November 2020 marked the 20th Anniversary of the “Needlestick Safety and Prevention Act” (PL 106-430). The purpose of the NSPA law was to set into place safety-engineered device requirement by employers for all employees that were at risk for bloodborne pathogen exposure. An important aspect of the law was that it required that employers include frontline workers in the device selection, at least an annual review of exposure-control plans so that they had updates in the technologies designed for sharps-safety, and to maintain all details in a sharps-injury log. In addition, the NSPA had a mandate that OSHA (Occupational Safety and Health Administration) incorporate these requirements in a revised edition of the Bloodborne Pathogens standard in 2001.
Bloodborne pathogen transmissions from sharps can cause deadly disease states for those working in close contact. Sharps include any item that has been potentially infected with a bloodborne pathogen that can pierce the skin.
The CDC (Centers for Disease Control) did an analysis on the safety progress of the NSPA by using historical data from multiple hospital sharps injury database that was maintained by University of Virginia’s International Healthcare Worker Safety Center. The data had been voluntarily contributed by U.S. hospitals since 1993 and the analysis chosen encompassed the reports for 1993 through 1995 involving 85 hospitals in 10 states. The data for that time showed 23,908 injuries.
Following the enactment of NSPA there was an immediate 30% reduction in sharps-related injuries in 2001 and continued to show a reduction well-below the rates before NSPA. It’s important to note that NSPA also catapulted a shift in the market to a higher adoption of safety-engineered devices and the development of new technologies.
NSPA offered employers in the healthcare vertical the option of thinking beyond the area of PPE (personal protective equipment) for exposure prevention as well as prompting them to look to methods of eliminating sharps/needles where possible with the substitution of clinical or therapeutic choices.
The data from EPINET® 2019 (Exposure Prevention Information Network) and the Sharps Injury Surveillance System 2018 of the Massachusetts Department of Public Health from U.S. hospitals showed that the devices involved in most sharps injuries were hypodermic syringes and suture needles. Identifying ways to bring in new and safer technologies for frontline worker safety involved the use of delivery systems for oral treatments, drug patches and vaccines via nasal delivery. Other methods were designed for incision closure that included adhesives and zipper closures.
Additional attention was given to the addition of new/more PPE such as face shields, eye protection, respirators and masks to protect workers against fluid splatter from patients.
In 2020 attention was given to the creation of a consensus statement called Moving the Sharps Safety in Health Care Agenda Forward in the United States: 2020 Consensus Statement and Call to Action for the purpose of creating a safer environment for healthcare workers. The statement involves data gleaned from all reported circumstances and injuries involving sharps injuries, the list of controls and measures in place by the facilities for the prevention of exposure and injury, details the OSHA Bloodborne Pathogens Standard requirements, and offers recommendations for healthcare worker protection that is policy-based to be used now and for the future.
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