Enforcement of Rules on Needlesticks Stepped Up in Four Southeastern States

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Enforcement of federal rules aimed at preventing needlesticks and other injuries from sharp medical tools is stepping up in four southeastern states, the Occupational Safety and Health Administration announced April 25.

The no-notice inspections are aimed at medical care facilities that probably have never had an OSHA inspection because the businesses were too small, with fewer than 10 employees, to attract OSHA's notice, Ben Ross, the assistant Region 4 administrator for enforcement programs, told BNA April 26.

These businesses include ambulatory surgical care centers, freestanding emergency care clinics, and primary care medical clinics that provide acute, chronic and emergency care on an as-needed or walk-in basis.

In line for the increased inspections are facilities in Alabama, Florida, Georgia and Mississippi, the states in OSHA's Region 4 that do not have state-run OSHA programs, Ross said. Each of the region's nine field offices--three each in Florida and Georgia, two in Alabama, and one in Mississippi--will conduct at least 10 inspections focused on enforcement of the needlestick and sharps rule through September 2012.

Hospitals Excluded

Hospitals are not included in the plan because many have undergone OSHA inspections, Ross said. However, if the inspections of the smaller clinics indicate there may be problems at larger facilities, there could be inspectors heading to hospitals.

The decision to start the “special emphasis” inspections was not brought on by reports of increasing needlestick problems. Rather, “It is preventative,” Ross said.

The main purpose of the inspections is to correct needlestick problems, not penalize the clinics, Ross said. Inspectors will also check for compliance with other OSHA rules and retain the right to recommend a penalty if they believe a violation warrants a sanction.

Tennessee Campaign

The decision to emphasize the inspections was based on the success of a similar effort by Tennessee's state-run workplace safety agency, Ross said.

Jan Cothron, Tennessee OSHA's health compliance manager, told BNA April 27 that prior to 2005, sharps injury prevention rules were widely ignored in the state. “We found problems everywhere they were using sharps,” Cothron said. Among the violations were people reaching with their hands into containers of dirty surgical instruments and not correctly using the anti-stick devices on syringes. “There were a lot of needlesticks that were preventable,” she said.

With the start of the program in 2005, Tennessee OSHA used seminars and enforcement to change practices, Cothron said. Since 2005, sharps injuries in Tennessee hospitals declined 21 percent, and injuries in surgery centers decreased 26 percent.

The problems were not unique to Tennessee. A 2007 study by Columbia University found nurses working outside hospitals often did not know how to report needlestick injuries (38 OSHR 8, 1/3/08).

Needlestick injuries are primarily covered by two standards, Bloodborne Pathogens (29 CFR 1910.1030) and Recording and Reporting Occupational Illnesses and Injuries (29 CFR 1904).

Federal rules aimed a preventing medical accidents with needles and other sharp instruments have been in place for a decade (31 OSHR 63, 1/25/01).

Nationwide Decline

While nationwide needlestick statistics are not kept in detail, the annual number of needlestick accidents is estimated to have declined from around 1 million in 2000 to around 500,000 in 2010, said Bill Borwegen, director of health and safety for the Service Employees International Union, which represents many healthcare workers.

Borwegen suspects the decline may not have been so deep at smaller medical facilities because they were not inspected. In hospitals, he said, there may also be a decline in adherence to the law in operating rooms.

Beyond enforcement of the safety standard, Borwegen said, accidents could be prevented if hospitals and clinics used safer devices, such as a syringe with a needle that automatically retracts after one use.

By Bruce Rolfsen