It has been four years since the Needle Stick Safety and Prevention Act was signed. Are health care workers any safer? And what more can I do to make my workplace safer?
Health care workers are exposed to blood-borne pathogens primarily through contaminated needle-stick and sharps injuries. Every year, health care workers experience an estimated 600,000 exposures to blood, according to the Centers for Disease Control and Prevention (CDC), with RNs sustaining an overwhelming majority of them.
Every needlestick and sharps injury carries a risk of infection from blood-borne pathogens such as HIV and HCV. Research has shown that the design of needle and sharps devices can increase the risk of injury, and current data suggest improvements in the design and distribution of equipment had decreased the number of needlestick injuries. More than 80% of needlesticks can be prevented with safer needle devices; when used in conjunction with worker education and work practice controls, injuries can be reduced by more than 90%.
The federal Needle Stick Safety and Prevention Act was signed into law in November 2000 and became effective in April 2001. Its passage was part of an effort by the ANA to amend the federal Occupational Health and Safety Administration (OSHA) Bloodborne Pathogens Standard. The law now requires the following.
* Engineering controls: the use of safer medical devices, such as sharps with engineered sharps injury protection and needleless systems.
* Frontline health care worker involvement and training requirements: the direct involvement of frontline health care workers (nonmanagerial employees responsible for direct patient care) in device evaluation and selection.
* Exposure control plan: written and updated at least annually with a hard copy made available to employees or their representatives within 15 working days of request.
* Other control measures: provide the hepatitis B vaccine to employees at no cost; access within two hours to postexposure follow-up that conforms to CDC guidelines for testing and prophylaxis; and gloves, masks, and other barrier equipment.
* Recordkeeping: maintain a sharps injury log updated regularly with the details of all needlestick injuries, including date, place, situation, and device brand and type.
Key achievements include requiring the use of devices with safer designs and involving front-line workers in selecting devices. California's 1998 needlestick laws led to the passage of the federal Needle Stick Safety and Prevention Act of 2000, and states continue to introduce legislation to strengthen needlestick protections.
While federal and state laws are successful, they don't ensure protection for health care workers. Two recent studies show uneven implementation of federal and state laws that require safer devices and education. A national sample survey of how hospitals were adopting safer needlestick programs found inconsistent implementation throughout health care. A California study found that almost 90% of all facilities expressed a need for educational materials and on-site training to help evaluate and select devices.
These examples show that much improvement is needed to ensure that workplaces institute necessary protections. Recognizing the need to protect state hospital employees not covered by the federal OSHA Blood-borne Pathogens Standard, the ANA worked to get legislation that now covers all hospital workers through the Medicare Prescription Drug Improvement and Modernization Act of 2003.
Recent evidence has revealed a 51% reduction in percutaneous injuries when safer devices are used. Nurses must be firm in demanding the protections they are entitled to by law-it's imperative that frontline workers become involved in their own work settings to determine how and which devices are selected, as well as who is selecting them. Also, nurses must insist on proper training and tools to ensure successful and safe care for patients and health care workers. For resources about needlestick and sharps injury safety and prevention, visit the ANA's Web site at http://www.needlestick.org.