[Congressional Record Volume 146, Number 136 (Thursday, October 26, 2000)]
[Senate]
[Pages S11041-S11044]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 NEEDLESTICK SAFETY AND PREVENTION ACT

  Mr. REID. Mr. President, on October 17, 1997, 28-year-old Lisa Black, 
a registered nurse from Reno, Nevada, was nursing a man in the terminal 
stages of AIDS when a needle containing his blood punctured her skin.
  Today, Lisa Black is infected with Hepatitis C and HIV.
  She must take 22 pills a day to keep her HIV infection from 
progressing to full-blown AIDS and to delay the effects of Hepatitis C.
  Karen Daley, a nurse for over 20 years and President of the 
Massachusetts Nurses Association, sustained a needlestick injury when 
she reached her gloved hand into a needle box to dispose of the needle 
with which she had drawn blood.
  Karen Daley did everything in her power and took all the necessary 
precautions--including wearing gloves and following proper procedures--
to reduce her risk of exposure to bloodborne pathogens. Her injury did 
not occur because she was careless or distracted or not paying 
attention to what she was doing.
  Karen Daley has good reason to believe that had a safer needle and 
disposal system been in place at her hospital, she would not be sick 
today. According to the CDC, eighty percent of all needlestick injuries 
can be prevented through the use of safer needles.
  I am pleased that today we are passing bipartisan legislation--the 
Needlestick Worker Safety and Prevention Act--that will help reduce the 
incidence of needlestick injuries and illnesses, like those sustained 
by Karen Daley and Lisa Black.
  The Health Care Worker Safety and Prevention Act will strengthen the 
Occupational Safety and Health Administration's (OSHA) standard on 
bloodborne pathogens to encourage greater utilization of newer, safer 
devices in health facilities. It will require the involvement of 
workers who provide direct patient care in determining which safer 
needles and sharps to use in the workplace and a more consistent 
documentation of all needlestick injuries.
  I would like to thank Senators Kennedy, Jeffords, and Enzi as well as 
Representatives Ballenger and Owens for their commitment to this 
legislation. I am pleased that we were able to come together across 
party lines to protect the health and safety of our front-line health 
care workers.
  Mr. KENNEDY. Mr. President, I commend Senator Jeffords, Senator Enzi, 
and Senator Reid for their effective work on this important 
legislation. And I also commend the American Nurses Association, the 
American Federation of Teachers, the Service Employees International 
Union and the American Federation of Federal, State, County and 
Municipal Employees for their effective efforts in supporting it.
  Needle stick protection is vitally important to health care 
professionals and to the many others who come in contact with them. 
Last year, as many as 800,000 health care professionals suffered needle 
stick injuries. Over 1,000 health care workers were infected with 
serious diseases, including HIV, Hepatitis B and Hepatitis C.
  These injuries were preventable, and because of this bill, many 
future needle stick injuries will be prevented. The Center for Disease 
Prevention estimates that this bill will reduce needle stick injuries 
by as much as 88 percent.
  But numbers alone cannot convey the human tragedy of these injuries. 
One of my constituents, Karen Daley of Boston, is the President of the 
Massachusetts Nurses Association and was a registered nurse, a job she 
loved and found very fulfilling. In January 1999, while on duty in an 
emergency room in Boston, Karen was accidentally stuck by a 
contaminated needle. Six months later, she tested positive for HIV and 
Hepatitis C. Fortunately, Karen is in reasonably good health today, 
although she may never again be able to practice her chosen profession 
of nursing.
  The Needle Stick Safety and Prevention Act will help prevent tragic 
accidents like Karen Daley's. This bill requires employers to use, 
where appropriate, safety-designed needles and other sharp devices to 
reduce the potential transmission of disease to health care workers and 
patients. It is not enough to rely solely on one type of control, such 
as disposable needles and other equipment, when safer, appropriate 
medical devices are available and can be effective in reducing the risk 
of contaminated needle injuries.
  This bill also provides that employers must establish an injury log 
to record the kind of devices, and the location, of all needle stick 
accidents.

