Availability of Equipment and Safety Procedures to Prevent Transmission of Bloodborne Diseases

ANA continues to carefully monitor the activities of the Centers for Disease Control (CDC) and the Occupational Safety and Health Administration (OSHA) in the area of safety procedures to prevent bloodborne diseases. In addition, ANA continues to be alert to new equipment and devices intended to reduce risks to health care workers. Accordingly, ANA strongly suggests the manufacturing industry, agencies at the federal and state levels and philanthropic organizations to support well-designed efficacy studies of newly designed equipment intended to reduce risks to health care workers of exposure to bloodborne disease. Most of these new devices are considerably more costly than those they are intended to replace, therefore, formal evaluation of these products is necessary. In addition to evaluating these devices' efficacy, financing mechanisms must be explored to assure that cost does not limit the availability of proven safety devices. For example, some states are considering the adoption of "pass-through" laws to assure the availability of needed safety equipment.

ANA supports an OSHA mandate requiring the use of engineering controls. OSHA is finalizing its rule for "Occupational Exposure to Bloodborne Pathogens," to be published in late 1991. It is anticipated that the rule will delineate responsibilities for employers and employees regarding reducing risks for occupational exposure. Also, it is hoped that the rule will encourage manufacturers to supply safe and effective devices. These risk reduction strategies are in three categories: engineering controls, work practices, and the use of personal protective equipment.

ENGINEERING CONTROLS are the first and best line of defense for worker protection, and are clearly the most important mechanisms for reducing risks of sharps injuries. The technology exists in most hazardous work situations to control the risks of injuries from hazardous machinery or instruments. However, in health care, technological developments have not been emphasized in the past because the risks were not perceived as being life-threatening. With the increased risk of serious injury and death from occupational exposure to bloodborne pathogens in health care settings, ANA urges increased research and development in this area.

WORK PRACTICE CONTROLS (WPC) are a second line of defense and include modifications in work practices to reduce risks. Work practice controls are sometimes of limited usefulness in the health care environment due to lack of control over many patient care situations where there is an urgent or emergent situation that requires immediate response by the health care worker. This need for immediate response to benefit a patient may put the health care worker at increased personal risk. Thus, work practice controls are dependent upon many situational issues that are not associated with the specific task but with the situation at the time the task is performed. For example, data from the occupational health literature suggest that individuals may be most injury-prone: at the end of a shift; when working a double-shift or overtime; after transfer to an unfamiliar area especially if orientation is lacking; at times when staffing is inadequate to the needs of the job; and when supervisory support is lacking or inadequate.

PERSONAL PROTECTION EQUIPMENT (PPE) is the third line of defense but one that has received a great deal of attention, both by OSHA and by the health care industry. PPE primarily includes gloves, gowns, masks, and eye protection. PPE does not include equipment to reduce sharps injury risks, either during use or disposal. PPE is focused on barriers to reduce risks of exposure to blood and certain body fluids by protecting the health care worker from skin, mucous membrane, and clothing contact. These types of exposure risks are far less likely to result in transmission of infectious agents than are puncture and sharps injuries.

ANA adamantly urges the modification of equipment and patient care practices to reduce the need for health care workers to handle sharp objects and large amounts of blood or blood-soaked items, and that, for these situations, newly designed equipment be evaluated systematically to determine effectiveness during use.

The American Nurses Association supports:

• immediate systematic research and evaluation studies of devices and equipment intended to reduce risk of injury from sharps and of personal protective equipment designed to reduce exposure risks.
• funding to support systematic studies.
• availability of proven safety devices.
• continued evaluation and modification of work practices to reduce the frequency of situations where exposure and/ or injury risk to health care workers is greatest.
• the consistent and strict use of Universal Precautions to reduce risk of exposure to bloodborne pathogens.
• continued monitoring of OSHA regulations.
• assurance of safe equipment.

THIS INFORMATION COPYRIGHT 1997 AMERICAN NURSES ASSOCIATION

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