Needle Stick Prevention Osha3161

8/2/2019 Needle Stick Prevention Osha3161

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How to PreventNeedlestick Injuries

Answers to SomeImportant Q uestions


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More than 20 pathogenshave been reportedly trans-mitted from n eedlesticks.2

The most serious are thetransm ission of Hepatitis C

1 G. Ipp olito; V. Pu ro; N. Petrosillo; G. Pu gliese; B.Wispelwey; P.M. Tereskers;N. Bentley; and J. Jagger, Prevention, Management & Chemoprophylaxis ofOccupational Exposure to HIV (Charlottesville, VA: Advances in Exposure

Prevention, International Health Care Worker Safety Center, 1997).

2 L.A.Chiarello, Deborah Nagin, and Franklin Laufer, Pilot Study ofNeedlestick Prevention Devices, Report to the Legislature, New York StateDepartm ent of H ealth, March 1992, p.16.3 U.S. Departmen t of Health and H uma n Services, National Institutes ofHealth, Consensus Development S tatement: Management of Hepatitis C.Available online at odp.od.nih.gov/ consensus/ statements/ cdc/ 105/105_stmt.html.1997.4 Centers for Disease Control and Preven tion,HIV /AIDS S urveillance Report88(2), 1996.5 Centers for Disease Control and Preven tion, Division of HIV/ AIDSPrevention, National Center for HIV, STD, and TB Prevention,HIV /AIDSSurveillanceReport 8(2): A tlanta, GA 1996.6 Title 29 Code of Federal Regulations, Pa rt 1910.1030.

Why Do I Need

to Worry AboutNeedlesticks?

When Might

My EmployeesBe Injured

By a

Needlestick?

injections, draw blood, or hand le trash or dirtylinens w here needles have been inappropr iatelydiscarded.

exposures (49.7 percent); physicians ranked second(12.6 percent); nursing assistants accountedfor 5.3 percent, and housekeepers, 5.1 percent.1

Hollow-bore need les are the cause of injuryin 68.5 percent of all cases.

Isnt There Just

a Small Chance

of Such an

Injury?

What Can

Happen from

a Needlestick?

(HCV), Hepatitis B (HBV), and H IV. In fact, the risk

of acquiring H BV or HCV from a contaminatedneed lestick is greater than for HIV.

Why Is the Risk

Greater from

Hepatitis B and C

Than from HIV?

The risk of acquiring aninfection has to do with theprevalence of these diseasesin the patient p opulationat large. For example, anestimated 1.25 million

peop le in the U.S. are chronically infected w ithHBV and 6,000 die each year from HBV-relatedliver d isease. HCV also is a major cause of chronicliver disease worldwide. In 1997, there were an

estimated 4 million people in the U.S. infected w ithHCV.3As many as 85 percent of all HCV-infectedpersons develop chronic hepatitis and are atincreased risk for cirrhosis and p rimary hepatocel-lular carcinoma.4 Liver failure from Hep atitis C isthe leading reason for liver transplants in the U.S.

So, Do I Still

Need to Worry

About HIV

Exposures

for Employees?

Yes. The total nu mber ofoccupationally acquired HIVinfections in health careworkers continues to in-crease each year. Of the 52such cases documentedduring 1996, 45 were fromneedlesticks or cuts.5

How Can I

Protect Employees

Against Potential

Exposures?

Make sure that emp loyeesuse universal precautions,engineering and w orkpractice controls, and p er-sonal protective equipmentto reduce their exposure to

bloodborne pathogens, as required by OSHAsBloodborne Pathogens Standard.6

If youre an emp loyer ofhealth care workers who are

potentially exposed to bloodand contaminated needles,you should know that there

are an estimated 800,000 needlesticks each year inthe U.S. Abou t 2 percent, or 16,000, of these arelikely to be contaminated with the Human Imm u-nodeficiency Virus (HIV). Needlestick injuriesaccount for up to 80 percent of accidental exposu resto blood. Nu rses in hospitals are the most fre-quently injured.

