Needlestick prevention bill includes new

                                                    workplace rules

GOVERNMENT & MEDICINE

                 The measure is expected to help guard physicians against

                 injuries but also adds regulations for them to follow as

                 employers.

                 By Geri Aston, AMNews staff. Nov. 13, 2000. Additional information

                 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 protections."

                 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 San Francisco.

                 "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 added.

                 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 would create.

                 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."

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                 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%

                    Skin                      3%

                    Bite                      1%

                 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 exposed:

                    Nurses                          44%

                    Physicians                      30%

                    Technicians                     13%

                    Housekeeping/maintenance         3%

                    Students                         3%

                    Clerical/administrative staff    1%

                    Researchers                      1%

                    Dental                           1%

                    Others                           4%

                 Source: National Surveillance System for Hospital and Health Care

                 Workers

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