INTRODUCTION OF THE ``NEEDLESTICK SAFETY AND PREVENTION ACT'' -- HON. MAJOR R. OWENS (Extensions of Remarks - September 18, 2000)

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HON. MAJOR R. OWENS OF NEW YORK IN THE HOUSE OF REPRESENTATIVES Monday, September 18, 2000

Mr. OWENS. Mr. Speaker, I am proud to join with my colleague, the Chairman of the Subcommittee on Workforce Protections of the Committee on Education and the Workforce, the Honorable CASS BALLENGER, to introduce the Needlestick Safety and Prevention Act. This legislation modifies the Bloodborne Pathogens Standard (29 C.F.R. 1910.1030) issued in 1991 by the Occupational Safety and Health Administration of the U.S. Department of Labor to improve the protection afforded to health care workers from the spread of bloodborne pathogens such as the HIV virus, hepatitis B, and hepatitis C, as a result of accidental needlesticks and other percutaneous injuries.

Though controversial at the time it was issued, today all agree that the Bloodborne Pathogen Standard has helped to significantly reduce the spread of bloodborne pathogens among health care workers. There is, however, more that can be done.

In March, the Center for Disease Control and Prevention estimated that more than 380,000 needlestick injuries occur in hospitals every year. At an average hospital, there will be an estimated 30 reported needlestick injuries for every 100 beds. It is estimated that there are between 600,000 and 800,000 needlestick injuries every year in all health care settings. Nurses, doctors, laboratory staff, emergency medical technicians, and housekeepers have all been victimized by needlesticks. Needlestick injuries may account for as much as 80% of occupational exposures to blood.

Needlestick injuries, unfortunately, are not uncommon among health care workers. However, they are by no means trivial. Needlestick injuries impose unnecessary and unacceptable costs on our health care system. Costs to employers associated with followup medical examinations to determine whether needlestick victims have been infected by a bloodbone pathogen are by no means insignificant and can run into the thousands of dollars. Where workers are found to have been infected as a result of a needlestick injury, costs of treatment and compensation can easily run into the hundreds of thousands of dollars. For those who are infected as a result of a needlestick injury, the costs cannot be measured in dollars, they are life-threatening.

At a hearing held on this subject in June, the Subcommittee on Workforce Protections heard from Karen Daley who testified on behalf of the American Nurses Association. In July 1998, Ms. Daley reached into a needle box with a gloved hand to dispose of a needle with which she had drawn blood and was stuck by a needle. Five months later, she was diagnosed with both HIV and hepatitis C. Ms. Daley has had to give up direct nursing care, work that she loves and had performed for twenty years. Ms. Daley has suffered weight loss, nausea, loss of appetite, hair loss, headaches, skin rashes, severe fatigue, and bone marrow depression as a consequence of treatments for her injury. Her life now revolves around treatment for her diseases. Even more seriously, current research indicates that co-infection of HIV and hepatitis C can accelerate progression to liver failure and may lead to cirrhosis, cancer, or failure in five to ten years.

What is most tragic about Ms. Daley's story and that of many like her is that her injury was not simply accidental, it was unnecessary and therefore inexcusable. In Ms. Daley's own words:

[T]his injury did not 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 did not 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.

It is estimated that 80% of all needlestick injuries could be prevented if greater use is made of available sharps with engineered sharps injury protections, such as retractable needles, and needleless systems. Since the publication of the bloodborne pathogen standard, there has been a substantial increase in the number and assortment of effective engineering controls that are commercially available. There is a large body of research concerning the effectiveness of engineering controls, including safer medical devices. Further, there is general consensus among health care employers as well as health care workers that
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the overall cost of using sharps with engineered sharps injury protections and needleless systems is substantially cheaper than the costs of contending with unnecessary needlestick injuries associated with the use of less safe devices.

The under-utilization of safer medical devices is a national issue. As of August 31st, sixteen States had already enacted legislation requiring the use of safer medical devices and a seventeenth was in the process of doing so. The State laws, however, only partially address the concern. They may not be applicable to private health care sector workers and impose differing requirements that may create burdens for both employers and medical equipment manufacturers. Legislation introduced earlier in this Congress by the Hon. FORTNEY PETE STARK and the Hon. MARGE ROUKEMA to address this same issue, the Health Care Worker Needlestick Prevention Act, H.R. 1899, currently has 187 cosponsors.

To its credit, the Occupational Safety and Health Administration (OSHA) has already acted to ensure that there is greater use of sharps with engineered safety protections and needless systems. In November 1999, OSHA issued a revised Compliance Directive on Enforcement Procedures for Occupational Exposure to Bloodborne Pathogens and has sought to highly publicize the new compliance directive. One of the principal purposes for issuing the new directive was to emphasize the requirement that employers identify, evaluate, and make use of effective safer medical devices in order to minimize the risk of occupational exposure to bloodborne pathogens.

The legislation that Mr. BALLENGER and I are introducing today builds on OSHA's efforts. By making modest changes in the bloodborne pathogen standard, this legislation, if adopted, will help to achieve substantial improvement in the safety and health of American health care workers. This legislation will help to ensure that health care workers use the safest available medical devices, that they are trained to ensure proper usage, and that employers and workers review and learn from experience to ensure continued improvement.

Specifically, the legislation amends the standard to provide for definitions of ``engineering controls,'' ``sharps with engineered sharps injury protections,'' and ``needleless systems'' in order to provide greater clarity of the requirements of the standard. The legislation ensures that employers regularly monitor and assess the development of ``appropriate commercially available and effective safer medical devises'' and implement use of the such devises appropriately. It further ensures that those who must use the equipment will have a voice in its selection and will be properly trained in its use. Finally, the legislation promotes greater awareness and more active vigilance by ensuring that needlestick injuries are monitored and tracked.

In developing this legislation, Mr. BALLENGER and I have sought the greatest possible consensus. For example, I have reluctantly agreed to leave aside for now the issue of extending the protections of the bloodborne pathogen standard to health care workers employed by state and local governments. We have sought to address the concerns of both health care employers and health care workers. While reinforcing the requirement that safer medical devices be used where they are commercially available, this legislation does not mandate the use of engineered controls where such controls are not commercially available. Neither this legislation, nor the underlying standard it amends, requires anyone to use any engineering control, including a safer medical device, where such use may jeopardize a patient's safety, an employee's safety, or where it may be medically contraindicated. This legislation leaves intact all of the affirmative defenses available to employers related to the use of engineered controls under the Bloodborne Pathogens Standard. Finally, we have worked closely with OSHA to ensure that this legislation appropriately builds upon and compliments the existing standard.

In conclusion, I want to thank the many people who have worked with Mr. BALLENGER and I to develop this legislation. For my part, I want to especially thank Madeleine Golde and Lorraine Theibaud of the Service Employees International Union; Barbara Coufel of the American Federation of State, County, and Municipal Employees; Bill Cunningham of the American Federation of Teachers; and Stephanie Reed and Karen Daley of the American Nurses Association. Finally, I would like to pay special tribute to Peggy Ferro. At a 1992 hearing by another committee entitled ``Healthcare Worker Safety and Needlestick Injuries,'' Ms. Ferro testified about how she contracted HIV from a conventional needle. Ms. Ferro died in 1998. I sincerely commend Chairman BALLENGER for his efforts to ensure that we are more responsive to Ms. Daley than we were to Ms. Ferro.
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