[Congressional Record Volume 146, Number 110 (Monday, September 18, 2000)]
[Extensions of Remarks]
[Pages E1512-E1513]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




       INTRODUCTION OF THE NEEDLESTICK SAFETY AND PREVENTION ACT

                                 ______
                                 

                          HON. CASS BALLENGER

                           of north carolina

                    in the house of representatives

                       Monday, September 18, 2000

  Mr. BALLENGER. Mr. Speaker, I am joined by my colleague and ranking 
member of the Subcommittee on Workforce Protections, the Honorable 
Major R. Owens, in the introduction of the Needlestick Safety and 
Prevention Act. This bipartisan legislation will address an important 
public health issue confronting our nation's health care workers.
  The Needlestick Safety and Prevention Act derives from the 
convergence of two critical circumstances that have a profound effect 
on the safety of health care workers. The first circumstance is the 
increased concern over accidental needlestick injuries suffered by 
health care workers each year in health care settings. ``Needlesticks'' 
is a term used broadly, as health care workers can suffer injuries from 
a broad array of ``sharps'' used in health care settings, from needles 
to IV catheters to lancets. The second circumstance is the 
technological advancements made over the past decade in the many types 
of ``safer medical devices'' that can be used in health care settings 
to help protect health care workers against sharps injuries.
  The Needlestick Safety and Prevention Act would modify the Bloodborne 
Pathogens Standard (29 CFR 1910.1030), one of the leading health and 
safety standards promulgated by the Department of Labor's Occupational 
Safety and Health Administration (OSHA). The legislation builds on the 
most recent action taken by OSHA related to the Bloodbome Pathogens 
Standard--the November 1999 revision of OSHA's Compliance Directive on 
Enforcement Procedures for the Occupational Exposure to Bloodborne 
Pathogens.
  The concern about accidental injuries to health care workers from 
contaminated sharps first entered the public consciousness in the mid-
1980's as concern over the AIDS epidemic grew, along with concern about 
the spread of hepatitis B. By the end of the decade, there were a 
number of documented cases of health care workers contracting the HIV 
virus by accidentally getting stuck with a needle when treating a 
patient. In 1991, responding to many of those concerns, OSHA issued the 
Bloodborne Pathogens Standard, which specified workplace safety 
requirements to protect against occupational exposure to bloodborne 
pathogens.
  Since that time, numerous studies have demonstrated the continuing 
serious risk to health care workers of percutaneous injuries from 
contaminated sharps. In March of this year, the Centers for Disease 
Control and Prevention estimated that more than 380,000 percutaneous 
injuries from contaminated sharps occur annually among health care 
workers in United States hospital settings. Estimates for all health 
care settings are that 600,000 to 800,000 needlestick and other 
percutaneous injuries occur among health care workers annually. At an 
average hospital, workers incur approximately 30 reported needlestick 
injuries per 100 beds per year. While most reported needlestick 
injuries involve nursing staff--laboratory staff, physicians, 
housekeepers, and other health care workers are also injured.
  At a Subcommittee on Workforce Protections hearing in June, Mr. 
Charles Jeffress, the Assistant Secretary of OSHA, testified about the 
most recent federal action to address this issue--OSHA's revised 
Compliance Directive on Enforcement Procedures for Occupational 
Exposure to Bloodborne Pathogens. While the goals of the Bloodborne 
Pathogens Standard are clearly stated, many aspects of the standard 
give employers considerable flexibility in choosing the methods most 
feasible for accomplishing those goals. Thus, the standard directs 
employers to use engineering controls and work practices to eliminate 
or minimize employee exposure to bloodborne pathogens, but it does not 
list or specify particular engineering controls (such as which medical 
devices) that employers must use. This approach allows the rule to take 
into account the continual progress of medical research and technology 
and the diversity of workplaces and workplace operations and processes, 
and allows the employer to detennine what engineering controls will 
provide the best protection.
  A highlight of the revised Compliance Directive, and indeed one of 
the main reasons for its revision, is the emphasis on the need for 
employers to identify, evaluate, and make use of effective commercially 
available engineering controls, including ``safer medical devices'' to 
reduce or minimize the risks of occupational exposure to bloodborne 
pathogens. These devices are also referred to as ``safety devices'' or 
``safe-needle devices,'' but their common element is that they have a 
built-in safety mechanism that reduces or eliminates exposure to the 
needle or sharp. Neither the Compliance Directive, nor the current 
bloodborne

