Federal needlestick legislation introduced
•Safeguard specifics
•Important Step Forward
•OSHA approach
•Not the first effort
The effort to provide healthcare workers with safe needle devices gained momentum recently when legislation mandating the use of these systems was introduced into the U.S. House of Representatives.
At the same time, the Occupational Safety and Health Administration (OSHA) is moving to reduce the number of injuries healthcare workers get from needles and other sharps that potentially carry bloodborne illnesses.
On May 20, Representatives Pete Stark (D-CA) and Marge Roukema (R-NJ) introduced the Health Care Worker Needlestick Prevention Act of 1999 (H.R. 1899). The bill would amend OSHA's bloodborne pathogens standard to require that employers use needleless systems and sharps with engineered sharps protections to prevent the spread of bloodborne pathogens.
"While states are stepping to the plate to address this pressing concern, this is a national crisis and it deserves a national solution," said Stark in a statement. To date, three states, California, Maryland, and Tennessee have enacted needlestick legislation, with legislation introduced into 15 other states plus the District of Columbia (see map), according to the American Nurses Association. In September 1998, California became the first state to pass legislation to protect workers from accidental needlesticks. The current legislation is modeled after the California law.
Estimates of needlestick injuries range from 590,000 to one million annually.
The legislation provides for the following, according to a summary of the bill provided by Stark's office:
- Exposure control plan.Employers would develop written exposure control plans to identify and select existing needleless systems and sharps with engineered sharps protections and other methods of preventing the spread of bloodborne pathogens.
- Sharps injury log.Employers would be required to keep a log containing detailed information about sharps injuries.
- Training.Employers would have to adequately train health care workers on the use of needleless technologies and systems.
- National clearinghouse.The bill would establish a clearinghouse within the National Institute for Occupational Safety and Health (NIOSH) to collect data on safety technology.
- Application to Medicare hospitals.Health and Human Services would promulgate new regulations regarding conditions of participation in Medicare for hospitals not covered by OSHA so that all hospitals across the country would be covered by the new bloodborne pathogen requirements.
- Exceptions.The bill provides for an exceptions process if an employer can demonstrate circumstances in which the technology:
- doesn't promote employee safety
- interferes with patient safety
- interferes with the success of a medical procedure
- isn't commercially available in the marketplace.
"Passage of this legislation would be an important step forward in addressing a serious problem that health care workers face," says Patti Tereskerz J.D., Ph.D., assistant professor of Neurosurgery and director, Health Law and Policy at the University of Virginia's International Health Care Worker Safety Center.
Tereskerz, points out, though, that the legislation's ability to enhance safety will ultimately depend on whether it is able to influence the supply and demand of safety devices.
Workers' compensation laws, she points out, usually have an exclusive remedy provision that precludes employees from bringing private suit against an employer to recover damages for an occupational disease, unless excepted. If legislators included language that would create a right of the injured employee to bring private suit and to be excepted from the exclusive remedy provision, she says, employers would have a significant monetary incentive to invest in safety devices.
The bill has the support of the American Nurses Association, which says it worked to help craft the bill. "It is unconscionable that there are safety devices available, yet they're not being provided to health care workers," says ANA president Beverly Malone, RN, PhD, FAAN.
The American Hospital Association (AHA) , however, takes a different stance. Jonathan Lord, M.D., chief operating officer of the AHA, calls the bill "well-intentioned but unnecessary" in a statement. "OSHA already has the authority (under the current Bloodborne Pathogen Regulation) to accomplish what the bill sets out to do," the statement says. "We'll continue to work with OSHA to ensure appropriate flexibility for caregivers when it comes to deciding what's best for patients and workers."
Tom Nickels, AHA senior vice president for federal relations, is quoted in an AHA News Now Web site story as saying that the legislation is "overly prescriptive." He added that it writes into law what should be done in regulation.
Apart from the Congressional effort, OSHA is pursuing a three-pronged approach to help minimize the risk of occupational exposure to bloodborne diseases due to needlesticks:
- According to a press release, the agency already proposed a requirement in the revised Recordkeeping Rule that all injuries resulting from contaminated needles and sharps be recorded on OSHA logs, used by employers to record injuries and illnesses. Final action in the rulemaking, which will be based on OSHA's evaluation of the public rulemaking record, is scheduled for this fall.
- OSHA will revise the bloodborne pathogens compliance directive later this year to reflect the newer and safer technologies available. The directive is used by OSHA's compliance officers to enforce the agency's bloodborne pathogens standard, OSHA says.
- The agency will take steps to amend the bloodborne pathogens standard by placing needlestick and sharps injuries on its regulatory agenda this fall.
Secretary of Labor Alexis M. Herman says OSHA's action stem in part from a report that summarizes nearly 400 comments from health care facilities, workers and others who responded to the agency's request for information last fall. At that time, OSHA asked for ideas and recommendations on ways to better protect workers from contaminated needles or other sharps.
In its review of the comments, OSHA found that a variety of safer devices exist that can protect workers from needlestick and sharp injuries; however, these devices are not being used widely enough to substantially reduce the hundreds of thousands of injuries each year, OSHA says.
Further, the report notes that training and education in the use of safer medical devices and safe work practices have proven effective in preventing exposures. Finally, responses indicate that staff involvement in the selection process plays an important role in the acceptance and proper use of safer medical devices.
In a sign of OSHA support for the legislation, Charles Jeffress, OSHA administrator, says that he wants to publicly acknowledge the Stark-Roukema legislation. He also says he would "welcome the opportunity to work with all members of Congress on how to better protect health care workers from these potentially deadly problems."
Congress has seen at least two previous efforts to legislate needlestick safety. One, a bill introduced in 1997, would have required hospitals to use approved hollow-bore needle products as a condition of participation in Medicare. Another, a 1993 effort, would have imposed an excise tax on sales of syringes and intravenous systems that didn't meet antineedlestick prevention standards.
Among the organizations endorsing the current bill: the Emergency Nurses Association, Kaiser Permanente, the American Federation of State, County and Municipal Employees, the Service Employees International Union, the American Federation of Teachers, and Becton Dickinson.