OSHA readies inspection program for needle safety

2,600 hospitals, nursing homes notified by letter

The Occupational Safety and Health Administration (OSHA) has notified 2,600 hospi-tals and nursing homes that they may be the subject of a future inspection due to their level of reported needlesticks and other injuries and illnesses in health care workers, OSHA chief Charles Jeffress announced at the Frontline Healthcare Workers Safety Conference in Washington, DC.

OSHA conducts an annual survey of about 80,000 employers in all industries, asking them to submit their OSHA logs and records of injuries and occupational illnesses, explained Jeffress, the assistant secretary of labor for OSHA. From that total, OSHA notified 13,000 locations with the highest rates of injuries and illnesses. Of those, 2,600 were either hospitals or nursing homes, he said.

While the exact time line of the program or a breakdown by type of health care facility was not immediately available, Jeffress said the agency will begin training inspectors in November and may visit a third of those notified.

"There is not a targeted number [of inspections]," he told Hospital Infection Control. "We won’t inspect that entire 2,600. We are going to inspect roughly a third of those on the list. They don’t get advance notice, so people won’t know whether we are going to inspect them or not. If they got a letter from us, they are on the list."

As part of the initiative, OSHA will begin training its inspectors on enforcing its revised compliance directive for enforcing the 1991 bloodborne pathogens standard.¹ In revising its compliance directive last November, OSHA mandated that needle safety device evaluation efforts must be documented at least annually in the exposure control plan.

"They are going to be looking for the exposure control plan to be reviewed and updated," said Jeffress. "They are not going to be looking for a specific device, but they are going to be looking to see if the hospital has reviewed what devices they are using [and] what devices are on the market. We’re not going to be second-guessing — saying use this device, use that device — but we want to make sure that there has been a conscious effort to look at the alternatives and select what is best for that hospital."

If a combination of engineering controls (such as shielded needle devices) and work practice controls (such as eliminating hand-to-hand instrument passing in the operating room) does not eliminate or minimize exposures, the employer shall be cited, OSHA specifies in its enforcement directive. "It’s not just enforcement," Jeffress said. "We do a lot of education, training, and outreach. Our goal is to reduce the numbers, not to issue penalties and citations."

Some explaining to do

HIC asked Jeffress to clarify a gray area in the compliance guidance, which mentions possible citations for hospitals using a safety device even though a "better device" is available. That is not going to be a subjective decision left to the determination of the inspector, he clarified. "It is a decision on the part of the hospital," he said. "If the hospital says, This device would be better, but we’re not going to use it,’ then they are going to have to explain that."

In that regard, there would be every expectation, for example, that hospitals would be using widely available needleless connectors — rather than needles — to join intravenous lines. "We’re not going to pretend that we know everything, and maybe there are [justified] situations where they are not using [safety devices]," he said. "In virtually every type of needle, there have been advances in terms of new devices. If somebody is using the same device today they were using five years ago, the chances are they haven’t kept up with the technology."

Nevertheless, OSHA is not going to issue an approved list of devices, which has proven difficult in California since that state passed its needle safety law. "California law requires an approved list of devices, but they are having a very difficult time with an approved list," he said. "We are trying to avoid that approach nationally because they are all just going to change so quickly, the bureaucracy would never keep up."

In a related development at the safety conference, Mary Foley, RN, MS, president of the American Nurses Association (ANA), said nurses will be urged to blow the whistle on health care facilities that are not purchasing needle safety devices.

"We’re gearing up to help people file OSHA complaints [requesting] inspectors where safety devices are not used," she told conference attendees. "We’re willing to be the whistle-blowers in health care for patient safety and worker safety because it is an appropriate role to be an advocate for the worker and be an advocate for the patient. We know that OSHA doesn’t have the funding to randomly [inspect] all of our facilities, but they will have to respond to people who give them a call."

Noting that the safety devices could prevent 80% of needlestick injuries, Foley said another aspect of the ANA’s agenda is to spur development of new safety devices. "The best devices haven’t been invented yet," she said.

[Editor’s note: The OSHA directive can be accessed on the Internet at the OSHA home page at http://www. osha.gov. Copies also can be obtained from the agency’s publications office by calling (202) 693-1888.]

Reference

1. Occupational Safety and Health Administration. 29 CFR 1910.1030. Occupational Exposure to Bloodborne Pathogens. OSHA instruction CPL 2.103. Field inspection reference manual. Nov. 5, 1999.