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Needlestick injuries are some of the most frightening and dangerous injuries in the healthcare environment, as they carried the potential to transmit infectious diseases to those that were injured. Worldwide, thousands of these injuries wreaked havoc on the lives of medical workers, and this prompted the OSHA (Occupational Safety and Health Administration) to get the Needlestick Prevention and Safety Act passed on November 6, 2000.
The Needlestick Prevention and Safety Act required employers to improve the protection of their staff by providing safety-engineered devices to employees who would be at risk to bloodborne pathogen exposure. The process of selecting the devices had to include frontline workers, and the Act also required an annual review of exposure-control plans to make sure that they were up to date in sharps-safety technology advances. An important aspect of the law required that employers maintain a sharps-injury log that included all details about the injury(ies). These changes were required to be included as updates in 2001 in the OSHA Bloodborne Pathogens Standard and were designed to bring attention to the high volume of injuries, take actions that will reduce the injuries, and require healthcare environments to comply with new guidelines that protects healthcare workers.
Needlestick injuries among healthcare workers has a high risk factor for transmitting blood-borne infections. These infections can be life changing or even to the point of being deadly. The most common of the blood-borne infections that are contracted due to needlestick injuries include: HPV (Hepatitis B virus), HCV (hepatitis C virus), and HIV (human immunodeficiency virus). The risks for each are: 37% HBV, 39% HCV, and 4.4% HIV. It has been estimated that there are approximately 2 million needlestick injuries per year for healthcare staff. The needles as well as other sharp instruments that can pierce the skin have been exposed to blood products or blood fluids. Due to the potential of transmission, healthcare workers are required to comply with safety precautions.
According to the CDC there are around 385,000 injuries each year that are caused by sharps in a hospital environment. The exposure to blood and other materials that could be potentially infectious are caused due to unsafe needle devices and/or improper handling and disposal of sharps. Sharps injuries occur due to:
“All of the requirements of OSHA’s Bloodborne Pathogens standard can be found in Title 29 of the Code of Federal Regulations at 29 CFR 1910.1030. The standard’s requirements state what employers must do to protect workers who are occupationally exposed to blood or other potentially infectious materials (OPIM), as defined in the standard. That is, the standard protects workers who can reasonably be anticipated to come into contact with blood or OPIM as a result of doing their job duties.”
In general, the standard requires employers to:
Taking action by addressing the critical issue of needlestick injuries translated into a lot of changes by healthcare organizations as well as behavioral adjustments by the healthcare workers. NSPA (Needlestick Prevention and Safety Act) wanted to measure the efficacy of the Act in reducing injuries within the healthcare arena. They made use of a database that listed multiple hospital sharps-injury reports that is maintained at the University of Virginia by the International Healthcare Worker Safety Center.
The initial data of sharps injuries was voluntarily contributed and included a review for the years 1995-2005. This data indicated that there were 23,908 injuries within 85 hospitals in 10 states.
The calculation used involved the annual rates of percutaneous injuries per one hundred full-time hospital employees as per the data given by the American Hospital Association. Using the change-point Poisson regression model they saw a trend of increasing injury rates before the NSPA was enacted. It was followed by a reduction of around 38% when NSPA went into effect in 2001. Additional analysis continued to show that the needlestick injury rates were maintained well below the pre-NSPA rates.
The Massachusetts Department of Public Health published a separate long-term study indicating that between the years of 2002-2007 there was a 22% decrease of annual sharps injuries in acute care hospitals.
Another documented condition was done by the New York City hospital, Memorial Sloan-Kettering Cancer Center that included the experiences where no safety devices were in use prior to the passage of the NSPA law and then additional data on almost total conversion to safety-engineered devices after the law was in effect. The study results indicated that there was a 58% overall reduction in sharps injuries, with 71% for those injuries from hollow-bore needles. The occupational group that experiences the most needlestick injuries are nurses and the data showed a 75% reduction to this group.
It should be noted that the OSHA Bloodborne Pathogens Standard which did require safer practices had been in effect since 1991 as well as healthcare organizations adopting safety-engineered sharp devices had been happening before NSPA was passed. Even with these two important factors, there wasn’t a significant reduction in needlestick injuries until the year after the NSPA was passed. This suggests that the NSPA did have an effect on the number of injuries.
In addition, another factor that came into play was the increase in the number of citations from OSHA for violation of the newly revised standards set in place for handling bloodborne pathogens. While it’s assumed that with a reduction in needlestick injuries there would also be a reduction in these injuries causing occupational mortality and morbidity, there is currently no data available for confirmation of this assumption.
“Since passage of the Federal Needlestick Safety and Prevention Act in 2000 some states continued to introduce and pass legislation to strengthen needlestick protections. As of June 2002, 21 states have needlestick legislation. Those without state OSHA plans have introduced legislation to cover state and municipal employees who are not covered by the federal Act. States with state OSHA plans have introduced legislation to strengthen the standard with additional requirements.”
Because some diseases that are transmitted due to needlestick injuries take long periods of time to culminate, many of the healthcare workers may have been denied treatment coverage. Due to the passage of NSPA, some states have passed and are passing legislation for healthcare treatment for these employees.
The experience in the United States demonstrated that adoption of safety technology on a voluntary bases wasn’t effective in any larger scale reduction in injuries due to sharps. The reduction in injuries only occurred due to an enforceable law and the availability of safety-engineered devices were part of the predominant technology.
The overall results of the studies done so far demonstrate that when a legislation receives the input from the people in the field and involved in using potentially dangerous devices, it can be well-written to reflect changes that can have dramatic effects on the safety and efficacy for the lives of healthcare workers.
Parent page – Sharps Container Disposal
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