Needlestick prevention bill includes
new workplace rules
The measure is expected to help guard physicians
againstinjuries but also adds regulations for them to
By Geri Aston, AMNews staff. Nov. 13, 2000.
Washington -- Each year 600,000 to 800,000 health
care workers, including many physicians, are accidentally stuck by
contaminated needles or other sharp objects. A bill that recently
passed Congress aims to reduce that number.
The measure requires employers, such as hospitals
and physician groups, to study and implement the use of medical
devices with safety features in their facilities and offices where
appropriate, effective and available. They must document annual
evaluation and adoption of safer medical devices, such as needleless systems or equipment with "sharps injury
Physicians are second only to nurses in the ranks
of health care workers injured by needles and other sharp objects.
These wounds put physicians and other health care workers at risk of
HIV and hepatitis B and C infection.
Resident physicians are at particularly high risk
for exposure to patients' blood or body fluids through punctures or
splashes, said Emilie Osborn, MD, a family physician at the Palo
Alto Medical Foundation in California. "There is pressure to do
things and act as though they know how to do things that they don't
know how to do, "said Dr. Osborn, who authored a study on the
subject published last year.
Although some hospitals are models of health care
worker safety, "most are not complying or complying marginally"
with federal rules designed to reduce needlesticks, said June Fisher, MD, associate
clinical professor of medicine at the University of California at
"At private physician offices, they either don't
know anything about [occupational safety] or they want to ignore
it," she said.
The legislation, expected to be signed by President
Clinton, builds on and strengthens a directive the Occupational
Safety and Health Administration issued to its inspectors in
November 1999. It requires employers in the health care field to
include frontline workers, such as physicians and nurses, in the
selection of safer devices.
This requirement is "vital," said Samuel Hughes,
MD, professor of clinical anesthesia at the University of California
at San Francisco.
"Those people are able to judge what equipment will
work and be safer," said Dr. Hughes, who chairs an infection
control task force for the American Society of Anesthesiologists'
occupational health panel.
This input also is necessary to ensure that
physicians and others use the new, safer equipment, said Jane Perry,
spokeswoman for the International Health Care Worker Safety Center
at the University of Virginia Health System. "Unless you get health
care worker buy-in, you can get all the safety devices you want, but
health care workers won't use them. They'll just sit on the shelf."
The bill, sponsored by Rep. Cass Ballenger (R,
N.C.) and Sen. Jim Jeffords (R, Vt.), also requires health care
employers to keep a log of all injuries caused by needles or other
sharp equipment. This provision applies only to employers with more
than 20 workers.
The log must include the type and brand of device
involved in the incident,the work area where the exposure occurred,
and an explanation of how the injury happened. The goal is to
identify patterns to determine which work areas have a high risk of
exposure; where new, safer devices might be needed; and where
employee training might be necessary.
Physicians have some concerns about how the bill
might be implemented if it becomes law.
For example, it is important that physicians and
other health care workers be allowed to choose between the old
versions of devices and the new, safer ones, Dr. Hughes said. In
some cases, the older device might be better for the patient, he
Dr. Hughes gave the example of when a physician
must administer a difficult, emergency IV. The old, familiar
equipment might be easier and quicker to use than new, safer
technology, he said.
Physicians and safety experts also note that the
legislation alone will not eliminate needlesticks.
"Safe needles are an improvement, but they don't
make up for [inadequate] training or bad technique," said J. Chris
Hawk III, MD, a member of the AMA Council on Scientific Affairs.
Many physicians believe that devices that enhance
health care worker safety interfere with patient care, Dr. Fisher
said -- a view that stems from a lack of training.
Some physicians and safety experts worry that more
education needs to be done to bring physicians up to speed on safety
technology, existing OSHA rules and the new requirements the bill
Dr. Fisher argues that self-retracting devices that
make injections and blood withdrawal safer already exist and can be
used effectively and without much added cost in physician offices.
But many physicians aren't familiar with the technology, she said.
Medical societies and the federal government have
not done enough to inform physicians of federal requirements,
Dr. Hawk said. "Doctors don't read the Federal Register," he added.
Physicians in small practices are likely to view
the new rules as "an additional burden," said Bruce Bagley, MD,
chair of the American Academy of Family Physicians. However, he
added, "if it's truly an improvement, then most physicians would
want to do it."
Workers at risk
Hundreds of thousands of health care workers are
exposed to patients' blood or body fluids each year, putting them at
risk for contracting HIV and hepatitis. Most exposures in hospitals
result from punctures by needles or other sharp objects:
Needle or sharp object 83%
Mucous membrane 13%
Chances of injury are high
Only nurses are more likely than physicians to be
exposed to patients' blood or body fluids in hospitals. Of those
Clerical/administrative staff 1%
Source: National Surveillance System for Hospital
and Health Care