The Needlestick Safety and Prevention Act (H.R. 5178) mandated that the 1991 Bloodborne Pathogens Standard (29 CFR 1910.1030) be revised to strengthen the requirements related to the use of safety-engineered sharp devices. OSHA published the revised standard in the Federal Register on January 18, 2001; it became effective April 18, 2001. Below we review the major provisions of the law and discuss some frequently asked questions about it.
Provisions of the Law:
- Requires health care employers to document in their exposure control plan that they have evaluated and implemented safety-engineered sharp devices and needleless systems in order to reduce employees' occupational exposure to HIV, hepatitis C and other bloodborne diseases; and
- Requires that exposure control plans be reviewed and updated at least annually to reflect changes in sharps safety technology.
- Requires each health care facility to maintain a sharps injury log with detailed information on percutaneous injuries (including type and brand of device involved in exposure incident, department where exposure occurred and an explanation of how it occurred).
- Requires employers to solicit input from non-managerial (e.g., frontline) health care workers when identifying, evaluating and selecting safety-engineered sharp devices, and to document this process in the exposure control plan.
- Expands the definition of "engineering controls"to include devices with engineered sharps injury protection.
Frequently Asked Questions:
- Which health care facilities are covered by the law?
The federal law and the revised Bloodborne Pathogens Standard apply to any facility under federal OSHA where employees may be exposed to blood or other potentially infectious material, such as hospitals, long-term care facilities, clinical laboratories, physicians' offices and dentists.
- What has our facility done since this law was enacted?
- Exposure control plan is reviewed annually.
- Safer devices have been selected, evaluated and implemented.
- A Safer Device Work Group has been established for several years and meets quarterly.
Preventing Sharp Injuries
Work practices to prevent sharps injuries are typically presented as a list of specific practices to avoid (e.g., recapping used needles) or to use (e.g., sharps disposal containers). As data on the epidemiology of sharps injuries has shown, the risk of a sharps injury begins at the moment a sharp is first exposed and ends once the sharp is permanently removed from exposure in the work environment. Therefore, to promote safe work practices, healthcare personnel need to have an awareness of the risk of injury throughout the time a sharp is exposed and use a combination of strategies to protect themselves and their co-workers throughout the handling of the device. The following is a suggested list of practices that reflect this concept and can be adapted as necessary to any healthcare environment.
Work Practices to Prevent Sharps Injuries throughout the use and handling of a device
Before the beginning of a procedure that involves the use of a needle or other sharp device:
- Ensure that equipment necessary for performing a procedure is available within arms reach.
- Assess the work environment for adequate lighting and space to perform the procedure.
- If multiple sharps will be used during a procedure, organize the work area (e.g. procedure tray) so that the sharp is always pointed away from the operator.
- Identify the location of the sharps disposal container; if moveable, place it as near the point-of-use as appropriate for immediate disposal of the sharp. If the sharp is reusable, determine in advance where it will be placed for safe handling after use.
- Assess the potential for a patient to be uncooperative, combative, or confused. Obtain assistance from other staff or a family member to assist in calming or restraining a patient as necessary.
- Inform a patient of what the procedure involves and explain the importance of avoiding any sudden movement that might dislodge the sharp, for successful completion of the procedure as well as prevention of injury to healthcare personnel.
During a Procedure That Involves the Use of Needles or Other Sharp Devices:
- Maintain visual contact with the procedure site and location of the sharp device.
- When handling an exposed sharp, be aware of other staff in the immediate environment and take steps to control the location of the sharp to avoid injury to oneself and other staff.
- Do not hand-pass exposed sharps from one person to another; use a predetermined neutral zone or tray for placing and retrieving used sharps. Verbally announce when sharps are being placed in a neutral zone.
- If the procedure necessitates reusing a needle multiple times on the same patient (e.g., giving local anesthesia), recap the needle between steps using a one-handed technique or a fixed device that enables one-handed recapping.
- If using an engineered sharps injury prevention device, activate the safety feature as the procedure is being completed, observing for audio or visual cues that the feature is locked in place.
During Clean-up Following a Procedure:
- Visually inspect procedure trays, or other surfaces (including patient beds) containing waste materials used during a procedure, for the presence of sharps that may have been left inadvertently after the procedure.
- Transport reusable sharps in a closed container that has been secured to prevent the spillage of contents.
- Visually inspect the sharps container for hazards caused by overfilling.
- Make sure the sharps container being used is large enough to accommodate the entire device.
- Avoid bringing the hands close to the opening of a sharps container; never place hands or fingers into a container to facilitate disposal of a device.
- Keep the hands behind the sharp tip when disposing the device.
- If disposing of a sharp with attached tubing (e.g., winged steel needle), be aware that the tubing can recoil and lead to injury; maintain control of the tubing as well as the needle when disposing the device.
- Visually inspect sharps containers for evidence of overfilling before removal. If a sharps container is overfilled, obtain a new container and use forceps or tongs to remove protruding devices and place them in the new container.
- Visually inspect the outside of waste containers for evidence of protruding sharps. If found, notify safety personnel for assistance in removing the hazard.
- Keep filled sharps containers awaiting final disposal in a secure area.
Improperly Disposed Sharps:
- If an improperly disposed sharp is encountered in the work environment, handle the device carefully, keeping the hands behind the sharp at all times.
- Use a mechanical device to pick up the sharp if it cannot be performed safely by handSharps Associated Injuries:
- Report all sharps associated injuries via the EH&S on line report form
- Report to Employee Health for evaluation.
Selecting Safer Devices
Education and Training of Healthcare Professionals