Need lestick injuries may

occur wh en emp loyeesdispose of needles, collectand dispose of materialsused d uring patient careprocedures, administer

Data from 63 hospitals showthat the overall rate of suchinjuries is 27 per 100 occu-pied bed s annu ally. Nurses

had the most frequent

ntroductionAs an employer of health care workers, you w antand need to provide a safe and healthful workplacefor your employees. In 1991, OSHA published th eBloodborne Pathogens Standard, Title 29 Code of

Federal Regulations, Part 1910.1030, to protect work-ers from exposures to bloodborne illnesses. Becauseneed lestick injuries are a major cause of theseexposures in the health care setting, it is impor tantto recognize that there are work practices andengineering controls to help red uce these exposuresand injuries. This brochure looks at the issue ofsafer needle devices and how they can help em-ployers like you create a safer workplace to protectyour workers.


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Figure 2. Self-Resheathing NeedleInitially, the sleeve is located over the barrel of the syringe withthe needle exposed for use. After the device is used, the userslides the sleeve forward over the needle where it locks in placeand provides a guard around the used needle.

Youre correct. Mostpersonal protective equip-ment can be easily pen-etrated by need les. Mostneed lestick injuries, how-ever, result from u nsafe

Yes, that w ould be helpful.For example, it is good toknow w hether the feature isactive or passive or wh etherthe engineering control is

7 Centers for Disease Control and Preven tion, Division of HIV/AIDS Prevention, National Cen ter for H IV, STD, and TBPrevention,HIV /AIDS S urveillance Report, 9(1): Atlan ta, GA,1997.8 Ippolito, et al, 1997.

Figure 1. Needleless IV ConnectorThese connectors use devices other than needles to connect one IVto another. Examples of needleless connectors include 3-waystopcocks and plunger-type systems. An example of the plunger-type system is shown here. These devices are passive and integral

to the system.

Cant Needles

Penetrate Most

Personal Protective

Equipment?

need le devices rather than carelessness by healthcare workers. Safer needle d eviceshave beenshown to significantly reduce needlesticks andexposures to potentially fatal bloodborne illnesses.7

A safer needle device hasbuilt-in safety controls toredu ce needlestick injuriesbefore, du ring, or after useand to make n eedlesticksless likely.

Whats a Safer

Needle Device?

Not all needlestick injuries

are preventable, but thenumber can be reduced byusing d evices containingneed les with bu ilt-in safety

Will These

Devices PreventNeedlestick

Injuries?

features or other devices that eliminate the use ofneed les altogether. Using needleless IV connectors,self re-sheathing need les, or blunted su rgicalneed les, for example, can help redu ce the risk ofinjury. In fact, almost 83 percent of injur ies fromhollow bore needles are potentially preventable.8

In general, properlydesigned devices shou ld

(1) provide a bar rier betweenthe hands and the needleafter use; (2) allow or require

How Do These

Devices Work?

the worker s hand s to remain behind the needleat all times; (3) have safety features integral to thedevice itself rather than as accessories; (4) be ineffect before d isassembly and remain in effectafter d isposal to protect downstream workers;(5) be simp le and easy to operate, with little or notraining; and (6) not interfere with the d eliveryof patient care.

Are There SpecificSafety Features

I Need to Know

About?

part of the device. Types of safety features includ ethe following:

Passive safety features remain in effect before,du ring, and after use; workers do not have toactivate them. Passive features enhance thesafety design and are more likely to have agreater imp act on prevention. (See Figure 1.)

Active devices require the worker to activate

the safety mechanism. Failure to do so leavesthe worker unp rotected. Proper use by healthcare workers is the primary factor in theeffectiveness of these d evices. (See Figure 2.)

An integrated safety designmeans that thesafety feature is built in as an integral part of thedevice and cannot be removed . This designfeature is usually preferred. (See Figure 1.)

An accessory safety device is a safety featurethat is external to the device and must becarried to, or be temporarily or permanentlyfixed to, the point of use. This design also isdependent on employee compliance, and

according to some researchers, is less desirable.


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To evaluate and select appropriate safer need ledevices, you also shou ld review availableneedlestick injury data including the personnelinvolved, the devices used, and the circumstancesand frequency of needlestick events. This informa-tion can h elp in determining how employees can

maximally benefit from a prod uct change to saferneedle devices. Although not required by OSHA,the collection and evaluation of comp leteneedlestick injury data are key to identifyinginjury patterns and then implementing an effectiveabatement plan. (See also, the sample SafetyFeature Evaluation Form, for help in determiningthe most appropriate device for your employees.)

10 L.A. Chiarello, Selection of Safer Needle Devices: A ConceptualFramework for Approaching Product Evaluation, Am J InfectionControl 23(6):386-395, 1995.

