Copyright 2000 Federal News Service, Inc.
Federal News Service
June 22, 2000, Thursday
SECTION: PREPARED TESTIMONY
LENGTH: 2089 words
HEADLINE:
PREPARED TESTIMONY OF KAREN DALEY, MPH, RN THE AMERICAN NURSES ASSOCIATION
BEFORE THE HOUSE EDUCATION AND THE WORKFORCE
COMMITTEE SUBCOMMITTEE ON WORKFORCE PROTECTIONS
BODY:
Good morning, Mr. Chairman and members of this distinguished
subcommittee. I am Karen Daley, a registered nurse and president of the
Massachusetts Nurses Association. I appear today on behalf ' of the American
Nurses Association and its 53 constituent state and territorial nurses
associations.
ANA appreciates having this opportunity to speak to you on
an issue of great importance to the 2.6 million registered nurses and other
health care workers in the United States who face the risk of potentially lethal
needlesticks every day. For nearly twenty years, ANA has been
calling for the use of safer devices and protections for health care workers.
Registered nurses have always cared for people in need whatever the
circumstances, often with little regard to our own health and safety. Now we are
in a situation in which health care workers sustain an estimated 600,000
needlestick injuries per year - at least 1,000 of those workers
contract serious potentially life-threatening infections, like HIV and hepatitis
C. And those numbers are probably too low - several studies show
needlestick underreporting rates of between 40 and 90 percent.
Despite the fact that these safer devices have been available since the 1970s
and that we know more than 80% of needlestick injuries can be
prevented through their use, fewer than 15 percent of U.S. hospitals have
switched over to these safer devices, except in states that have enacted laws
requiring them. As a result, thousands of health care workers each day are stuck
by needles and needlessly exposed to disease. And for some truly unfortunate
health care workers, one needlestick can become a devastating
source of infection and illness that has a life-long, life-altering and
life-threatening impact.
I am one of those cases. In July of 1998, while
working in a hospital emergency department where I had been a nurse for more
than 20 years, I sustained a needle stick. After a routine occupational health
follow-up five months later - two days before Christmas - I received the
horrifying news that I might be HIV and Hepatitis C positive. Just before New
Year's of 1999, joined by a team of physicians, nurses and a social worker, I
was told both infections had been confirmed. It's impossible for me to describe
for you how that one moment - the moment when I reached my gloved hand into a
needle box to dispose of the needle with which I had drawn blood - has
drastically changed my life.
Up until this point in my life, I had
enjoyed good health with little need to seek medical care beyond my annual
visits to my primary care provider. Since that time. I have had to come to terms
with the fact that I am infected with not one, but two potentially
life-threatening diseases. As the direct result of my injury, for the first time
in my life, I had become "a patient."
My primary care has been taken
over by a physician who specializes in infectious diseases and particularly HIV
management. I am also followed by a hepatologist who manages the hepatitis C. I
have had weekly to monthly blood tests drawn - easily totaling hundreds of tubes
over the past 18 months. In the early stages of my treatment, both of my doctors
readily admitted that the experience and knowledge regarding the treatment of
hepatitis C, in particular, was limited. The medical community's experience with
treating both infections together was even more limited and problematic. What
they do know based on their experience to date is that treating an individual
infected with both HIV and hepatitis C can be much more difficult and that each
infection can make it more complicated to successfully treat the other. Current
research indicates that co-infection with HIV and hepatitis C can accelerate
progression to liver failure. If treatment is not successful, it can mean that
instead of the typical two or three decades before possible progression to liver
cirrhosis or failure or cancer, a co-infected individual can progress in a much
shorter time - as short a time as five to 10 years.
In the first year of
my treatment, I took a daily regimen of potent antiviral drugs - a regimen that
at one point consisted of 21 pills a day and an injection and caused a wide
range of side effects, among them: weight loss, nausea, loss of appetite, hair
loss, headaches, skin rashes, severe fatigue and bone marrow depression. To say
these side effects interfered with my normal day-to-day routine is a gross
understatement. The single moment when my injury occurred 18 months ago has
changed many other things for me. In addition to the emotional turmoil it has
created for myself, my family, my friends, my colleagues - it has cost me much
more than I can ever describe in words. As a result of my injury, I have given
up direct nursing practice, work that I love.
Mr. Chairman, this injury
didn't occur because I wasn't observing universal precautions. I did everything
within my power - taking all the necessary precautions including wearing gloves
and following proper procedures - to reduce my own risk of exposure to
bloodborne pathogens. This injury didn't occur because I was careless or
distracted or not paying attention to what I was doing. This injury and the
life-altering consequences I am now suffering should not have happened. And
worst of all, this injury did not have to happen and would not have happened if
a safer needle and disposal system had been in place in my own work setting.
We have made some progress. In November 1999, OSHA released a compliance
directive to the Bloodborne Pathogens Standard. This directive provides
instructions to OSHA inspectors to cite employers for failing to evaluate,
purchase, and implement safer needles and sharps devices. While ANA commends
OSHA for releasing this directive, we strongly believe this process should be
taken one step further and that, for a number of reasons, these requirements
need to be placed into the actual standard through federal legislation.
