Infection Prevention

Bloodborne Pathogens Update

William Butter illustrated this early injection device in 1754. Significant improvements have been made since then. New advances have been made in needle designs to protect health care workers.

According to the US Centers for Disease Control (CDC), every year nearly 600,000 healthcare workers in hospital and non-hospital settings sustain skin penetration injuries involving contaminated sharps. The Service Employees International Union (SEIU) believes the total number of sharps injuries exceeds 800,000.

The CDC also believes that selection of safer medical devices such as needles and other sharps could result in prevention of 62-88 % of sharps injuries in hospital settings.

OSHA’s revisions to the Bloodborne Pathogens Standard (29 CFR 1910.1030) can be summarized as follows:

• Includes new examples in the definition of engineering controls, and new definitions.



• Requires that Exposure Control Plans (ECPs) include provisions on reviewing and adopting new safer technologies.
  
  
• Requires employers to seek input from employees in the identification, evaluation, and selection of safer devices and procedures.
  
  
• Requires certain employers to establish and maintain a log of skin penetration injuries from contaminated sharps.

Revisions to the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) took effect on April 18, 2001. President Clinton signed the revisions into law on November 6, 2000 under the Needlestick Safety and Prevention Act. On July 17th 2001, OSHA will begin to enforce the standard. OSHA has long recognized that blood and other potentially infectious materials pose a serious threat to the livelihood of health care workers. Health care workers can be exposed to diseases when their skin is penetrated by needles or broken by other objects (such as bone fragments, scalpels, and suture needles) during patient care. Although health care workers can be subjected to an increased risk of disease from over 20 different infectious agents when injured by sharps, the primary agents of concern are HIV, Hepatitis B and Hepatitis C.

Workers sustaining injuries from sharps must undergo testing to see if a disease has been contracted. Often, the injured health care worker must endure extensive medical treatment. This treatment may include drugs that will inhibit disease transmission. Some of the drugs have serious side effects and can cause health problems. Should testing show a disease has been contracted, costs for treatment can exceed one million dollars in the case of an HIV transmission. The emotional costs to injured employees are staggering, and generally not taken into account.

The revisions to the standard more closely adhere to the UAW Health & Safety Department’s philosophy regarding the hierarchy of controls. Prior to these revisions, the healthcare industry largely relied on instructions, warnings, procedures or work practices to prevent needlestick injuries. This has not been very effective considering the notably high frequency of injuries. The revisions to the Bloodborne Pathogens standard place a greater emphasis on engineering controls rather than relying strictly on procedure or work practices.

Not All Safer Needle Devices Are Created Equal

It is important for health care workers and unions to participate in identification, evaluation and selection of safer needle devices. There are a variety of devices on the market. Each device is different in the manner that safety features are activated. This makes input from front-line health care workers essential in determining which devices are most appropriate for their particular workplace.

The UAW believes that the more advanced safer needles are passive in design, meaning they require less manipulation by the worker to activate the safety feature. Other benefits to passive devices include: less training required to educate users, less change in “technique” or work practices. Examples of better needles incorporate retracting or “self blunting” technology. On the other hand, safer needles with more “active” safety features frequently require workers to put their hand “in harms way” to activate the safety feature.

You will find two forms that can be used to help evaluate safer needles and IV access devices. (Forms are in Adobe Acrobat format (65k) so they can be printed out) These forms should be used in accordance with Exposure Control Plans to gather feedback from employees who are directly responsible for patient care. This way, the safest most convenient devices can be selected.

Costs for safer needle devices can range from a few cents per needle up to 35 cents per needle. However, the benefits of using safer needle devices substantially outweigh the costs for investigating and treating needlestick victims.

The UAW currently represents approximately 15,000 health care workers, in hospitals, clinics, and medical, dental and vision care offices throughout the United States.

For more information on Safer Needles the OSHA Press Release regarding updates to the OSHA Bloodborne Pathogen Standard can be found on the World Wide Web at: http://www.osha.gov/media/ oshnews/jan01/national-20010118a.html OSHA compliance information on prevention of needlestick injuries can be found at http://www.osha-slc.gov/SLTC/needlestick/compliance.html

Checklist: What Local Unions Should Do About The Bloodborne Pathogens Standard Updates
3	Obtain a copy of and evaluate the employer’s “Exposure Control Plan” or ECP for Bloodborne Pathogens. The ECP must be reviewed and updated at least annually or whenever necessary to reflect changes in personnel exposed. When tasks or procedures that would affect exposure are modified the ECP should also be evaluated.
3	Become educated about the safer needle devices on the market. The union can also start by contacting vendors and requesting demonstrations of their products.
3	Become active on the committee set up by the employer to consider safer needle devices.
3	Ensure “employee input” during consideration of safer needle devices by assigning an interested, competent union member to sit on the evaluation committee. The employees involved should represent the range of exposure situations encountered in the workplace.
3	Ensure that the employer does not rely solely on cost as a deciding factor in determining which safer needle devices to evaluate or purchase. The union’s priorities should be: best protection from needlestick, ease of use of the device, and acceptability of the proposed device by the employees affected.
3	Ensure that the employer maintains a “sharps injury” log that tracks all needlestick incidents.
3	Ensure the sharps injury log records information in a manner that protects the confidentiality of the injured employee.
3	Train employees affected by the new Bloodborne Pathogen Standard.

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