Chairperson Allen and members of the Committee on Human Services:

My name is Susan Whittaker. I am a registered nurse and Associate Director of the Department of State Government Relations for the American Nurses Association (ANA). I come before you today at the request of our constituent member, the District of Columbia Nurses Association, to support the passage of Bill 13-266, the Needlestick Prevention Act of 1999. The passage of this bill in reality, is a matter of life and death for nurses and other health care providers in the District of Columbia. This is because the majority of nurses and other health care providers do not have access to safer needle devices that could protect them from deadly needlestick injuries.

Why are needlesticks so deadly? Some of these needlestick injures can expose a nurse or other health care workers to bloodborne pathogens from a patient that has an infection. More than 20 diseases can be transmitted through sharps or needlestick injuries including Tuberculosis, Malaria, Herpes, and Syphilis. The most important of these pathogens are the potentially life threatening diseases HIV, Hepatitis B, and Hepatitis C.

According to the National Institute for Occupational Safety and Health (NIOSH), there are more than 8 million health care workers in the United States working in hospitals and other health care settings. While the exact number of needlestick injuries are not available, it is estimated there are 600,000 to 1,000,000 needlestick injuries in the United States per year resulting in up to 1,000 new cases of HIV, Hepatitis B or Hepatitis C annually. The American Nurses Association is particularly concerned because half of those injuries occur to nurses. In an average hospital each year, workers, the majority being nurses, incur approximately 30 needlestick injuries per 100 beds.

Exposure to Hepatitis B can be successfully prevented or treated either through a vaccination or post exposure treatment. This is not true with Hepatitis C or HIV. Prevention of needlestick injuries is the best way to prevent these diseases. The good news is, 90% of needlestick injuries could be prevented with the use of safer needle devices. The FDA has approved over 250 safer needle devices designed to reduce needlestick injuries and new devices are being designed all the time. The bad news is, less than 15% of U.S. hospitals use these devices.

It is astonishing, in an industry where 1 million needlestick injuries occur each year and the consequences are so deadly, that everything possible is not being done to prevent these injuries. It is unconscionable that nurses and other health care workers must face this risk each time they take care of a patient, especially when this risk is largely preventable through safer needlestick devices.

Why aren't more safer needle devices used ? According to OSHA, one of the most common reasons cited for not using safer needle devices is the cost. However, in the state of California, the first state to pass needlestick legislation, hospitals and health care employers are expected to save over $100 million per year after implementing the legislation. Safer needle devices are more expensive than conventional devices, about 28 cents per device. However, this is a small fraction of the total health care costs that may result if a nurse or other health care provider is stuck with a contaminated needle let alone the emotional trauma and human suffering. The costs of follow-up for a high risk exposure are around $3,000 per needlestick injury, while drugs to combat hepatitis C, the most frequent infection resulting from a needlestick injury averages $1,700 per month.

According to the American Hospital Association, one case of a serious infection by a bloodborne pathogen can soon add up to $1 million or more in expenditures for testing follow-up, lost time and disability payments. Liver transplants resulting from Hepatitis C are also expensive. Recently, three liver transplants were done at Johns Hopkins University Hospital in Baltimore at a cost of $300,000 a piece. Also, the largest worker's compensation claim on record in South Carolina was the result of a housekeeping contracting Hepatitis C from an unsafe needle left in a bed.

In November of 1999, the federal Occupational Health and Safety Administration (OSHA) issued a new compliance directive to enforce the use of available, approved and effective safety engineered needles in every healthcare workplace in this country. While the American Nurses Association applauds this effort, it doesn't go far enough. Federal OSHA is not applying additional dollars to enforce this directive and there is no mandate in the directive or current OSHA Standard that would require health care facilities to use and evaluate safer needlestick devices nor collect needlestick injury data. In addition, neither the federal OSHA directive or Standard covers public employees. Federal legislation, the Health Care Worker Needlestick Prevention Act (HR 1899) was introduced in May of 1999 that would mandate the inclusion of these safeguards in the OSHA Standard. This legislation is pending in the House of Representatives.

Many state legislators throughout the country are dismayed by this lack of needlestick protection and believe it makes good sense to legislate the use of safer needle devices to protect nurses and other health care workers that work in public and private health care facilities. Fifty seven bills addressing needlestick prevention have been introduced in 25 states this year alone. Legislation has passed in six states, Georgia, Iowa, Maryland, Maine, Minnesota and West Virginia. Four additional bills are pending governor's signatures in Alaska, New Hampshire, Ohio and Oklahoma. In the past two years, legislation has become law in six states: California, Hawaii, Maryland, New Jersey, Tennessee, and Texas.

These state and federal legislative and regulatory actions are building momentum to ensure that health care workers across the nation have access to safer needle devices by going beyond the current, inadequate OSHA standard. Manufacturers of these safer needle devices are seeing this ground swell and are gearing up for increased product demand and the development of new devices. Bill 13-266 will carry this momentum to the District of Columbia by mandating that health care workers, in both public and private health care settings, have access to safer needle devices. In addition, this legislation would require the collection of needlestick injury data to assess the device specific injury rates in order to improve programs and products for prevention.

Currently, needlestick injury data is woefully lacking. When the rules on Bill 13-266 are promulgated, I would urge you to mandate additional data collection on needlestick injuries including: the job classification of the employee; department or work area where the exposure incident occurred; if the employee was working overtime; how many patients the exposed employee was responsible for; if the exposed employee was part time, full time or a temporary employee; the procedure the exposed employee was performing at the time of the incident; the body part involved in the incident; if the protective mechanism was activated; if the employee received training on how to use the device; and an assessment of whether any other engineering, administrative or work practice control could have prevented the injury as well as the basis for the assessment.

I would also urge you to consider an amendment to the legislation that would require front line nurses and other health care workers to be a part of the evaluation, selection and implementation of the safer devices in the facility where they work. A more successful implementation plan will result when the users of the safer needle devices are involved in the decision making. Decision will be made on the basis of clinical appropriateness and cost, not just the cheapest product which may not work in a particular setting.

There is no time to waste in assuring that health care workers have the protections they need

. In other industries, OSHA requires adequate safeguards. In the building industries there are mandates about building safe scaffolding. In the manufacturing industry there are mandates requiring machine guards to prevent amputation of fingers. While a finger amputation can be devastating, they are seldom fatal. Contracting HIV or Hepatitis C has the potential to be fatal. We need greater safeguards to protect nurses and other health care workers. Through the passage of legislation in the District of Columbia and states throughout the nation, mandates to protect workers go beyond the current inadequate OSHA standard and improve protections for nurses and other health care workers-- just like it has been done in other industries.

On behalf of all the nurses in the District of Columbia and all across this nation, we urge you to support this critical legislation.

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