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INA Testimony

Protection of Persons Who May be At Risk Of Needlestick Injuries in the Course of Employment

September 21, 2000

Linda Goeldner, Executive Director

On behalf of the members of the Iowa Nurses Association, I am pleased to offer these comments on the issue of protection of persons at risk for needlestick injuries. The Centers for Disease Control and Prevention HIV/AIDS Surveillance Report, June 1999 stated that nurses were the health care workers with the highest documented occupationally acquired AIDS/HIV infections. Registered nurses working at the bedside sustain an overwhelming majority of these exposures compared with other health care workers. Needlesticks are preventable.

The American Nurses Association (ANA) has embarked on an extensive campaign to educate nurses at the national and state level about a safer workplace. Their educational project is called " Safe Needles Save Lives". The American Nurses Association has educated registered nurses about their right to a safer workplace and the importance of registered nurses participating in the effort to evaluate, select and implement safer needle devices. The educational project also works with state nurses associations to negotiate contracts that mandate employers provide safe needle devices and to ensure additional financial support to RNs who have sustained accidental needle sticks. At the national level, ANA has worked with members of Congress to craft the Health Care Worker Needlestick Prevention Act, which was introduced in the U.S. House and Senate in May 1999. Due to ANA’s efforts, the Occupational Safety and Health Administration (OSHA) has added needlestick prevention to its agenda. ANA is pressing OSHA to mandate that all medical facilities use safer devices.

Although AIDS is a significant risk, the greatest risks to nurses are hepatitis B and C viruses (HBV and HCV). Since the first Bloodborne Pathogen Standard issues in 1991, tremendous progress has been made to protect health care workers. Yet more than 1,000 infections caused by 20 pathogens are estimated to be transmitted through sharps or needlestick injuries annually. One in six of those 1,000 contamination’s stems from HBV, one in 20 from HCV and one in 300 from HIV. Post-exposure prophylaxis guidelines call for treatment with antiviral medications "within a few hours" following the needle stick. Formal reporting of the incident is also essential since it is estimated that only 10% of all needlestick injuries are recorded on OSHA 200 logs, which chronicle and classify incidents of occupational injuries and illnesses. (The current guidelines for reporting exposures on the OSHA 200 log is that treatment is required, so it currently does not keep track of all needlesticks, just those resulting in treatment.)

According to the Centers for Disease Control, up to 86% of needlestick injuries can be prevented with safer needlestick devices. Advances in engineering controls have made it possible to eliminate sharps from many uses and to have blunted or retracted needles or sharps when the sharps cannot be eliminated. Placing sharps containers within reach and at eye level in every patient room also reduces the risk of injury that could be prevented.

We believe RNs need to be active on several levels. We encourage RNs to review needlestick injury data in their facility and ask questions like: In what areas have needlestick injuries increased and where has there been a decrease? Have nurses and other health care workers been reporting injuries? Can an RN or other health care worker receive support including immediate evaluation for postexposure prophylaxis? What is being done to reduce the injury rate?

Our national and state association holds the following positions:

1. The American and Iowa Nurses Association are making an effort to educate nurses regarding the dangers of hollow bore needles, protective behaviors individual nurses can use to prevent injuries, how to evaluate, select and implement safer devices and provide post-exposure follow-up and treatment.

2. The American and Iowa Nurses Associations are interested in collaborating with other interested parties and support initiatives to: 1) decrease or eliminate accidental injuries from hollow bore needles, 2) increase reporting of hollow bore needle stick injuries, and 3) track disease transmissions from patient to worker.

3. The American and Iowa Nurses Associations strongly encourage registered nurse participation on employer purchasing and product evaluation committees and that all available engineering controls (not just those available through Group Purchasing Organizations) be considered when decisions are made regarding personal protective equipment and workplace controls that may enhance worker safety.

4. The American and Iowa Nurses Associations support a safe work environment and provisions for public sector employees not covered by the Occupational Safety and Health Administration (OSHA) regulations. We support involvement of frontline workers in identifying and evaluating safe needle devices; having employers provide training on the proper use of safe devices and ensuring that all needlestick and sharps injuries be reported to OSHA. (This includes physicians, resident physicians and dentists, as well as registered nurses.)

5. The American and Iowa Nurses Associations urge institutions and agencies to develop post-exposure follow-up protocols with provisions including testing, medications, counseling and support as needed and/or as indicated by established Centers for Disease Control (CDC) recommendations.

6. The American and Iowa Nurses Associations support national legislation (H.R. 1899 and S.1140). These bills would amend the federal OSHA’s bloodborne pathogens standard to require all health care facilities to use needles and sharps with engineered protections such as retractable needles and that employers seek input of direct health care workers who use the technology to ensure appropriate system selection. Additionally support is given to the U.S. Department of Health and Human Services to promulgate new regulations in the Medicare Conditions of Participation for those hospitals not covered by OSHA so all hospitals would in effect be covered by these new bloodborne pathogens requirements.

Our membership would like to see all hospitals, nursing homes and other health care facilities move to needleless or safe needle device systems, however, our membership is sensitive to the costs of implementing these systems. Some nursing staff of Iowa’s rural hospitals have been utilizing "needleless"/safe needle device systems for as long as three years, some are still exploring with vendors. There is a balance of cost issue in the policy debate. There is national data, which identifies that safe needle systems cost 28 cents per unit more than standard devices. While this adds to the organization’s expense, this cost must be balanced by the cost incurred when a registered nurse or other health care provider is stuck and no infection occurs, which is an average national cost of treatment of $3000. When an infection does occur, the cost of treatment can rise to as high as $1 million. The past president of the Massachusetts Nurses Association is a testimonial to the after effects of an unsafe needlestick resulting in her contracting HIV and HBV. She has had to quit work and take 21 pills daily along with suffering emotional trauma. She and staff of the American Nurses Association have worked extensively with manufacturers of safe needle devices to enhance education of nurses and other health care providers.

Our association is supportive of the national legislation and the Medicare Conditions of Participation proposed rule changes to move employers toward safer workplace conditions. We support the position that all employers, both public and private, should adopt safe needle systems. The Iowa Nurses Association supports this change occuring in stages in Iowa where hospitals, nursing homes, home health agencies and public health nursing agencies are among the lowest paid in the nation for the patients that are served. We support employers working with nursing staffs to select appropriate systems that protect the health of the nurse in Iowa’s highly cost-sensitive environment.