First, the legislation is needed for public sector employees who are not
covered by OSHA. These and all health care workers must be protected through
legislation. The reality is OSHA has no plans to enhance its enforcement
programs or to increase the number of OSHA inspectors. At its current funding
level, OSHA has the ability to make one spontaneous visit per facility about
every 75 years. We also know that OSHA will increase the number of inspections
in response to complaints. In the absence of complaints, however, workers are
assuming unnecessary and potentially life-threatening risks in settings where
safer devices are not being used. despite the directive and the widespread
availability of these safer devices for more than 20 years.
We know the
risk for health care workers and the cost to this nation will only grow over
time since the present number of 4 million cases of hepatitis C alone is
expected to triple over the next 20 years. As the current leading reason for
liver failure and transplants, potential exposure and infection of health care
workers with hepatitis C, the most common infection transmitted through
needlesticks, represents not simply an occupational health and
safety, issue, but a major public health issue. And hepatitis C is just one of
more than 20 bloodborne pathogens we know can be transmitted through a
needlestick.
As thousands of preventable
needlestick injuries continue to occur around this country
everyday, the cost of not requiring use of safer devices also grows. The average
cost of follow-up for a high-risk exposure is almost $3,000 per
needlestick injury even when no infection occurs.
Based
on estimates of 600,000 needlesticks a year, the cost for
follow-up alone is $1.8 billion. According to the American
Hospital Association, once case of serious infection by bloodborne pathogens can
soon add up to $1 million or more in expenditures for testing
follow-up, lost time and disability payments. And while we know safer devices
cost more, we also know they can prevent more than 80 percent of these injuries.
And as these devices are used on a more widespread basis, we know their cost
will approximate the amount currently spent on unsafe needle devices.
The federal legislation is needed to require involvement of frontline
health care workers in the evaluation, selection, and implementation of safe
devices. It is crucial that the selection and evaluation of safer devices not be
left in the hands of those who may only understand how a device ought to work.
Selection should be in the hands of those who are actually going to work with
the device. It is also important to say that health care workers will often
resist changing over to these newer safer systems. In reality, it is not
unexpected that workers will go through some awkward years adapting to these new
devices. That is not a good reason for failing to move forward since, with a
consistent approach from within the industry and as these devices become the
norm, we can expect that situation to change over time. Routinely involving the
workers who use these devices in their selection has been shown to be one of the
most effective ways to reduce their resistance to using them.
The
legislation is also necessary for the collection of needlestick
injury data to assess the device-specific injury rates in order to improve
prevention programs and products. At present, the OSHA recordkeeping standard
does not require reporting and recording of all needlestick
injuries and provides no specific information about the device and working
conditions surrounding the injury. We need that data to tell us which of the
more than 1000 patented devices are the most effective. Simply because a device
is labeled a safer device doesn't make it one and it isn't necessary for
employers to buy the most expensive devices for an exposure control plan to be
effective.
Finally, it is important to understand that compliance
directives are easily subject to change and that amending the Bloodborne
Pathogen Standard itself through regulation is too slow a process, given the
unacceptable risks to which hundreds of nurses and other health care workers are
exposed to every day. ANA urges Congress to amend the Standard by statute so
that nurses and health care workers can be assured expeditious protection.In
offering our strong support for federal legislation, I think it's also important
to be clear on what we are and are not saying. We are not suggesting an
unreasonable or cost-prohibitive approach to what we believe is a preventable
and serious public health problem. We are not suggesting that employers use the
most expensive devices on the market. We are saying that employers should choose
and utilize devices that are found to be most effective in their own
environment. We are saying that the financial resources should be used to
prevent injuries and exposures, not simply to follow-up workers once they have
needlessly been exposed. We are saying that the choice should no longer be
between an employer saving relatively minuscule amounts of money on the front
end while a worker pays with his health, piece of mind, and perhaps even his
life.
Mr. Chairman, the American Nurses Association has been pleased in
recent years to work with Representatives Stark and Roukema, who have led
congressional efforts on this issue, and with our nursing colleagues who serve
in the House of Representatives, including Representative Carolyn McCarthy, a
distinguished member of this committee. We have worked also with a broad
coalition of health care workers, institutional health care providers, and
manufacturers to find a way to make sure that safer devices are the norm for
every health care worker in America. ANA is committed to work with you and other
members of this committee in this effort.
Institutions and health care
professionals often speak of the importance of prevention. Hospitals and others
that employ nurses and other health care workers have an obligation to apply the
same standard of prevention for caregivers as they do for patients. We all must
do everything possible to protect health care workers from unnecessary and
preventable exposure to injury and disease. This legislation is critical to that
end. I share my personal story with you today and I will continue to do this so
no other nurse, doctor or other health care worker has to experience what I am
going through.
Thank you for allowing me the opportunity to offer
testimony on this important public health and workplace issue.
END
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