States begin passing sharps and needle-stick legislation to protect health care workers - Statistical Data Included

AORN Journal, Oct, 2000 by Kimberly Matson

Sharps injuries are wounds caused by sharp instruments accidentally puncturing the skin.(1) Each year, health care workers report between 600,000 and one million sharps injuries, and it is suspected that approximately 70% of sharps injuries go unreported. The Occupational Safety and Health Administration (OSHA) estimates that, of the sharps injuries reported in the United States annually, approximately 2% (ie, 16,000) of these devices were likely to be contaminated with HIV.(2) Currently, more than 54 cases of occupationally acquired HIV have been documented.

The most frequent infection resulting from sharps injuries is the hepatitis C virus (HCV). Of health care workers who are infected with HCV, 85% become chronic carriers of the virus and risk spreading the disease to others, including their partners. Hepatitis C may lead to liver cancer, liver transplantation, and liver failure.(3) Another virus commonly acquired by health care workers via sharps injuries is hepatitis B. In 1992, the Centers for Disease Control and Prevention (CDC) estimated that 6,800 nonvaccinated health care workers in the United States become infected with the hepatitis B virus each year. Of these, 250 are hospitalized as a result of acute complications, and approximately 100 die from cirrhosis, liver cancer, or fulminant hepatitis.(4) Injuries caused by sharps can result in the transmission of many other diseases, viruses, bacteria, fungi, and microorganisms as well.

Registered nurses, on average, sustain 50% of all sharps injuries. Up to 80% of such injuries can be prevented through the use of safe-needle devices. Unfortunately, less than 15% of US hospitals currently use such devices--many health care facilities blame the high cost of these devices.(5) Although safe needles cost approximately $.28 more per device than standard devices, the cost of treating a sharps injury is significantly higher. Health care facilities can expect to pay approximately $3,000 per sharps injury for high-risk exposure follow-up, even when no infection occurs.(6) The cost soars to more than $1 million for a case of serious infection. The consequences of occupational exposure to bloodborne pathogens include not only infections, but also psychological trauma, postponement of childbearing, altering of sexual practices, side effects from prophylactic medications, infection, chronic disabilities, loss of employment, denial of worker compensation claims, liver transplantation, and premature death.(7)

FEDERAL POLICY

The issue of health care worker sharps injuries came to the public eye in the mid 1980s and early 1990s, primarily as a result of reported AIDS and hepatitis cases occupationally contracted by health care workers. Although guidelines for the recapping of needles and sharps disposal were in place, increased awareness and the potential for downstream injuries to patients and housekeeping workers precipitated OSHA to issue its bloodborne pathogen standard in 1991. This standard, developed to protect health care workers from bloodborne pathogens, calls for universal precautions to educate, prevent, reduce, document, and treat needle-stick and sharps injuries arising from contact with bloodborne pathogens and other infectious materials.(8)

In 1998, regulators and legislators took serious notice of the effect of sharps injuries. Thanks to the ongoing efforts of health care employee labor organizations and improved documentation of sharps injuries, legislators and regulators began enacting state laws and issuing compliance directives requiring revision of the bloodborne pathogen standard to more definitively address needle-stick and sharps injuries.(9)

On Nov 5, 1999, OSHA issued a compliance directive that provides instruction to OSHA inspectors on how to apply the bloodborne pathogen standard when conducting an inspection. This directive gives inspectors guidance on how to cite employers for failing to evaluate, purchase, and implement safer needle devices and also gives inspectors the authority to issue citations.(10) On Nov 22, 1999, the National Institute for Occupational Safety and Health (NIOSH) published an alert, "Preventing needle-stick injuries in health care settings." Unlike the compliance directive, employers are not required to adhere to the alert--NIOSH has no enforcement power. The alert, however, can help employers develop a needle-stick prevention program that adheres to OSHA's compliance directive. To order a free copy of the alert, call (800) 35-NIOSH and request publication number 2000-1087.(11)

The bloodborne pathogen standard and OSHA's 1999 compliance directive only cover employees in the private, nonprofit or, for-profit health setting or public employees in the 25 states that have been certified by OSHA to have a state plan. The compliance directive is a step forward in the battle to protect the health and safety of health care workers, but the compliance directive does not

* cover public employees (except in the 25 states with certified OSHA plans);