Copyright 2000 Federal News Service, Inc.
Federal News Service
June 22, 2000, Thursday
SECTION: PREPARED TESTIMONY
LENGTH: 946 words
HEADLINE:
PREPARED TESTIMONY OF MURRAY L. COHEN, PH.D., MPH, CIH, CHAIRMAN FRONTLINE
HEALTHCARE WORKERS SAFETY FOUNDATION
BEFORE THE
HOUSE EDUCATION AND THE WORKFORCE COMMITTEE SUBCOMMITTEE ON
WORKFORCE PROTECTIONS
SUBJECT - OSHA'S COMPLIANCE DIRECTIVE ON
BLOODBORNE PATHOGENS AND THE PREVENTION OF NEEDLESTICK INJURIES
BODY:
U.S. HOUSE COMMITTEE ON EDUCATION AND
THE WORKFORCE SUBCOMMITTEE ON WORKFORCE PROTECTIONS HONORABLE CASS BALLENGER,
CHAIRMAN
"OSHA's Compliance Directive on Bloodborne Pathogens and the
Prevention of Needlestick Injuries"
Statement of Dr.
Murray L. Cohen
22 June 2000
Mr. Chairman, Honorable members of
the Committee, I am Murray Cohen, Chairman of the Frontline Healthcare Workers
Safety Foundation.
Previously I served as a Public Health Service
scientist for 21 years with the Centers for Disease Control and Prevention, and
I have worked in the area of healthcare worker safety and
needlestick injury prevention since 1981. I sincerely
appreciate this opportunity to speak with you today about the underlying
epidemiologic basis for the OSHA Compliance Directive and occupational
transmission of bloodborne pathogens.
Please let me open by thanking and
congratulating the Subcommittee for your work on this important public health
issue. Healthcare worker safety is not a partisan issue; bloodborne viruses are
deadly, equal opportunity pathogens. Safety in hospitals, for both workers and
patients, is good public health, good medicine, and good business. The
leadership demonstrated by this subcommittee of the Congress is exceptional, and
timely, as you are literally dealing with matters of life and death in an
emerging crisis in U.S. healthcare. The emergence of important new bloodborne
pathogens over the last 20 years has made needlestick injury
prevention a public health priority. I have submitted for the record a more
complete history of how our public health and scientific communities rose to
these challenges. Let me just say that on May 27, 1987, the CDC published the
first reports of occupational transmission of HIV infection to three healthcare
workers. Healthcare worker safety and patient safety at once became immediate
public health crisis issues. The OSHA Bloodborne Pathogens Standard crafted in
this environment required the best practices for prevention of bloodborne
pathogen transmission known at the time.
Unfortunately, healthcare
workers are still suffering injuries that can transmit bloodborne infections.
Although we often refer to these generically as "needlestick"
injuries, these include all types of sharp object injury causes: broken
glassware, hollow bore needles, solid needles/scalpels/wires, etc. Good data
suggest that 600,000 of these injuries still occur in U.S. hospitals each year.
The care and treatment of workers following high risk
needlestick injuries is difficult and costly. These workers
endure 6 months of counseling, blood tests at prescribed intervals, safe sex
precautions, and the fear that they may become infected during this period of
latency or incubation. The employer or insurance company must pay the costs of
this clinical management, which can include worker compensation, laboratory
tests, treatment with anti-HIV drugs and their side effects, and psychological
counseling and treatment.Furthermore, since 1992 we have come to recognize that
the Hepatitis C virus may be the bloodborne pathogen of greatest significance
for risk of occupational transmission to healthcare workers. This virus is
responsible for 40% of all chronic liver disease in the U.S., and is the single
highest underlying cause of liver transplants in the U.S. HCV exposures can cost
worker compensation plans as much as $600,000, and more if a
liver transplant is required. The overall assessment of the risk for
occupational transmission of HCV is that it is 40-times greater than that for
HIV.
The OSHA Bloodborne Pathogens standard is a regulation that is
effectively preventing injury and disease in the workplace. In 1997,
investigators at the CDC reported that incident new Hepatitis B infections among
healthcare workers declined 95% between 1983 and 1995. This remarkable success
in disease prevention was due in large part to the requirement by OSHA in 1991
that all healthcare workers at risk for blood and body fluid exposures be
vaccinated against Hepatitis B.
Dozens of scientific studies have
demonstrated efficacy of injury surveillance and implementation of safety
devices, but there are no absolutes. This problem is difficult to solve.
Successful injury reduction requires that every facility gather its own unique
surveillance data, target its highest risk areas with multiple intervention
strategies, and conduct evaluation trials of safe medical devices that meet the
demands of its individual complex work environment.
Perhaps the most
important conclusions from studies of occupational transmission of bloodborne
pathogens over the past 20 years are that:
(1) There are really no
"minor" bloodborne pathogen exposures. Even in the absence of transmission of
infection, exposures may subject workers to time consuming, stressful, and pain
fid medical follow-up, while employers or insurance companies must pay for
expensive medical and indemnity claims.
(2) The vast majority of these
exposures are preventable with techniques and technologies that are available
today.
(3) These are enormously complex problems. Solutions require that
every facility conduct surveillance to identify their specific problems. Maximum
safety can only be accomplished through comprehensive, multi-faceted strategies
that include the use of engineered sharps safety devices by interdisciplinary
teams of workers and management working together in each institution.
(4) The value of needlestick prevention is going up, as
the cost of medical management of the injuries that occur will necessarily go up
as new drugs are developed for new and existing bloodborne infections.
Thank you.
END
LOAD-DATE: June 23, 2000
