State Legislatures Address
Issues of Protecting
Health Care Workers From Sharp Medical Instruments
By S. Van McCrary, Health Law & Policy Institute
An important aspect of the pending bills relating to viral hepatitis discussed in Texas Legislature to Address Issues on Viral Hepatitis is that they contain provisions addressing injuries to health care providers from sharp medical instruments.
Accidental sticks from needles and other sharp medical instruments are a hazard to health care providers because of the risk of transmission of serious bloodborne diseases such as HIV, hepatitis B, and hepatitis C. The risk of infection to any particular health care worker from one stick appears low, but the cumulative risk to all health care providers is significant. The U.S. Centers for Disease Control and Prevention estimate that there are about one million accidental needle sticks in the U.S. annually; out of these sticks, approximately one-third of one percent resulted in HIV infection. In 1997, the most recent year for which data are available, 54 persons were confirmed to be newly HIV positive as a result of medical instrument sticks. Among exposed persons, the hepatitis B virus has a seroconversion rate that is 1,000 times greater than HIV.
Health care providers contend that latex gloves and other barriers are inadequate to protect them against the risk of accidental sticks. Numerous "safety needle" technologies exist to lower the risk of accidental sticks. These include retractable needles, needles with automatic shields or internal blunting devices, and needleless systems. Currently, over 250 different safety needles and other devices to reduce accidents and reuse of needles have been approved by the federal Food and Drug Administration. It has been estimated that universal and consistent use of safety needles could eliminate up to 70 to 76 percent of needle stick injuries. At this time, only about 10 percent of the needles sold for use in the U.S. are safety needle designs.
One organization spearheading the drive to promote state and federal laws designed to prevent injuries from sharp medical instruments is the Service Employees International Union, a significant proportion of whose members are health care workers.
Many individual hospitals and some hospital associations oppose adoption of safety needles in routine care on grounds of increased costs. Cost estimates on individual traditional needles vary from six to ten cents. In contrast, for safety needles estimated costs per needle range from 30 to 40 cents. Becton Dickinson and Co., the manufacturer with the largest share of the needle market, estimates that for a 300-bed hospital it would cost an additional $75,000 per year to use safety needles.
Accidental sticks themselves are also currently associated with certain costs, such as post-stick testing for transmissible diseases and preventive medications. It has been estimated that each accidental stick costs about $250 (not including the high costs of treating serious disease, and lost productivity, if the exposed person is infected through the stick). Increased use of safety needles would likely reduce substantially these aggregate costs.
Health care providers argue that even if safety needles do increase overall hospital costs, there are strong moral and public health arguments that they should be used in order to prevent both disease and emotional distress in health care providers.
One additional cost-related factor is the impact of "group purchasing organizations" (GPOs), which are entities that negotiate discount contracts for health care supplies in bulk quantities for major purchasers. Often, GPOs negotiate long-term, exclusive contracts with manufacturers which prevent individual hospitals from seeking better technology (such as safety needles) from other suppliers. There is an ongoing dispute among purchasers, GPOs, and manufacturers regarding the extent to which health care supplies are discounted under such contracts and whether the contracts may constitute restraint-of-trade or violate antitrust laws.
Legislative Activity in the States
Pending legislation in Texas (SB 905 and HB 1646) would require regulations mandating that applicable governmental health care facilities implement needleless systems and sharps with "engineered sharps injury protection," except in cases where the use of such protective devices in the specific medical procedure involved would increase risk to the patient or health care worker. The bills would also add to the Texas Health and Safety Code a statewide plan for control of bloodborne pathogens (including HIV, hepatitis B and C) among health care providers in governmental facilities, and would require that a "sharps injury log" be set up to provide statewide surveillance of needle stick injuries in governmental health care facilities in Texas.
At least one state, California, has already developed a comprehensive worker-protection plan applicable to bloodborne diseases, including mandatory sharps injury protection measures and statewide surveillance for sharps injuries (See Cal. Labor Code Ann. § 144.7; Cal. Health & Safety Code Ann. § 105325 through § 105335).
In addition to Texas, many other states are following California's lead on these issues. At least 16 other states have similar bills pending in current legislative sessions, including Connecticut (SB 1375); Florida (HB 2159 and SB 2084); Illinois (HB 979); Indiana (HB 1557); Iowa (House File No. 407 and Senate File No. 222); Maine (House Paper No. 1532); Maryland (HB 287); Massachusetts (HB 969); Montana (SB 480); New Jersey (Assembly Bill No. 2317); New York (SB 4936 and Assembly Bill No. 7144); Oregon (HB 3416); Rhode Island (HB 6249); Tennessee (SB 1023 and HB 634); Washington (SB 5597, SB 5880, HB 2253, and HB 1800); and West Virginia (HB 2933).
These legislative initiatives have potential to make a significant, favorable public health impact. They should be enacted and implemented for the protection of health care providers and the public at large.