MASSACHUSETTS NURSE NEWSLETTER :: January/February 2004

Pathogens and the use of safe needle devices

By Evelyn I. Bain, M Ed, RN, COHN-S
Associate Director/Coordinator, Occupational Safety and Health Specialist
Printed in the Jan./Feb. 2004 issue of the Massachusetts Nurse Newsletter

Are nurses and others in your hospital protected—according to law—from exposure to blood and body fluids? Is your hospital in compliance with the OSHA Bloodborne Pathogens Standard (1910.1030) by providing safe needle and sharp devices?

Recently, Public Citizen reported on a letter written on behalf of the Montefiore Medical Center urging the American Hospital Association (AHA) to contact all AHA-affiliated hospitals alerting them to the fact that their hospital was cited and fined for failure to comply with the OSHA Bloodborne Pathogens Standard. Also outlined in the letter was the Montefiore Medical Center's belief that many hospitals still do not provide safer alternatives to many of the (needles and sharps) devices currently used in U.S. hospitals.

OSHA found 46 instances of unsafe practices under the Bloodborne Pathogens Standard (OSHA 1910.1030) in this one hospital alone. These unsafe practices included, "needles and sharps without engineering controls used for administration of intramuscular injections, central line blood drawing and flushing, the placement of central venous catheter lines, scalpels used for incision and drainage, chest tube insertions, etc., etc., etc."

But the Montefiore Medical Center is not alone. Across the country OSHA is finding that similar conditions exist in many of the hospitals they inspect. From September 2001 to September 2002, OSHA cited 1,339 violations of this standard in 408 hospital inspections, and the hospitals were fined close to $70,000.

What are the OSHA requirements? Simply stated, "Employers must implement the safer medical devices that are appropriate, commercially available and effective, and get input from those responsible for direct patient care in selecting these devices." In addition, the employer must maintain a log of injuries to workers that result from contaminated sharps. More details are available at www.osha.gov; select e-tools on the right menu; select hospitals; review information on the Bloodborne Pathogens Standard, which includes a list of all the requirements that hospitals must meet.

Engineered safety devices, blunt suture needles, retracting needles and scalpels, needleless systems and other devices are now available due to the demands of the market. Medical sales representatives can identify devices from the manufacturers they represent that meet the OSHA requirements. Alternative sources for information on device selection also exist, including: EPINET at epinet@virginia.edu and the Sustainable Hospitals Project at the UMass Lowell at www.sustainablehospitals.org.

By now, fully three years after this law was signed into effect, your hospital should have made the commitment to develop and support a "committee that includes management and frontline health care workers to select and trial safety devices. This committee should also oversee implementing the use of these devices, through training and education of all staff members who will use them." Finally the committee should continue the process of reviewing and reevaluating devices (some do not perform as expected), as well as newer products that come to the market. The activities of this committee should also include reviewing needlestick injury data to identify areas where injuries continue. This will insure that safer devices and work practice controls will be implemented.

If this is not happening at your hospital, then call your local OSHA office to discuss your concerns and the options available to ensure safe and healthful working conditions in your hospital. To contact the OSHA office nearest your hospital, go to the U.S. government pages in your telephone book and look under the listing for U.S. Department of Labor and/or OSHA, or visit www.osha.gov.

OSHA is interested in hearing from you, as injuries to nurses and other health care workers have become more frequent than injuries to workers in any other industrial sector.

Note: MNA members who are concerned that they are still using unsafe needles and sharps should contact their bargaining unit chairperson and/or Evie Bain or Chris Pontus at the MNA. (See contact information.)

Submitted to the Journal of Emergency Nursing. Reprinted with permission.