Sharper images
Despite needlestick law, nonsafe sharps practices still go unchecked

By Ed Frauenheim
February 12, 2001
Photo: Courtesy of the White House

When Lynda Arnold, RN, contracted HIV from an IV needlestick in 1992, it turned her life upside down.

"I was engaged to be married. I was 23 years old; I had my whole life ahead of me," Arnold said. "It was a death sentence at the time."

Arnold has survived, however, and devotes her professional life to preventing other health care workers from facing the same trauma. In the early 1990s, she spearheaded a campaign for hospitals to voluntarily adopt safer sharps that decade.

"It’s been nine years since I’ve been in this battle," Arnold said, "and we still have a long way to go. I heard for years, ‘Until it’s mandatory, nothing’s going to happen.’ "

Many other safer-needle advocates such as Lisa Black, RN, also HIV-positive after a needlestick accident, were instrumental in making safer needles mandatory.

President Clinton signed the Needlestick Safety and Prevention Act in November. The law requires federal hospitals and clinics to use safe needles and to gather comments on safer sharps from nurses and other front-line workers.

Some hospitals have been trying to do this, but the new rules mean many institutions must develop ways to solicit employee input, handle the short-term cost spikes from buying safer sharps and pinpoint the most hazardous work areas.

Few other health care workplace issues loom as large as the life-threatening danger of a needlestick injury.

The American Journal of Nursing reported that the number of needlesticks has held steady at about 1 million per year, with 16,000 involving HIV-infected blood and 12,000 involving exposure to hepatitis B and C. The American Nurses Association estimates that 1,000 or more health care workers contract serious infections each year from contaminated sharps.

Although the Occupational Safety and Health Administration has required hospitals to use safer needles since 1999, the Needlestick Safety and Prevention Act stipulates that in every state, front-line employees in federal hospitals must ensure that new safety-engineered needles are in use at all times.

The CDC estimated in March that safer devices could potentially prevent 62 percent to 88 percent of sharps injuries. If someone is stuck despite the safer needles, employees must report the incident. They also must report to OSHA instances when employers still use the old needles, Arnold said.

Some hospitals have balked at buying the devices, said the American Nurses Association, which estimates that fewer than 15 percent of hospitals have been using safer sharps.

Even if everyone follows the new law to the letter, the battle to protect nurses from contaminated sharps will continue, said Karen Daley, MPH, RN. The federal law doesn’t cover state and municipal public hospital settings or the tendency of pharmaceutical firms to package their products with nonsafe devices.

Daley proudly points to Massachusetts as a role model. The Massachusetts needlestick law passed last summer effectively has more teeth than the federal law, because hospitals’ licenses are tied to compliance with safe sharps regulations. Under the federal law, OSHA is authorized only to fine and issue citations to violators.

"I’m hoping the hospitals and the employers will do the right thing for the right reason," Daley said.

Despite the restrictions, she is optimistic that the new law will mark a happier era in worker safety. "I’m hopeful this is going to have a ripple effect," said Daley, who travels across the country and speaks to nurses.

Her own experience drives her. In July 1998, a needle stuck her while she was disposing of a second needle in a sharps container. She learned that she’d contracted HIV and hepatitis C around the holidays.

At first, the HIV-positive diagnosis concerned her most, but she quickly learned that hepatitis C was the deadlier disease. In otherwise healthy people, it can destroy the liver in 20 to 30 years, Daley said, but in combination with HIV, that length of time can shrink to just five or 10 years. A cure for hepatitis C remains elusive.

Fighting both diseases has taken a huge toll on Daley. She went on a triple drug regimen for HIV, but that worsened the hepatitis C. She took daily doses of interferon and ribavirin to combat the liver infection, but that led to a series of debilitating, difficult side effects: She lost a third of her hair, dropped from 135 pounds to 116 pounds, battled nausea and fought fatigue so numbing she could barely walk up stairs.

At the end of a year on the hepatitis drugs, her liver disease went into remission. But by then her bone marrow and T-cells were so ravaged that she had to take a new drug, Bactrim (trimethoprim-sulfamethoxazole), to avoid developing AIDS.

