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Will OSHA build on 10-year BBP success?
Rule review may result in changes
Ten years ago this month, the U.S. Occupational Safety and Health Administration issued its revised Bloodborne Pathogens Standard. As the agency now considers making changes to that rule, it has amassed largely favorable reviews from health care providers, professional organizations, and safety experts alike.
Unquestionably, the Bloodborne Pathogens Standard has led to fewer injuries and reduced risk of transmitting HIV and hepatitis B and C. It is the only standard directed specifically at the health care industry, and it is the most frequently cited standard in inspections of hospitals.
About 95% of core hypodermic needles and blood collection needles purchased by acute care hospitals are safety-engineered, according to manufacturer data. And sharps injuries dropped by about a third (31.6%) from 1993 to 2006, according to surveillance data collected by the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville.
Since 2001, OSHA has conducted almost 20,000 inspections in health care facilities. The largest number of inspections occurred in nursing homes, which have been included in targeted inspection programs as a high-hazard workplace.
The most cited section of the standard: Employers must update their exposure control plan annually and consider new technology. Failure to use safety devices is the second most-frequent cause of citations.
"We are more frequently citing that section of the standard that deals with use of engineering devices because there are more devices available and it's easier for us to say...employers should be using those," says Dionne Williams, MPH, an OSHA senior industrial hygienist who presented the enforcement data at the conference of the International Healthcare Worker Safety Center marking the 10th anniversary of the Needlestick Safety and Prevention Act.
The center plans to release a white paper outlining areas for improvement in sharps safety. The comments received in OSHA's review of the Bloodborne Pathogens Standard also reveal what may be the new direction for needle safety.
More emphasis on the OR?
In 2007, suture needles were responsible for about one-quarter (23.9%) of all sharps injuries, and OR was the site of 35.9% of sharps injuries, according to EPINet surveillance data from the International Healthcare Worker Safety Center. Sharps injuries rose by 6.7% in the operating room while they declined by almost 32% elsewhere in hospitals.1
"We think more focused attention by OSHA on enforcement and compliance in this clinical setting is warranted and needed," says Jane Perry, MA, associate director of the International Healthcare Worker Safety Center.
The American College of Surgeons has endorsed the use of blunt suture needles, double-gloving, a neutral zone for passing instruments, and other safety devices in the OR. The Association of periOperative Registered Nurses also is pressing for safer practices in the OR.
Weaker rules in non-hospital settings?
The National Federation of Independent Business (NFIB) asked OSHA to scale back its enforcement of the sharps safety rules, particularly in dentists' offices. "OSHA should limit the scope of this standard to only the most at-risk workplace settings. By doing so, OSHA could substantially limit the number of small businesses affected by this clearly burdensome standard, without sacrificing the safety of the workers employed by those businesses," said Susan Eckerly, NFIB senior vice president for public policy.
However, others argued for continued protections for health care workers outside acute care. "For outpatient settings, particularly long-term care and home health, the need is for more basic epidemiological research. We need a better grasp on how the sharps injury risk picture differs in the various healthcare settings that are grouped in the category 'alternate sites,' " says Perry. "These vary from a single healthcare worker providing in-home care to large staffs working in long-term care facilities or nursing homes.
"While data for outpatient and alternate care settings are limited, it would be unwise to weaken any part of the standard or grant exemptions to specific non-hospital settings, given that non-acute care settings are currently the most rapidly expanding segment of the health care market."
More pressure on manufacturers?
Health care employers are required to provide safety devices, when possible, but manufacturers are not required to produce the devices. While manufacturers have responded to the demand for safety products, there are still gaps remaining, as noted in comments to OSHA.
For example, surveillance data from Massachusetts hospitals found that in 2008, 20% of sharps injuries involved devices contained in pre-packaged kits. Some 58% of those injuries involved devices that had no safety feature. "Many hospitals are working to comply with the letter and spirit of the regulations but find that much energy is put into negotiating with product suppliers and manufacturers to obtain [devices with safety-engineered sharps injury prevention]. Hospitals have also questioned how it is possible that manufacturers and suppliers can continue to provide devices lacking sharps injury prevention features," wrote Angela Laramie, MPH, epidemiologist with the Sharps Injury Surveillance Project in the Massachusetts Department of Public Health in Boston.
1. Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation. J Am Coll Surg 2010;210:496–502.