by Leigh Morgan
July 8, 1998

Engineers have built a better needle, but that doesn’t mean hospitals will buy it. As a result, lawmakers, state officials, healthcare leaders, and union organizers across the country are taking steps to publicize the dangers of conventional needles and to mandate safer needles in all health settings.

Some 800,000 needlestick injuries are reported by healthcare workers each year, according to the national Centers for Disease Control and Prevention. Roughly half of these injuries are to nurses, but any worker who handles blood products, biological samples, or contaminated materials for disposal is at risk for exposure to bloodborne illnesses such as HIV, hepatitis B, and hepatitis C.

The chance of infection from a hollow-bore needlestick involving contaminated blood is only about 0.4 percent for HIV, said Stephanie Tabone, RN, director of practice for the Texas Nurses Association (TNA). But the risk can reach 30 percent for hepatitis B and 10 percent for hepatitis C.

Technological marvels

Safer needles already exist, including various retractable and self-sheathing models. "There have been more than 1,000 U.S. patents issued during the past decade in the area of safer needle technology," said Lynda Arnold, RN, founder and president of the National Campaign for Healthcare Worker Safety. "Dozens of these devices are widely available today and have been shown to significantly reduce the risk of exposure to bloodborne pathogens." Arnold is working to persuade every hospital in the United States to make a written commitment to using safety devices in place of conventional blood-drawing needles and IV catheters. At least 22 Texas hospitals have already agreed.

Arnold’s goal is based on personal tragedy. In 1992, she contracted HIV following an accidental needlestick from a catheter needle. Arnold, then 23, was caring for an HIV-positive patient in the intensive care unit at a community hospital in Lancaster, Pennsylvania. The patient moved suddenly, bumping into Arnold’s arm and forcing the contaminated needle into her left palm. Had the needle been a newer model designed for safety, it might not have penetrated her skin.

"No matter how cautious [healthcare workers] are, they must use the equipment that the hospital provides to them," Arnold said. She believes hospital administrators and those making purchasing decisions have a responsibility to provide their employees the safest medical devices available.

A better product

The price of replacing standard needles with safety devices can be steep, however. Safety needles can cost more than 50 cents each, up to 10 times as much as conventional models, said Matthew T. Wall, JD, associate general counsel for THA-The Association of Texas Hospitals and Healthcare Organizations .

But sometimes hospitals don’t even have the opportunity to buy the devices. "In Texas, it’s come to our attention that there may be some difficulty bringing needlestick technologies to the marketplace," Tabone said. The problem stems in part from the strategy of big purchasing groups to restrict the types and brands of products hospitals buy. If the purchasing group isn’t contracting with the manufacturer of a new technology, that technology may get overlooked, Tabone explained.

The result is that many new devices fail to reach hospitals for evaluation. "It’s like how we’ve all heard there’s a better battery out there that never goes dead, but none of us can have it," Tabone said.

The TNA recently filed a letter with the Department of Justice expressing concern that purchasing groups may be stifling competition and hampering the development of better needle products. "We want to make sure these big purchasing groups don’t limit the availability of safer technologies to RNs and healthcare workers," she said.

Conventional risks

Meanwhile, conventional needles remain "inherently unsafe," said Bill Borwegen, health and safety director for the Service Employees International Union, which represents a half million healthcare workers. "The Food and Drug Administration refuses to ban typical needles, and hospitals refuse to buy these safer products in quantities needed to protect workers. So it begs the question ‘Do these employers care about their employees?’ "

"We’re very concerned about employee safety, and we take it very, very seriously," Wall said. "The people I’ve talked to in infection control and purchasing are aggressively interested in looking at new technologies." Wall said hospitals have the ability to amend contracts with group purchasing organizations to include new products—although there may be minor penalties for doing so.

Mandating safety

Two bills pending in Congress would require hospitals nationwide to use safety needlestick devices as a condition for participating in Medicare. The bills, together known as the Healthcare Worker Protection Act, have the support of the American Nurses Association and other healthcare groups. Senate Bill 2055 by Sen. Harry Reid, D-Nevada, would earmark $5 million to set up a Food and Drug Administration task force to determine the relative safety of various needlestick devices. The bill is a companion to a nearly identical bill introduced in the House last year as HR 2745, by Rep. Fortney "Pete" Stark, D-California.

But, Borwegen said, "A lot of forces out there are preventing workers from getting safer needles." Some needle manufacturers generate 90 percent of their sales from conventional devices and only 10 percent from safety devices, according to Borwegen. "It’s as if General Motors sold cars with brakes and without brakes."

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Who Gets Injured?

Between 1993 and 1995, the Exposure Prevention Information Network (EPINet) tracked 664 needlesticks and sharps injuries cases reported by healthcare workers employed at 77 hospitals.

Nurses were by far the largest group of workers represented in the total figure, with 49 percent of the needlesticks;

Physicians, including interns, accounted for 16 percent;

Phlebotomists for 8 percent;

Paramedics for 1 percent; and

Respiratory therapists and housekeeping staff for 3 percent each.

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