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As of April 18, hospitals will be required to maintain a detailed log of needlestick injuries and update their exposure control plans annually, requirements of a federal law that have now been outlined in a revised bloodborne pathogen standard. In the last days of the Clinton administration, the U.S. Occupational Safety and Health Administration (OSHA) issued the rule that implements the Needlestick Safety and Prevention Act. The standard requires hospitals to:
• Use safety devices and needleless systems to reduce the risk of bloodborne pathogen exposures.
• Maintain an exposure control plan and update it annually. The plan must document the consideration of new technology as it emerges and the involvement of frontline workers in device selection.
• Maintain a sharps injury log. The log must include detailed information such as the type and brand of device involved in the needlestick incident. (Needlesticks will become reportable injuries as required by the new record-keeping standard. See "Exposure control plan: Meeting the standard" and "Needlestick record keeping: What OSHA requires," in this issue.)
• Include the input of frontline health care workers who are involved in direct patient care in the evaluation and selection of safety devices.
With this tougher OSHA standard, backed by federal law, needle safety experts expect to see a great improvement in the quality and availability of safer devices. Sharps with "engineered controls" can reduce needlesticks by 80%, according to research by Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville.
However, the battle for safer needle devices is far from over, says Bill Borwegen, MPH, occupational health and safety director of the Service Employees International Union in Washington, DC.
The union and others, such as the American Nurses Association, will be back in state legislatures, trying to pass laws that cover public sector (i.e., state and local) employees. In the states that are regulated by federal OSHA, public employees are not covered; however, seven of the 25 federal OSHA states passed laws that include the public sector.
States with state OSHA plans, which cover public employees, have six months after publication of the new standard to come up with a regulation that is at least as effective. Some already have met that requirement. In all, 17 states have passed some version of a needlestick safety act, many of them with provisions that mirror those in the new federal law.
Meanwhile, Borwegen says he is concerned about the quality of safer devices purchased by hospitals. "Our biggest battle right now is to get hospitals to buy the better safer needles, not the cheapest safer needles." Most health care workers favor devices that don’t require extra steps for activation, such as self-blunting or retractable needles and needleless systems, says Borwegen.
With other products that require the health care worker to activate a sheath or other safety device, needlesticks can actually rise, he says. "Unfortunately, some of the better products are made by smaller companies that don’t have an ability to move into the market because of barriers imposed by group-purchasing organizations."
The union plans to file complaints with OSHA in cases where "where employers are buying what we think are deficient safer needles," says Borwegen.