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1st
appeared 30 June 1999
UCSF Ready for New Needle Safety Law
As of July 1, all hospitals and health care agencies in California will be required to use
safety-enhanced devices for any task that could possibly lead to bloodborne pathogen
exposure.
 Mandated by the state Legislature, the
regulations are the first in the nation designed to reduce the number of accidental needle
injuries suffered by employees who may be exposed to life-threatening diseases, such as
HIV and hepatitis C. The legislation mandated that the state's Bloodborne Pathogens
Standard (BBP) be revised to require not only that employers convert to safe needle
devices but also create procedures for keeping detailed documentation of needle injuries.
UCSF has been on the leading edge of needle safety, providing safety devices and training
for its workers and students for many years. The School of Nursing has also been a leader,
overseeing a statewide surveillance study of needlestick injuries and developing an injury
log that is serving as a model for other health care agencies, which are now being
mandated to create their own.
Although the regulations are primarily aimed at health care workers, researchers at risk
for exposures to bloodborne pathogens are also required to comply.
In two workshops in June, incoming UCSF house staff were trained in "Skills
Labs" to learn how to use the safe devices that are available at the UCSF-affiliated
medical centers. On July 7, UCSF Environmental Health and Safety (EH&S) will present a
workshop and training to researchers on campus about how they can comply with the
standards and what safety devices are available for their often unique procedures.
Protecting Health Care Workers
Occupational exposure to HIV is of grave concern to health care providers, as is exposure
to hepatitis C, which is the most prevalent bloodborne pathogen currently detected in
source patients, says Ellie Lannen, a nurse practitioner who is coordinator of the
needlestick hotline at UCSF. Workers exposed to HIV can begin immediate post-exposure
prophylaxis (PEP) treatment to avoid becoming infected with the virus; however, no
prophylaxis or treatment is available for the hepatitis C virus.
"Our highest priority is to prevent exposures," Lannen says.
The training sessions for new house staff, which have been offered for seven years,
include lectures on safe practices as well as hands-on practice with each device they will
use in clinical practice. Medical students, as well as graduate research students, receive
separate training on how to avoid bloodborne pathogen exposure.
UCSF already makes available a variety of safe devices, including resheathing syringes and
needles; resheathing butterfly needles for drawing blood; needles with hinged, one-handed
recappers; retractable needles; individual retractable lancets; safety IV catheters; and
needleless IV systems.
"We have the new law's components in place already," Lannen says. "The
Chancellor's Advisory Board on AIDS and Emerging Infections, which makes recommendations
on safety procedures for all UCSF-affiliated medical centers, made an institutional
decision in 1991 to use safety devices for phlebotomy and IV catheters. Although safety
devices were definitely more expensive eight years ago, the Board felt it was money well
spent to protect employees from becoming infected with pathogens such as HIV, hepatitis C,
and hepatitis B."
Exposures to bloodborne pathogens are costly not only in terms of health but also in terms
of testing and treatment. In fact, a 1995 study found that a single sharps injury that
doesn't lead to infection can cost up to $1000. A single case of an injured health care
worker acquiring hepatitis C may have a lifetime cost of over $600,000.
 Lannen, who has tracked possible exposures via needlesticks, spills,
and splashes at UCSF since 1993, says there has been a significant drop in high-risk
exposures since the use of safety devices was initiated. In 1998, UCSF's hotline logged
175 needlesticks at the Parnassus campus and 60 at Mount Zion, she says.
Health care workers and researchers are exempt from the new regulations if no safety
device exists for their purposes or if the standard device works better. For example, not
many engineered safety devices are available for dental procedures, Lannen says. However,
the law does mandate that those seeking an exemption justify in writing why they don't use
a safety device.
Protecting Researchers
"We're well into implementing the new standard on the research side," says Glenn
Funk, Biosafety Officer for UCSF. "We're taking a different approach than the
clinical side. The uses of sharps as research tools are often unique and there is a wide
range of agents and materials that pose risks."
Funk says that although researchers sometimes do accidentally stick themselves with
needles, they are more at risk than clinicians for other types of exposures. "A very
small percentage of exposures reported to the needlestick hotlines are research
exposures," Funk says. "We usually see a quarter to a half of research exposures
from punctures with needles but we see a greater percentage of splashes, spills and
squirts to the face and
eyes, which is much less common in the clinical setting."
The July 7 safe sharps workshop and training session will provide researchers with an
awareness of what devices are available on the market, as well as demonstrations of how to
use the devices properly. "I have invited all the major manufacturers of devices and
asked them to bring their full line of safety sharps and information with them," Funk
says. The manufacturers' representatives will be available all day to discuss sharps use
with investigators and their staff and students. Funk will offer concurrent thirty-minute
training sessions on the new BBP standard that will count as annual bloodborne pathogens
retraining.
Sharps Injury Control Program
Another part of the new BBP standard is the logging of exposures and injuries. UCSF has
created a model for logging these injuries as a result of its leadership in the Sharps
Injury Control Program (SHARPS), which was mandated in 1996 by the California Legislature
in response to public concern about sharps-related hazards to health care workers. The
bill mandated that a multi-year pilot surveillance study be undertaken statewide and
Marion Gillen, an assistant professor in the School of Nursing, undertook the task of
principal investigator, working in conjunction with the California Department of Health
Services, Occupational Health Branch.
The goals of the SHARPS program are:
To identify the degree of risk associated with
various types and brands of medical devices and procedures and to make recommendations
about the relative safety of sharps devices;
to reduce bloodborne disease risk by encouraging the
development and use of medical devices designed to maximize worker and patient safety; and
to serve as a clearinghouse for evaluations of
safety-enhanced devices for preventing sharps injuries.
It is expected that the resulting data will allow
health care institutions to benefit from each other's experiences and encourage medical
device manufacturers to develop safer products, Gillen says.
"We're asking people to submit their sharps injury logs to us on a quarterly or
yearly basis," says Gillen. "We are in the process of collecting data and will
be delivering a report to the State Legislature in December of 1999."
The Sharps Injury Log that Gillen and her colleagues created complies with the revised
Bloodborne Pathogen Standard. It asks for the device and brand involved, whether it was a
safety device, if the injured employee thought a safety device would have prevented the
injury, and if the injured employee thought any other engineering, administrative or work
practice control could have prevented the injury. The UCSF needlestick hotline revised its
injury log in January to include these additions.
"California is the first state to have something like this in place," says
Gillen. "People are looking to us for guidance in how they can do it."
Links:
UCSF Environmental Health and Safety
SHARPS Injury Control Program
California OSHA
Training for the Development of Innovative Control
Technologies
Related Daybreak stories
Accidental Needlesticks
Still a Concern in Medical School Training
SFGH Sets National Model for
HIV Prevention Intervention
New Hotline for Advice on
Occupational Exposures to HIV and Other Blood-Borne Diseases
Source: Paula Murphy, Daybreak
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