Case Overview, Preventing Needlestick Injuries

           One of the unfortunate consequences of the AIDS epidemic is that health workers-those who are working to treat AIDS patients and those who work in ancillary positions at health facilities-can become infected with the virus through workplace accidents. The HIV/AIDS virus is a blood-borne pathogen. Any transfer of blood from an individual who has the virus to another individual threatens that second person with infection. Infection is not certain but the recipient of the blood, even a tiny amount of blood, is at grave risk.
           Once the blood connection in AIDS became understood, public health experts began calling for safer procedures for all who came into contact with those infected. In health care settings, where blood testing and injections are common, the needles used in such procedures are highly dangerous. An accident where a health worker gets stuck with a needle just used on an AIDS patient can, ultimately, turn fatal. Doctors, nurses, and physician assistants who take blood from patients, quickly learned to take precautions. Nonetheless, accidents can sometimes happen and a slip of the hand could have disastrous results. Needle manufacturers began creating devices that worked without a needle or that featured a needle that automatically retracted into a safe housing in order to protect health care workers. The devices were more expensive than traditional needles, however, and many large hospitals balked at the idea of requiring such devices.
           Some interest groups representing health workers like nurses or maintenance workers began to lobby Congress and the Occupational Safety and Health Administration (OSHA) for government-mandated measures. In 1991 OSHA implemented a new regulation designed to protect workers. Preventative measures like latex gloves and thick receptacles for used needles were implemented, but the discussion of needleless devices and other devices designed to prevent needle injuries was imprecise and health care facilities were not actually forced to take serious preventative measures. Although health care facilities certainly didn't want their workers at risk, some resented government interference and felt that they knew what were the best procedures to use. Even after OSHA followed up the regulation with more detailed instructions on what should be done, critics were not satisfied and the problem was not eliminated.
           An effort to persuade Congress to act was initiated in the 106th Congress. With Republicans firmly in control of the House a bill mandating additional government regulation appeared to face stiff odds of success. Cass Ballenger, chair of the Workforce Subcommittee of the House Committee on Education and the Workforce, was openly hostile to labor unions, one of the chief backers of the proposed legislation. The Service Employees International Union (SEIU), the nation's largest union of health workers, made a strategic decision to hire an outside lobbyist, Rich Bond, who was a well-known and well-connected Republican. Bond met with Ballenger and other Republicans, and convinced many of them that it was an issue worth considering. This was not just a "labor" issue, but a public health issue.
           Ballenger and his staff worked to fashion a bill that was satisfactory to Republicans. Saving people from AIDS certainly has political appeal. As one observer noted during the legislative effort, "It's a very attractive issue. It's about sex, it's about death, it's about hospitals." In addition, the opposition to requiring hospitals and large medical offices to use safer devices whenever practical had been diminished by the passage of legislation that did much the same thing in several large states. Hospitals and needle manufacturers began to believe that it would be better to have one unified standard than many disparate state standards. Legislation was, in fact, passed and President Clinton signed it into law toward the end of his term.