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Needlesticks – Frequently Asked Questions

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Needlesticks – Frequently Asked Questions

Needlesticks are categorized as one of the sharps injury types. Sharps are any item that can pierce the skin and has the potential to transmit dangerous and/or deadly diseases. While needles are used in the healthcare environment, they are also used in several other business types. A needlestick injury can cause exposure to bloodborne pathogens due to an accident. Those involved with needles as part of their occupational exposure have a higher risk of needlesticks through use and disassembly.

Needlestick injuries can result in infection and exposing an individual to such diseases as hepatitis B, hepatitis C, HIV (human immunodeficiency virus) and others. With over 18 million healthcare workers in the U.S., the potential for needlestick injuries without safety precautions would continue to grow. In the last 20 years, there has been a serious focus on the topic of needlesticks which has resulted in new laws, updated and safer technologies and alternative therapies to replace needles as the main delivery method.

What types of Disease are Transmitted with Needlesticks?

Injuries involving needlesticks can transmit bacteria, viruses, and fungi. Any worker that has an occupation involving needles can be potentially exposed to many disease states including but not limited to:

The Needlestick Safety Prevention Act: What is it?

The NSPA (Needlestick Safety Prevention Act) (Pub L. 106-430) was enacted on November 6, 2000 to offer more specific details for the safety and prevention of needlestick injuries. Accidents due to sharps injuries in healthcare and other settings that involved the use of needles presented serious problems in the potential to expose bloodborne pathogens. NSPA was established to address the needlestick situation and was required to be added to the existing Occupational Safety and Health Administration’s “Bloodborne Pathogens Standard.” NSPA requires that employers of any facility that uses needles must identify, evaluate, and implement medical devices that are safer. In addition, NSPA requires that employers maintain a sharps injury log that has all details about any sharps injury incident and that non-managerial healthcare workers must be involved in the evaluation and selection of the devices.

How is the NSPA applied to the OSHA Bloodborne Pathogens Standard?

Part of the NSPA is a direct requirement for the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) to revise the standard to include the details of the NSPA. The revision was published on Jan. 18, 2001 in the Federal Register and took effect on April 18, 2001. An initial outreach and education effort was instituted for a 90-day period for OSHA staff and the public as part of a review process before implementing any enforcement of the new requirements. OSHA did not begin enforcing any of the new standard provisions until July 17, 2001, which included the requirement of a sharps injury log by employers and involvement of non-managerial staff to review and select new devices. It should be noted that the 1992 law included the requirement to implement the use of engineering controls including medical devices that were safer.

In What Ways Does the NSPA revision Affect States that have their own OSHA programs that are federally approved?

To be a federally approved State OSHA program, the state or territory must comply with all federal OSHA guidelines including the Bloodborne Pathogens Standard and any revisions or put in place amendments to their existing standards that are more stringent that comply with the requirements. The original requirement for compliance or change was July 18, 2001, with an additional 3-months to allow for the 90-day education campaign that was federally established. At this time, all states or territories should have made changes to existing plans or have adopted the federal NSPA revision.

Does the NSPA standard apply to State and Local Government employees (public sector)?

State and local government employees, also listed as public sector employees are not required to follow Federal OSHA standards, however, those states and territories that have OSHA-approved state plans (24 states and 2 territories), are required to enforce “at least as effective” standards in the public sector.

What is the Date for Implementation of Safer Medical Devices?

The original 1991 Bloodborne Pathogens Standard included safer medical devices, however, there is further clarification in the revised version regarding the term “engineering controls.” The additional details in the revision reflected the definition of development and availability of safer and newer medical devices. The original 1991 verbiage stated, “engineering and work practice controls shall be used to eliminate or minimize employee exposure.” The revised version defines engineering controls as “controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace.” The date for compliance has already passed. If a facility or location does not have safer devices in place they need to evaluate and implement them now. In addition, employees that have occupational exposure to blood or OPIM (other potentially infectious materials) are required to be trained for the proper use and safety of all engineering and workplace controls.

How Do I know If the “Needlestick Safety and Protection Act” Applies to Me?

All employers that have staff that have reasonably anticipated occupational exposure to blood or OPIM are required to comply with OSHA’s Bloodborne Pathogens Standard that includes the 2001 revisions. Employers are the ones required to comply with implementation of the requirement details that are included in the standard. There are provisions that have been clarified that pertain to healthcare activities and others, specifically those that pertain to updating the Exposure Control Plan and maintaining a sharps injury log that may pertain to healthcare activities as well as non-healthcare.

