Shot in the arm.

Needle-safety legislation spreading nationally

IN JULY, CALIFORNIA BECAME THE FIRST state to implement new regulations requiring all health care providers to protect workers by using safety-engineered devices for all sharps, including syringes and scalpels. Since then, Tennessee, Maryland, and Texas have passed similar measures. Now 20 more states--and Congress--are considering similar legislation requiring employers to provide needles with retractable sheaths and other protective features. Nationally, at least one provider plans to implement use of safety syringes, regardless of whether national legislation passes.

The Healthcare Worker Needlestick Prevention Act was introduced in the House and the Senate in May. The Centers for Disease Control and Prevention and the National Institute of Occupational Safety and Health are producing alerts similar to California's, OSHA also expects to act soon. "The replacement directive due this fall emphasizes sharps," says Craig Moulton, industrial hygienist with OSHA's Office of Health Compliance Assistance. "Employers should already be doing more and using engineering controls to prevent sharps injuries."

That includes evaluating procedures and safety devices annually or more often to assess new technology that reduces injuries and exposure.

California's regulations added hepatitis C as a bloodborne pathogen, and beefed up existing standards by mandating sharps protection such as needleless systems or engineered sharps devices, exposure control plans covering sharps injuries, and extensively-detailed sharps injuries logs, explains Roger Richter, senior vice president of professional services at the California Healthcare Association.

California provides exemptions, however, in such instances as when employees demonstrate safety devices aren't more effective preventing accidents or no reliable safety data exists. Experts say some safety-engineered sharps may be unsuitable for elderly patients with fragile skin and veins.

"We didn't oppose the bill, which would send the wrong message to facility staff, but were very concerned about cost implications," says Bob Macaluso, director for Medi-Cal and behavioral health programs at the California Association of Health Facilities.

In bulk, safety-engineered devices can cost three to five times more than standard equipment; for smaller providers, they can be 10 times higher. Retractable needle syringes may cost 50 cents, compared to five cents for standard syringes.

In October, Pennsylvania's House Health and Human Service Committee unanimously urged legislation mandating safety needles. Days later, Kennett Square, Pennsylvania-based Genesis Health Ventures announced it's evaluating safety needle options and developing training programs so its 333 ElderCare skilled nursing centers can switch to safety syringes in 2000, followed by its 53 assisted living facilities. Neighbor-Care, its pharmacy division, is negotiating bulk-purchase discounts with device manufacturers, and plans to offer customers discounts and training.