CHICAGO—Needlestick and similar percutaneous injuries are common: An estimated 800,000 such incidents occur annually among health care workers. To help address this problem, the Council on Scientific Affairs of the American Medical Association (AMA) has released a report on the prevention of needlestick injuries in health care settings.[1]

“Physicians should … know that federal law requires health care employers to keep very accurate records on needlesticks,” council member J. Chris Hawk, III, MD, told PULMONARY REVIEWS. Other federal regulations call for an annual review of bloodborne pathogen exposure control plans to ensure that they reflect technological improvements in needle device design, he said.

NEW SAFETY DEVICES

Caregivers may suffer needlestick injuries when giving injections, drawing blood, or recapping or throwing out needles. The injuries occur mainly with syringes containing hypodermic or winged-steel needles. These hollow-bore needles are most often associated with bloodborne pathogen transmission because they are most likely to harbor blood or bodily fluids after use, the report warns.

Self-blunting needles, hinged needle guards, needle shields, and safety intravenous (IV) catheters that enclose the needle after use are among the devices available to prevent needlestick injuries.

Syringes with retractable needles are remarkably effective in preventing injuries, the report states. Needleless IV systems are also quite good for that purpose, especially with regard to needlestick injuries from IV connectors. Use of needleless IV systems should be carefully considered, though, because some data suggest that IV lines are unlikely to transmit bloodborne pathogens but the needleless systems may pose a risk of bacterial contamination when used improperly.

WELL WORTH THE COST

The Occupational Safety and Health Administration (OSHA) reports that health care employers may be reluctant to use needlestick prevention devices because of the higher price and the cost of educating employees about proper use. However, these devices are well worth the added expense, recent data strongly suggest.

In a cost-analysis study comparing a $0.50 retractable needle to an $0.08 conventional needle, for example, the former yielded a $0.25-per-needle savings.[2] After associated costs for needlestick injuries, preventive measures, and disposal were factored in, the total cost of the retractable needle was $0.60 versus $0.85 for the conventional one. It has been conservatively estimated that health care employers nationwide could save more than $100 million annually by using safety needles, the council’s report states.

NEEDLESTICK MANDATES

Since 1992, OSHA has required employers to purchase safer needle devices as they become available. The agency recently completed a congressionally mandated revision of its November 1999 compliance directive on bloodborne pathogens that requires health care employers to review and update written bloodborne pathogen exposure control plans.[3,4] Under the revised directive, health care employers with 11 or more employees must also keep a sharps injury log and involve the employees who provide direct medical care in the selection of safer medical devices. OSHA has begun an outreach program—in partnership with other federal and state agencies, associations, and labor organizations—to educate employers, health care workers, and the public about these revisions.

OSHA’s revisions to its compliance directive were mandated by the Needlestick Safety and Prevention Act of 2000, a federal law requiring the use of safety-engineered sharps devices to protect health care workers from needlestick injuries. Proponents of this legislation argued that its passage would make it easier for OSHA to enforce compliance with its regulations. Similar legislation has been enacted in 17 states and is in various stages of development in six other states and the District of Columbia.

—Timothy Begany

References
1. Tan L, Hawk JC 3rd, Sterling ML. Report of the Council on Scientific Affairs: preventing needlestick injuries in health care settings. Arch Intern Med. 2001;161:929-936.

2. Wilner NA. Using a value chain approach for effective decision making. J Healthc Resour Manag. 1997;15:20-23.

3. Occupational Safety and Health Administration. OSHA Instruction CPL 2-2.44D: Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens. Washington, DC: OSHA Directorate of Compliance Programs; 1999.

4. Occupational Safety and Health Administration. Revisions to OSHA’s bloodborne pathogens standard: technical background and summary.Available at: http://www.oshalpha-slc.gov/needlesticks/needlefact.html. Accessed June 7, 2001.