9 29 CFR, Part 1910.1030, (c)(1)(ii)(B) and (d)(2)(i).

No. OSHA does not requireemployers to institutespecific devices, but it doesrequire that emp loyersevaluate the effectiveness ofexisting controls and review

Does OSHA

Require the

Use of Specific

Devices?

the feasibility of instituting more advanced engi-neering controls. Further, OSHAs BloodbornePathogens Standard9 requires that emp loyersestablish a w ritten exposure control plan as well asengineering and w ork practice controls to eliminateor minimize employee exposure. Additionally,employers are required to provide p ost-exposurefollow-up if an employee sustains a needle punc-ture and to record the injury on the OSHA 200 login some cases.

As an emp loyer of healthcare workers, you h ave the

flexibility to develop indi-vidual w orksite-specificneedlestick preventionprograms to protect employ-ees. Such a program wouldmean that you have amechan ism in p lace to selectand evaluate safer medical

What Steps Do

I Need to Take

to Have a

Comprehensive

Prevention

Program and to

Implement Safer

Needle Devices?

devices in a systematic manner. In evaluating saferneed lestick devices, ideally you shou ld evaluateyour workplace and base your choices for thesetypes of products on the following:

The needs of the primary users. The need of the patientswho must continue to

receive safe, efficient, and comfortable care.(Workers are likely to reject products that theythink w ill interfere with p atient care in anyway.)

In addition, a comprehensive needlestick preven-tion program might includ e the following:

Creating a mu ltidisciplinary team to investigateand assess needlestick inciden ts.

Defining p revention priorities on the basisof collection and analysis of an institutionsinjury data.

Developing design and performance criteriafor prod uct selection according to needsfor patient care and health care worker safety.

Planning and implementing an evaluationof prod ucts in clinical settings.10

Source: Reprinted with p ermission of Training for Development of Innovative Control

Techn ology P roject, June Fisher, M.D., June 1993.


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For OSHA assistance, you cancontact the bloodborne patho-gens coordinator in yournearest regional office listedelsewhere in this booklet. SeealsoOther Resourceslisted in

this brochure. OSHA also

experience and expertise. For more informationon VPP, contact your VPP coordinator in you rnearest OSHA regional office.

PublicationsOSHA has many p ublishedmaterials, including specific topics for small

businesses, that are available or ordered on lineat w ww.osha.gov. Publications lists and singlecopies of various OSHA materials can be ob-tained by send ing a self-addressed label to theOSHA Publications Office, P.O. Box 3753,Washington, DC 20013-7535, or by calling(202) 693-1888.

OSHA regulations are contained in Title 29of the Code of Federal Regulations, Parts 1904(Recordkeep ing), 1910 (General Indu stry), 1911through 1925 (Maritime), 1926 (Construction),and 1928 (Agricultu re). All OSHA regu lations

are available or can be ord ered online atwww.osha.gov. Printed copies of OSHA regula-tions are sold by the Government Printing Officeand can be ordered on line as ind icated above.

Small Business LiaisonOSHAs liaison isavailable to answer questions on small businessissues at 202-693-2317.

State PlansTwenty-five states and territoriesoperate their own federally app roved occup a-tional safety and health programs. The statesconduct most OSHA enforcement through theirown stand ards, which are at least as effective asFederal OSHAs, but m ay have d ifferent oradditional requirements. Many states offeradditional programs of assistance to smallbusinesses. For more information on stateplans, see the list of plans at the end of thisbrochure or visitOutreachon OSHAs Web siteat w ww.osha.gov.

Training and EducationOSHAs TrainingInstitute in Des Plaines, IL, and OSHAs TrainingEducation Centers p rovide basic and advanced

courses in safety and health. OSHAs area officesoffer information services, such as aud iovisualaids, technical advice, and speakers for specialengagem ents. For more information, contact theInstitu te at 1555 Times Drive, Des Plaines, IL60018, (847) 297-4810, or fax (874) 297-4874. Alist of courses also can be found underOutreachon OSHAs Web site at w ww.osha.gov.

EmergenciesFor life-threatening situationsonly,call(800) 321-OSHA. Complaints will go imm edi-ately to the nearest OSHA area or state office forhelp.