Do I Need to Use Safer Devices even if I have never had an employee that had a needlestick injury?

Yes. The OSHA standards were created as a method to prevent the needlestick injuries and illnesses. To maintain an effective environment to avoid the kinds of injuries received from needles and sharps that may be contaminated, employers need to implement safer devices as part of the engineering controls.

Who Would I Report a Needlestick Injury to?

There should be a posted list of emergency contacts in case of injury that the employer is responsible for. Get immediate medical advice to reduce the risk of infection. If there isn’t a list of emergency contacts, contact your employer and/or call your GP, NHS 111 or go to the nearest accident and emergency department.

What is the number of non-managerial staff are needed in the review and selection of safer medical devices?

The number of non-managerial employees involved in the review and selection of safer medical devices depends on the size of the facility and the overall governing attitude of operation. In smaller environments, the feedback from all staff might be of interest in making the choices. However, larger organizations may choose some from various departments and exposures. Both the outreach process and the input process must be included in the documentation of the Exposure Control Plan.

Is there a List of Safer Medical Devices that OSHA can Recommend?

No. OSHA isn’t involved in either endorsement or approval of any products. It is the responsibility of the employer to make the determination of which engineering controls are the best for your organization based on the specific hazards, types of medical procedures conducted, and what is both feasible and available commercially.

What Should I do if the Medical Device that I use doesn’t Have a Safer Option?

The point of the NSPA is to make sure that the medical device used is appropriate for effectiveness and the procedure, but also for market availability. If in reviewing an employer finds that there isn’t any option that is safer for a medical device that is involved in blood or OPIM exposure, the employer isn’t required to use an alternative that might not normally be used. Part of the review process involves the requirement of asking about new or prospective safer choices and this information must be documented as part of the written Exposure Control Plan. Continued pursuit as new and safer devices become available for various procedures is required. If there continues to be no available engineering control, additional work practice controls should be implemented. In a condition where occupational exposure is still in existence PPE (personal protection equipment) must also be used.

What Should I do if the Safer Medical Device is not Immediately Available or is On Back Order?

There should always be safety equipment available, on the location, always. In the case where the engineering control is not available due to shipping delays, back orders or shortages in supplies, this information is required to be documented in the employer’s Exposure Control Plan. It is the responsibility of the employer to implement the control(s) selected as soon as they are available and make the changes in the Exposure Control Plan to reflect the updates. In the interim, work practice controls must be set in place and if there is still occupational exposure, implementation of PPE (personal protection equipment) must be applied.

Is a Sharps Injury Log required to be kept Confidential?

All employers are required to maintain a log of illnesses and injuries that are occupationally related under 29 CFR 1904. The sharps injury log requirement records percutaneous injuries due to contaminated sharps and needs to have at least information about the injury; if known, the brand and type of device involved in the injury, the work area, division or department where the injury occurred, and details regarding how the injury happened. The log is required to be recorded and maintained so that it protects the confidentiality of the employee that was injured so it cannot have any personal identifiers. 

What if I have a Medical or Dental Office with less than ten employees? Does the Revised Bloodborne Pathogens Standard apply to my office?

There are two parts to this answer: OSHA’s Bloodborne Pathogens Standard applies to all employers with any number of employees that have occupational exposure to blood or OPIM. If the office has ten or fewer employees, it is exempt from the recordkeeping requirements that OSHA has established and also doesn’t have to maintain a Sharps Injury Log. All other Bloodborne Pathogens Standards provisions still apply.

What Is Needed in an Exposure Control Plan and when do I need to Update?

An employer should already be complying with the 1991 standard. The revisions to the 1991 standard sets the requirements for documentation as (1) annual consideration and implementation of appropriate engineering controls, and (2) solicitation of non-managerial healthcare workers in evaluating and choosing devices. The plan must be reviewed and updated at least annually.

Is there a source that I can access to explain what is expected for OSHA and NSPA?

There are several sources available for employers as well as employees for the topic of occupational exposures to blood and OPIM. The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) is the first source. There is also the Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens. This information is available online and through OSHA’s Consultation and State Plan State Offices on the OSHA website: www.osha.gov as well as by calling 1-800-321-OSHA. Both the CDC (Centers for Disease Control and Prevention) and the NIOSH (National Institute for Occupational Safety and Health) have several documents available that relate to the prevention of occupational exposure to blood and OPIM.

Parent page – Sharps Container Disposal


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