"To say it was a rough therapy is an understatement," Daley said. She feels better these days, but her HIV drug treatment puts her at greater risk for premature heart disease and diabetes. AIDS remains a threat, too.

"The greatest concern for me now as for many HIV patients is the danger that I could become resistant to the drugs," she said. "If they stopped working for me, my illness could actually progress and I could die from AIDS."

Daley, also the president of the Massachusetts Nurses Association, is determined to help others avoid her fate.

"There’s no reason for people to go through what I’ve gone through for the last two years," she said.

Devices that reduce the likelihood of needlesticks have been available since 1987, when Norma Sampson, PHN, RN, designed and marketed a Safety Lock syringe, which has a shield to prevent the hypodermic needle from sticking health care workers.

Although a major manufacturer licensed and built Sampson’s syringe, she said the sharps industry as a whole has overpriced safe sharps and failed to promote them aggressively.

"Initially, I think they dragged their feet," Sampson said. She finds it sad that it took an act of Congress to give nurses the protection they deserve, but she’s glad the politicians did what they did.

"I feel that [now] the law is signed, my work is finally done," said Sampson, who won a California NurseWeek Nursing Excellence Award for Innovation in 1999.

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California and Massachusetts will be ahead in terms of figuring out the logistics, because they already have passed needlestick safety laws.

Kaiser Permanente’s California facilities, for example, have been subject to an "input from front-line workers" regulation for sharps since 1999. Kaiser spokesman Jim Anderson said the health care giant used a formal process.

"They had the front-line people test the products and complete evaluation forms," he said. "What did they think about product X, what did they think about product Y."

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Another hospital that won’t be changing its practices much is Provena Covenant Medical Center in Urbana, Ill.

Lynda Creutzburg, RN, is the infection control and employee health coordinator for the facility. Safer engineered syringes, phlebotomy devices and IV systems have been standard there for years.

Creutzburg also has kept a log of sharps injuries, although until now she hasn’t recorded the type and brand of device involved. She has made a habit of checking in with nurses and other front-line employees about the best equipment available. Nurses on committees have evaluated devices and suggested changes at an annual safety fair for the past several years. In the wake of the law, Creutzburg said that Provena now plans to solicit nurses’ comments on sharps during annual training days.

"We’re not totally sure what it’s going to take to be in compliance, but we think we’re in compliance," Creutzburg said. "If [OSHA] could put out some guidance to us that would be helpful."

An OSHA official said those guidelines haven’t been written yet, but she added that acceptable staff input will vary depending on the size of the facility. In other words, she said, a 5,000-employee hospital won’t be expected to poll every worker.

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call-out box for South Central edition Feb. 19:

You don’t have to persuade Susan Parnell, MPH, RN, to ask nurses and other front-line employees about safer-engineered devices. Parnell, who handles infection control at the University of Texas-Houston Health Science Center, details a horror story about leaving workers out of the loop.

"You can pay an awful lot of money, as we did on what we thought was a safer sharps dispenser container, only to see our needlesticks increase," she said.

On the other hand, Parnell found that giving workers a choice did not necessarily lead to the use of the most expensive device. Nurses evaluated two types of syringes, one costing three times the traditional needle and one costing 10 times as much. The more expensive device involved "single-hand" action rather than a needle sheath that required two hands. The nurses preferred the cheaper syringe because they could more easily switch needles. The more expensive model tended to spray tiny droplets of blood into the air.

Parnell’s greatest concern is the difficulty of training a large staff on the use of ever evolving safety devices. The Health Science Center has 9,000 students and employees, about 65 percent of whom are caregivers.

"Any time you have to train that many people, it’s a huge task," she said. "If you have a number of devices, you have [to train] on each of them."

End of cuttable section from California and Midwest editions.

When she speaks to groups of nurses, Daley finds that 90 percent have experienced needlesticks, but only 50 percent of those stuck have followed through with reporting. Nurses may not report because they’re busy, unsure of the proper procedure or fearful of losing their job. But the risk of not reporting is too high, Daley said. She points out that hepatitis C, a fatal disease, can show no symptoms for 10 years.

"This is about taking care of yourself," Daley said. "It goes way beyond whether you’re going to be blamed. We do it for everyone else but ourselves."

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