How Can I

Get More

Information

or Assistance

on This Topic?

provides other services and assistance, including:

Consultation ProgramThis service is deliv-ered by state government agencies or universi-ties employing professional safety health andconsultants. Primar ily developed for smalleremployers with more hazardous operations,comprehensive assistance includ es an onsiteapp raisal of all work practices and environmen-tal hazards and all aspects of the employerspresent job safety and health program. Largelyfunded by OSHA, the service is provided at

no cost to the emp loyer and is available onrequest to employers who wan t help in estab-lishing and maintaining a safe and h ealthfulworkplace.

Electronic InformationInternet: OSHAstand ards, interp retations, directives, interactivesoftware, compliance assistance materials, andadditional information are available or can beordered on the World Wide Web atwww.osha.gov. See in particular, Safer NeedleDevices: Protecting Health Care Workers, underIndex, Needlestick Injuries, andNew s Room,

Publications, on the OSHA hom e page.

CD-ROM:includes directives, standards,interpretations, and other materials on CD.Available from the U.S. Governm ent PrintingOffice, Superintendent of Documents, P.O. Box371954, Pittsbu rgh , PA 15250-7954 or at (202)512-1800. Specify OSHA Regulations, Documents,and Technical Information on CD-ROM, (ORDT),Ord er No. S/ N729-013-00000-5; $43 per yearand $15 per single copy. Issued quarterly.

GrantsOSHA gives training and educationgrants to various n on-profit groups to developprograms to help small businesses establishsafety and health programs.

MentoringOSHAs Volun tary ProtectionProgram s (VPP) recognize worksites whereemployers and employees work together toachieve safety and health excellence. Smallfirms can be matched w ith and m entored by aVPP site that w ill share its safety and health


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The Service Emp loyees International Un ions(SEIU) Guide to Preventing Need lestick InjuriesInclud es a listing of safer need le devices, checklistfor comp liance with OSHAs bloodborne p athogenstand ard, safe device feature evaluation checklist,and guide for post-needlestick exposure followup.To order, send a check for $5.00 (pre-paid orders

only) to the SEIU Mailroom, 1313 L St., NW Wash-ington, DC 20005.

Region V

(IL, IN,* MI,* MN,* OH, WI)230 Sou th Dear born StreetRoom 3244Chicago, IL 60604Telephone: (312) 353-2220

Region VI(AR, LA, NM,* OK, TX)525 Griffin StreetRoom 602Dallas, TX 75202Telephone: (214) 767-4731

Region VII(IA,* KS, MO, NE)City Center Square1100 Main Street, Suite 800Kansas City, MO 64105Telephone: (816) 426-5861

Region VIII(CO, MT, ND, SD, UT,* WY*)1999 Broad way, Suite 1690Denver, CO 80202-5716Telephone: (303) 844-1600

Region IX(American Samoa , AZ,* CA,* Gu am , HI,* NV,* Tru stTerritories of the Pacific)71 Stevenson StreetSuite 420

San Fran cisco, CA 94105

Region X(AK,* ID, OR*, WA*)1111 Third Avenu eSuite 715Seatt le, WA 98101-3212Telephone: (206) 553-5930

U.S. De partment of Labor

Occup ational Safety and H ealth AdministrationOSHA 3161

Other ResourcesAmerican Hosp ital AssociationAHA report,December 1996,Implementing SaferNeedle Devices(Item No. 196310). Call (800) AHA-2626 to ordercopies.

American Nurses AssociationANA positionpapers on safer need le devices. Call (202) 652- 7130.

EPINet ProgramIncludes manuals and software,data collection tools, and tracking and reportingsystems for surveillance of bloodborne exposures,tracking d evice specific injuries, and evaluating theefficacy of safer need le devices. Call EPINet Pro-gram (800) 528-9803.

Other WebsitesCDC AIDS Clearinghouse -www.cdcnac.org

EPINet - www.med.virginia.edu~epinetCDC Hepatitis Branch - ww w.cdc.gov/ ncidod /diseases/ hepatitis/ hepatitis.htm

OSHA Regional Offices - For more information,contact the bloodborne pathogens coordinator atthe nearest OSHA Regional Office.

