Slow lane to safety
A year later, success of needlestick legislation
still unclear

By Chris Schreiber
July 10, 2000

It’s been a little more than one year since California’s needle safety law went into effect, but experts say it’s still too soon to tell how much protection the law has provided. Other states are closely watching how well the legislation has worked.

The new regulations require safety needles or needleless devices to prevent the transmission of bloodborne diseases, such as HIV and hepatitis B and C.

Varying needlestick legislation has passed in 14 other states and sharps injury protection is being considered in seven more, said Jane Perry, communications director for the International Healthcare Worker Safety Center at the University of Virginia, which tracks needle safety legislation around the nation.

The laws in many other states, including Texas, do not mandate the use of safety devices, only the reporting of sharps injuries and accidental needlesticks. The Texas statute, which passed shortly after California’s and goes into effect Sept. 1 at government-funded hospitals, only requires hospitals to keep a log of such injuries for a report by the state’s Department of Health.

Nursing groups would like to see the reporting of needlestick injuries spur hospitals to take the initiative in implementing safety devices if the data indicates a problem, said Stephanie Tabone, RN, director of practice for the Texas Nurses Association.

"What the law we passed in Texas will do is bring to the attention of nurses and employers safer engineered products," Tabone said. "You’ll start to see people experimenting more with products designed to decrease needlesticks. And hopefully, after the law is enacted, the reporting will give us a clearer picture of how needlestick trends impact us today.

"If we saw there was trending that warranted it, then there would be some move toward mandating specific devices."

In California, most proponents of the federal Bloodborne Pathogen Standard are satisfied with the state’s commitment to enforcing the new regulations. Since August, state health officials have cited more than 30 facilities found in violation of the law, including hospitals, fire and police departments, dental practices, clinics and long-term care facilities.

But inspections and fines have not helped hospitals and nurses across California overcome a host of problems that arose after the law was passed. In fact, some hospitals have experienced an increase in the number of accidental needlesticks in the last year.

"It has the potential to be a success," said Susan Forsyth, RN, nursing practice representative for the California Nurses Association. "But I don’t think one could judge the success of the law until a number of other things happen."

Like most nurses, Forsyth remains optimistic about the future of safety needles. But in California, where the law went into effect last July 1, even optimists are not sure if the protections have helped to reduce the number of needlestick injuries.

Len Welsh, acting deputy chief of health for California’s Occupational Health and Safety Administration, which monitors compliance with the law, said an accurate picture of the law’s success or failure is at least two, maybe three years away. The agency has no data on the number of needlesticks in the state during the last 12 months, but the national Centers for Disease Control and Prevention reports that as many as 800,000 accidental needlesticks are reported by health care workers each year.

In the meantime, health workers have had to cope with imperfect implementation plans that vary from hospital to hospital.

"What we’ve found is that hospitals are moving into compliance with getting safe devices, but that direct care providers were not brought in on the process of selection or were only given a limited number of products from which to select," Forsyth said.

In the worst of such cases, nurses have been forced to use devices they don’t like, devices selected for their cost as much as for their effectiveness, or altogether inferior devices, she said.

Charlene Gliniecki, RN, an occupational health nurse practitioner, director of employee health and safety, and vice president of human resources at El Camino Hospital in Mountain View, Calif., said her hospital has had a "continuous downward trend since 1987" in its incidence of blood and body fluid exposures because of internal safety procedures. But there have been "slightly more exposures related to sharps" this year compared to last year.

"When you introduce new things, there is a learning curve," Gliniecki said.

At Alameda County Medical Center in California, reported incidents have decreased 6 percent to 8 percent per year since 1996, but still 71 incidents were reported in 1999, said Kathi Ruel, RN, a certified occupational health nurse-specialist and employee health manager at the hospital.

Ruel said the new devices were met by "resistance from some practitioners to any kind of switch to a safety device."

Ruel and Gliniecki said proper training was the most critical aspect of implementation, but Forsyth said proper training often is neglected and can lead to injuries – even with safety needles.

Even with the active participation of nurses and staff in the selection process, the marketplace has led to problems, said Susan Vikker, RN, a certified infection control nurse and infection control practitioner at Beverly Hospital in Montebello, Calif. Often, the demand from hospitals has far outstripped the supply from safety device makers.

"We had representatives from nursing and surgery, and we did trials and evaluations on the devices," Vikker said. "In one case, we tried one device, then switched to another, only to have the nursing staff decide they liked the first one better. This is a process of education and re-education, and it takes a lot of time."

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