[[Page E1513]]

pathogens standard advocates the use of one particular device over 
another.
  At the Subcommittee hearing, a consensus among all of the witnesses 
was that choosing and using a safer medical device is a complicated 
process for many reasons, not the least of which is that most health 
care settings, particularly hospitals, are enormously complex work 
environments. While no one type of intervention in the workplace will 
completely eliminate the risk of exposure, numerous studies have 
demonstrated that the use of safer-medical devices, when they are part 
of an overall bloodborne pathogens risk-reduction program, can be 
extremely effective in reducing accidental sharps injuries.
  Witnesses also stressed the importance of including health care 
workers in the selection and evaluation of newer devices. This is 
particularly so because there are many types of safer medical devices 
available on the market and using them may involve some adjustment in 
technique on the part of the health care worker. It is also important 
for facilities to have some type of surveillance system, such as a 
sharps injury log, in place to monitor the sharps injuries. This type 
of system is useful both for helping a facility track its high risk 
areas and for evaluating which types of devices are most effective.
  While the revised OSHA Compliance Directive emphasizes ``safer 
medical devices,'' the Bloodborne Pathogens Standard does not include 
safer medical devices in its examples of engineering controls. And so, 
this legislation would include that language in the Bloodborne 
Pathogens Standard.
  The bill requires that the Bloodborne Pathogens Standard explicitly 
state that employers must document in their Exposure Control Plans the 
consideration and implementation of appropriate commercially available 
and effective engineering controls, such as safer medical devices. This 
legislation does not advocate the use of one particular device over 
another and it would not change the flexible-performance-oriented 
nature of the Bloodborne Pathogens Standard.
  In addition, the bill would add two new sections to the Bloodborne 
Pathogens Standard. The first section adds a new part to the Standard's 
recordkeeping section, specifying that employers maintain a ``sharps 
injury log'' for the recording of percutaneous injuries from 
contaminated sharps. Through the use of this log, employers would be 
able to better monitor sharps injuries and by doing so, better evaluate 
high risk areas and the types of engineering controls and devices that 
are most effective in reducing or minimizing the risk of exposure. 
Employers may decide what information is useful and the information 
must be recorded in such a manner as to protect the confidentiality of 
the injured employee. The log would record the type of device used, an 
explanation of the incident and where it occurred. Employers who are 
exempt from maintaining OSHA 200 logs, such as employers with 10 or 
fewer employees, would likewise be exempt from maintaining a sharps 
injury log.
  A second section would be added to the Bloodborne Pathogens Standard 
to specify that employers solicit input from frontline health care 
workers (non-managerial employees responsible for direct patient care) 
in the identification, evaluation and selection of effective 
engineering and work practice controls and to document that 
solicitation in the Exposure Control Plan.
  Sixteen states have already passed some type of safe needle 
legislation over the past two years and many other states are 
considering similar legislation. These state actions result in coverage 
of state public health care facilities and state public employees both 
of which are not reached by federal OSHA, except in those states which 
are OSHA state plan states. I hope that our action on the federal level 
will encourage more states to take similar action--as it is well within 
their prerogatives to do--and adopt the same standards as those we are 
putting forward today for inclusion in the federal Bloodborne Pathogens 
Standard.
  I also want to point out that many of the state bills that have 
passed and been signed into law during the past two years, beginning in 
California, have included a number of explicitly stated exceptions to 
the requirement for the use of safer medical devices. The lack of 
explicitly stated exceptions in this legislation may cause some concern 
for those upon first review. I emphasize there should be no cause for 
concern. The current Bloodborne Pathogens Standard, which we are 
revising through this legislation, does not contain explicitly stated 
exceptions. Therefore, all of the traditional defenses, including 
affirmative defenses available to an employer related to the use of 
engineering controls under the current Bloodborne Pathogens Standard, 
remain in effect even as to the use of safer medical devices. I would 
point out also that the requirement in this legislation for the 
consideration and implementation of safer medical devices is hinged 
upon the ``appropriateness'' and the ``commercial availability'' of 
such devices. Finally, while this may be stating the obvious, it is not 
the intent of this legislation, nor for that matter of the current 
Bloodborne Pathogens Standard, for employers to implement use of any 
engineering control, including a safer medical device, in any situation 
where it may jeopardize a patient's safety, an employee's safety or 
where it may be medically contraindicated.
  Finally, I would like to commend the many groups who have worked so 
diligently on this issue over the past few years and worked so hard to 
reduce sharps injuries for health care workers. The broad consensus we 
have reached on this issue is due in no small part to the work of the 
American Nurses Association, the American Hospital Association, 
manufacturers and many others who represent health care workers. I 
especially want to thank Karen Daley, who testified at the hearing in 
June about her personal experience on behalf of the American Nurses 
Association.
  More than 8 million health care workers in the United States work in 
hospitals and other health care settings. I urge my colleagues to 
support the Needlestick Safety and Prevention Act, which is designed to 
make their work places safer.

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