Region I(CT,* MA, ME, N H, RI, VT*)JKF Federal Build ingRoom E-340Boston, MA 02203Telephone: (617) 565-9830

Region II(N J, NY,* PR,* VI*)201 Varick StreetRoom 670New York , NY 10014Telephone: (212) 337-2378

Region III(DC, DE, MD,* PA, VA,* WV)Gatew ay Building, Suite 21003535 Market StreetPhiladelphia, PA 19104Telephone: (215) 596-1201

Region IV(AL, FL, GA, KY,* MS, NC,* SC,* TN*)Atlanta Federal Center61 Forsyth Street, SW, Room 6T50Atlanta , GA 30303Telephone: (404) 562-2300

*These states and territories operate their ow n O SHA-app roved job safety and health program s (Connecticut and New Yorkplans cover pu blic employees only). States with app roved p rograms m ust hav e a standard that is identiical to, or at lease aseffective as, the federal stand ard .


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The following is the most recent copy of the Sample Safety Feature Evaluation Form, devel-

oped by the Training for Development of Innovative Control Technology Project (TDICT), Trauma

Foundation, San Francisco General Hospital, 1001 Potrero Avenue, Building 1, Room 300, San

Francisco, CA 94110. OSHA has permission to reprint this form in both traditional and electronic

publishing formats. Since the form is copyrighted, however, extensive use of the form by others

may require additional permission from the copyright holders. Other evaluation forms for different

devices also are available from TDICT.


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GUIDELINESFORTHE USEOFSAFETY FEATURE EVALUATION SHEETS

Coordinators:Determine which products are to be evaluated and provide at least four or more testsamples for each individual evaluating the product. (Each evaluator should have enoughsamples to disassemble and examine the design thoroughly.)

Set up a testing station for each type of device which allows testers to evaluate products ina simulated patient procedure. Provide training dummies (injection pads, oranges, etc.) asnecessary.

Provide visual instructions and demonstrate proper use of each device.

Review the instructions and rating system with each evaluator.

Encourage each evaluator to comment on the sheets and prioritize the questions at the endof the evaluation. This will provide a useful decision making tool and will help alert you tospecific areas of concern which may not have been covered by the questionnaire.

Evaluators:Re-enact all steps of intended or possible procedures performed with the device beingtested.

Attempt to misuse the device and circumvent or disable the safety feature.

Answer each question, including the short answer section at the end. If you do not under-stand a question, please write comments directly on the sheets.

NOTE: Certain assumptions have been made in the development of these forms based oninformation about currently available products. We recognize the likelihood that the idealproduct may not exist.

June1993Training for Development of Innovative Control Technology Project

SAMP

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SAFETY FEATURE EVALUATION FORM

SAFETY SYRINGES

Number of times used:

Please circle the most appropriate answer for each question. Not applicable (N/A) may be used ifthe question does not apply to this particular product.

During Use: agree............disagree

1. The safety feature can be activated using a one-handed technique............1 2 3 4 5 N/A

2. The safety feature does not obstruct vision of the tip of the sharp..............1 2 3 4 5 N/A

3. Use of this product requires you to use the safety feature...........................1 2 3 4 5 N/A

4. This product does not require more time to use than a non-safety device...1 2 3 4 5 N/A

5. The safety feature works well with a wide variety of hand sizes...................1 2 3 4 5 N/A6. The device is easy to handle while wearing gloves......................................1 2 3 4 5 N/A

7. This device does not interfere with uses that do not require a needle.........1 2 3 4 5 N/A

8. This device offers a good view of any aspirated fluid....................................1 2 3 4 5 N/A

9. This device will work with all required syringe and needle sizes...................1 2 3 4 5 N/A

10.This device provides a better alternative to traditional recapping.................1 2 3 4 5 N/A

After Use:

11. There is a clear and unmistakeable change (audible or visible) that occurs

when the safety feature is activated........................................................1 2 3 4 5 N/A

12.The safety feature operates reliably..............................................................1 2 3 4 5 N/A

13. The exposed sharp is permanently blunted or covered after use and prior to

disposal.........................................................................................................1 2 3 4 5 N/A.

14. This device is no more difficult to process after use than non-safety

devices..........................................................................................................1 2 3 4 5 N/A

Training:

15. The user does not need extensive training for correct operation................1 2 3 4 5 N/A

16. The design of the device suggests proper use.............................................1 2 3 4 5 N/A

17. It is not easy to skip a crucial step in proper use of the device....................1 2 3 4 5 N/A

Of the above questions, which three are the most important to your safety when using thisproduct?

Are there other questions which you feel should be asked regarding the safety/ utility of thisproduct?

June1993Training for Development of Innovative Control Technology Project

SAMP

LE