Continued from Page 1

"Generally speaking, people are trying to be in compliance," said Butch de Castro, Ph.D., MSN, MPH, RN, senior staff specialist with the American Nurses Association's Center for Occupational Safety and Health. "It's definitely on the minds of the Occupational Safety and Health Administration compliance inspectors. Not to minimize [hospitals'] goodwill toward their staff, but the legislation certainly added some motivation."

Still, the industry seems to be substantially shy of 100-percent compliance. OSHA, admittedly hampered by its own staffing shortages, issued 673 citations for bloodborne pathogens violations between Oct. 1, 2001 and Sept. 30, 2002, including 93 for failing to incorporate adequate engineering controls. The bulk of the citations went to nursing homes, but hospitals received 111. On the bright side, total bloodborne pathogens violations were down from 768 in fiscal 2001; engineering-control violations were down slightly, from 98.

Already strapped for cash, many hospitals have found it difficult to budget for new, safer sharps, which can easily cost twice as much as traditional needles. Even those facilities willing to upgrade their technology experienced bumpy transitions, especially the larger players.

"The training is extremely challenging," said Barbara DeBaun, RN, director of infection control for California Pacific Medical Center in San Francisco, which employs about 1,300 nurses. "This is not an industry where everyone works full time. We have nurses who work here every other Tuesday. It wasn't so hard with new nurses, but grandfathering people who had been here for a while was definitely challenging."

According to DeBaun, her medical center had jump-started a needlestick prevention program at least a decade before the 2001 compliance date. But for most of that time, the technology lagged behind the intentions.

On board

"They passed this legislation, but they really didn't have the products to back it up," DeBaun said. "There were not a lot of choices. Some devices weren't good-either the quality was poor or they required so much manipulation that people were getting stuck more than they were with the old devices."

As DeBaun said, "Now, manufacturers are realizing this thing is here to stay. They're either going to jump on board or miss the train."

BD, a medical equipment manufacturer based in Franklin Lakes, N.J., is aiming to catch that train. In April, the company announced plans to fully discontinue U.S. sales of many conventional sharps in favor of safety-engineered designs.

BD estimates that U.S. hospitals have transitioned more than 80 percent of their IV catheters, "needleless" IV connectors, blood-drawing needles, winged needle sets and lancet sharps from conventional to safety-engineered designs.

Finding the best device can be a tricky proposition, too.

"The problem with this whole area of equipment," said Sean Clarke, Ph.D., NP, RN, who has led several needlestick studies for the Center for Health Outcomes and Policy Research (part of the University of Pennsylvania School of Nursing in Philadelphia), "is that the solid evidence [comparing pieces of] equipment is really very thin. It falls on the shoulders of hospital folks-infection control managers and nursing directors and so forth-to make calls on which manufacturers and models should be used."

Technology is only one weapon in the battle against sharps injuries. Federal regulators said as much when they drafted the bill to change the bloodborne pathogens standard. Of the six violations for which OSHA is empowered to hand out penalties, only one specifically mentions safety devices. The others have more to do with reporting and non-technological prevention.

Worker-friendly measures

Institutional support could be another weapon against sharps injuries. In their research on rates of needlestick injury and near miss, Clarke and his cohorts have reinforced the importance of institutional support, noting that the safest hospitals are the ones that maintain a worker-friendly environment.

Their 1998 study, for example, showed that using capless-valve secondary intravenous set systems and any type of protective equipment for IV starts or blood draws was associated with a 20 percent to 30 percent decrease in risk for needlesticks and near misses. Compare that with a 50 percent to twofold increase in injuries and near misses associated with poor organizational climate and high workloads.