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Susan Wilburn is the occupational safety and health specialist at the ANA.
"How can I work in my institution to prevent needlestick injuries?” Lynda Arnold, RN, asked herself this question five years ago after learning that a needlestick injury had infected her with the human immuno- deficiency virus (HIV). She has since launched the National Campaign for Healthcare Worker Safety, in order to educate nurses and facilities on needlestick injuries, and to urge hospitals to implement safer devices.
Like Lynda Arnold, you may be among the 16,000 health care workers who annually receive a needlestick contaminated with HIV. According to the federal government, 600,000 to one million needlestick injuries to health care workers occur every year.
The first Occupational Safety and Health Administration (OSHA) standard specifically written to protect health care workers was the 1991 Bloodborne Pathogen Standard. Although tremendous progress has been made as a result, more than 1,000 infections caused by 20 pathogens are estimated to be transmitted through sharps or needlestick injuries annually. The greatest threat to nurses are hepatitis B and C viruses (HBV and HCV)—not HIV, as many believe. In fact, one in six contaminations stems from HBV, one in 20 from HCV, and one in 300 from HIV.
If you are stuck by a needle, immediately report to employee health services at your facility for evaluation, counseling, and treatment if appropriate. Timing is critical. The Centers for Disease Control and Prevention’s (CDC) postexposure prophylaxis guidelines call for treatment with antiviral medications “within a few hours” following the needlestick. For more information, contact the National Clinician’s Post-Exposure Treatment Hotline at (888) 448-4911.
Formal reporting of the incident is also essential. It’s estimated that only 10% of all needlestick injuries are recorded on OSHA 200 logs, which chronicle and classify incidents of occupational injuries and illnesses. Without accurate data, OSHA cannot justify the demand for safer devices. Lack of documentation has also made obtaining worker’s compensation and other benefits more difficult for nurses.
According to the CDC, up to 86% of needlestick injuries can be prevented by using safer needlestick devices. Advances in engineering controls have made it possible to eliminate sharps from many uses—such as iv piggybacks—and to blunt or retract the needle so it’s no longer a danger. Placing sharps containers within reach and at eye level in every patient room also reduces the risk of injury.
You can be active on several levels in order to help prevent needlestick injuries. Work with your state nurses association (SNA) and your colleagues to encourage your institution to address the issue. Review needlestick injury data in your facility and ask the following questions: In what areas have needlestick injuries increased, and where has there been a decrease? Have nurses and other health care workers been reporting injuries? What happens at your workplace in the event of a needlestick incident? Can you receive support, including immediate evaluation for postexposure prophylaxis? What is being done to reduce the injury rate?
Also, remember that several organizations can offer protection. For example, OSHA will cite hospitals for failure to evaluate and use safer products. Your SNA can assist you in filing a complaint with OSHA.
Another option is the negotiation of contracts containing firm language. Several SNAs have successfully negotiated contracts that require hospitals to involve nurses in reviewing needlestick injury data, as well as in evaluating, selecting, and implementing safer devices. For further information, call (877) ANA-ORGANIZE.
To increase workplace safety, encourage elected officials to cosponsor and support state and federal legislation. In the coming year, many measures are set to take place on the political front: The Health Care Worker Protection Act will be reintroduced in Congress in 1999 to demand the implementation of safer needle devices by all health care institutions as a condition of participation in Medicare. In addition, the 1999 federal budget includes recommendations by the ANA, requiring that all potentially contaminated needlesticks be reported, and asking the CDC to revise its 1998 Hospital Infection Control Manual to include information regarding safety needles. Finally, a new California law will require health care institutions to introduce safer devices. Other states are considering similar legislation.
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