The history of our move toward needle safety
The history of our move toward needle safety
But there’s still reason for concern
By Nina Moore Elledge, RN, CRNI
Independent nurse consultant
Castro Valley, CA
By now, many of us should be aware of the changing climate in health care facilities regarding protection of its employees against accidental injuries with contaminated needles. When we look at the history that led to this change and the resulting legislation, we can see why it is so important to fully accept these changes and adjust our practice now.
In the late 1980s, the first generation of safety devices was introduced to the market in response to the discovery of HIV. With HIV came the potential of transitioning the workplace into a possibly life-threatening environment. IV lines, lab draw devices, and injection needles were introduced that would be shielding or self-blunting to protect workers from this newly discovered virus, as well as the more than 20 other bloodborne pathogens (BBP). However, many health care facilities did not carry these new safety devices due to cost and/or politics.
In the mid 1990s, health care workers’ public outcry for safer devices in the workplace began. For the first time, there were names and faces in the stories behind the devastation of a contaminated needlestick injury. Cost analysis began to become apparent: An average workers’ compensation claim for a needlestick injury was $2,000 to $3,000,1,2 depending on which statistics you read, and that is if there is no seroconversion.
Analysts began to understand the volume of the government expense if the claimant becomes positive for a BBP. If these figures are multiplied by the number of employees exposed to sharps on a daily basis (doctors, nurses, respiratory therapists, lab technicians, patient care aides, housekeeping, and environmental services staff), it was obvious that something had to be done on a regulatory level. If not, workers’ compensation insurance premiums would skyrocket, resulting in the government incurring significant expenses to cover these claims. Health care facilities would need to pass on these costs in the form of increased premiums, cuts in services, or decreases in employee benefits.
Safety devices were 50% to 100% more expensive than conventional non-safety devices. However, the total cost for each device was still typically less than $2 per item.3 Needleless systems were generally in use on intravenous lines, but there were limited safety devices available on hollow-bore needles.
A step to safety
The impact on home infusion providers is clear. In general, the patient population in hospitals is sicker than ever before, yet stays in the hospital for less time and receives IV therapy more than 90% of the time.4 Alternate sites are becoming popular for IV therapy. We have non-RN staff providing care for patients, and many do not have the IV experience or device knowledge as in years past when IV teams cared for all patients with a vascular access device. This further increases the risk of needlestick injury. Training on the use of these devices is at times incomplete due to a variety of factors most likely due to the staffing crisis.
In August 1998, California became the first state to pass a safety initiative to protect health care workers from accidental needlestick injury by contaminated needles used to start IVs, draw labs, and give injections. The CalOSHA bloodborne pathogens standard will be revised as a result.
In May of this year, Tennessee and Maryland passed BBP protection revisions to their state Occupational Safety and Health Administration (OSHA) regulations. Twenty more states have similar legislation pending. Health care facilities won’t be covered for needlestick injuries if the facilities do not have safety devices in use, i.e., are compliant with the new OSHA regulations. The Stark/Roukema bill was introduced in Congress to revise the federal OSHA regulation to include protection for health care workers against accidental needlestick injuries, similar to the California bill already enacted.
Shortly thereafter in July, California health care facilities have either put the safety devices into use or have a plan of action to implement their use within the next several months. Congress reconvenes to vote on the Needlestick Prevention Act of 1999. Health care workers are beginning to use these devices, many with successful transitions.
But the transition is far from complete. There are still health care workers who do not like safety devices, some of whom stash conventional product to fall back on if they do not have successful outcomes with the new safety products. Change is hard, particularly when it involves a product we are used to and have had success with. This is especially true when it involves an invasive and oftentimes painful procedure to our patients. However, remember that many of these safety devices were developed using input by health care workers themselves and, as a result, are user-friendly.
Safety devices reduce needlestick injuries
This change in practice must happen not only because of the protection offered to health care workers, but also the protection from accidental needlesticks offered to patients. Studies have shown that needlestick injuries significantly decrease when safety devices are put into use.5 Health care costs have skyrocketed, and this measure is an attempt to put an end to a portion of it.
The upfront cost of health care is not the only concern. In addition, we need to look at health care workers’ malpractice insurance coverages. It is unlikely that coverage would extend to a worker whose facility has safety devices to use and the worker opts not to use them. This is because facilities will be revising policies, or have already done so, to mandate use of safety devices. This keeps the facilities in compliance with OSHA regulations and protects them from legal liability as well.
We are seeing manufacturers stand behind their legal obligation to properly train health care workers who use their devices. This will also limit their legal liability in a needlestick injury case.
This change to a safer work environment is a long time coming, similar to construction workers who wear their hard-hats at work every day. But the process won’t be complete until all workers take advantage of this simple precaution.
References
1. Centers for Disease Control and Prevention Web site, www.cdc.gov.
2. Occupational Safety and Health Administration Web site, www.osha.gov.
3. Do A, Ray B, Banjeree S, et al. Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting. J Infect Dis 1999; 179:442-448.
4. Baranowski L, et al. Intravenous Therapy, Clinical Principles and Practice. New York: W.B Saunders & Co.; 1995.
5. International Health Care Worker Safety Center. Prevention of Occupational Blood Exposures in Health Care Settings. Prevention, Management, and Chemoprophylaxis of Occupational Exposure to HIV. Charlottesville, VA; 1997.
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