogens standard’s requirement for engineering controls to reduce workplace hazards.

Criticism also focuses on the fact that while federal OSHA is just beginning an information-gathering process, California OSHA already is revising the state bloodborne pathogens standard to mandate the use of safer needle technology in health care facilities. The state became the first in the nation to enact such legislation designed to protect HCWs, and state officials have challenged federal regulators to follow suit. (See Hospital Employee Health, December 1998, pp. 144-146.)

More action,’ less finger-pointing’

Drissel says federal agencies have been engaging in "a lot of finger-pointing and not a lot of action."

"The FDA says they don’t have the data; it’s up to NIOSH [the National Institute of Occupational Safety and Health] to pull the data together. NIOSH says they can’t do anything because they’re under the direction of the CDC. OSHA says [the issue] involves medical devices, so it’s not their problem, and the FDA says they don’t do worker safety issues. We want them all to sit down together, figure out what belongs in whose bailiwick, and then address this problem," she states.

Boxer is urging the CDC to collect more comprehensive data on accidental needlesticks, such as how and when they occur, the types of devices that have been used in different settings to try to prevent them, success rates, and the effectiveness of education campaigns. The CDC also has been asked to recommend the use of safer needle devices in its hospital infection control guidelines.

OSHA is being encouraged to require reporting of all needlesticks in the OSHA 200 log, instead of the estimated one in 10 that is reported now.

The FDA, which so far has issued only one safety alert on hazardous needle devices — a 1992 warning against using hypodermic needles to access intravenous lines — is "in a clear position to send [additional] alerts to users of conventional needles articulating safety concerns that have been raised," Drissel says.

The language in the appropriations bill marks the first time congressional attention has focused on the needlestick issue.