[[Page S11042]]

This information must be considered when determining appropriate 
devices to be used.
  This bill strikes a critical balance between the reasoned judgment of 
health care professionals on patient safety and OSHA's responsibility 
to protect the health and safety of employees. The bill also provides 
that non-managerial employees and their representatives--those on the 
front lines of service delivery--must participate in determining the 
appropriate devices used in health care settings. Nothing in this bill 
would justify the establishment of an employer-dominated labor 
organization or the bypassing of a collective bargaining representative 
in violation of the National Labor Relations Act.
  I urge all of my colleagues, on both sides of the aisle, to support 
this important legislation.
  Mr. ENZI. Mr. President, I am extremely pleased to speak today at the 
passage of H.R. 5178, the Needlestick Safety and Prevention Act. By 
passing this bill, we ensure a safer workplace for the men and women 
who perform the valuable service of taking care of the people of this 
country. The bi-partisan nature of this bill is a testament to the 
importance of the problem we have addressed and the fairness and 
reasonableness of the solution. I want to commend the hard work of my 
colleagues Senators Jeffords, Kennedy, and Reid and their staff in 
crafting this solution. I also want to recognize the efforts of my 
House colleagues, Representatives Ballenger and Owens and their staff. 
This truly was a bipartisan and bicameral effort and it is a wonderful 
example of what we can accomplish when we all work together.
  We came together over this bill to address the convergence of 
increased concern over accidental needlestick injuries 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) with the 
technological advancements made over the past decade in the many types 
of engineering controls that can be used in the workplace to help 
protect health care workers against sharps injuries. We responded to 
these two factors by drafting a bill that highlights the importance of 
using newer, safer technologies but also allows health care employers 
the flexibility to choose the technology that provides the best 
protection under the circumstances. I have further elaborated on my 
views on the substance of this legislation in the Joint Statement of 
Legislative Intent, submitted with the legislation.
  The passage of this bill today is extremely significant on several 
levels. First and foremost, this bill will save lives because fewer 
health care workers will contract deadly diseases from accidental 
needlesticks. Almost equally as important, it will also reduce the 
number of health care workers who are forced to suffer the living hell 
of not knowing whether they contracted a deadly disease after a 
contaminated needlestick. The health care workers on the front lines in 
hospitals, clinics, and other locations are absolutely critical to this 
country and I hope this bill will provide some peace of mind to these 
individuals.
  Finally, I want to reiterate the significance of the bipartisan and 
bicameral nature of this legislation. I believe this bill brings 
employers and employees together to improve safety in the workplace and 
I hope to be able to work with my co-sponsors and my colleagues in the 
House on more such measures in the future.
  Mr. JEFFORDS. Mr. President, I rise today to express my gratitude and 
delight because of the successful outcome of a bipartisan, bicameral 
effort to protect the health of those who protect the health of others. 
I speak, of course, of our nation's health care workers, who dedicate 
their lives to caring for others. And I am gratified because today we 
have enacted legislation, the Needlestick Safety and Prevention Act, 
which addresses an important health issue threatening our nation's care 
givers.
  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 hospitals. Estimates for all health care settings are that 
600,000 to 800,000 needlestick and other percutaneous injuries occur 
annually. Due to these injuries, numerous health care workers have 
contracted fatal or other serious viruses and diseases, including the 
human immunodeficiency virus, (HIV), hepatitis B, and hepatitis C.
  The statistics paint a bleak picture, but there is hope. There has 
been an explosion of technological development, resulting in a 
substantial increase in the number and assortment of new, and much 
safer, medical devices, such as needleless systems, retractable 
needles, and syringes with needle guards or sheaths. The legislation 
that we have passed today will require employers to identify, evaluate, 
and make use of these devices. As a result, lives will be saved.
  This bipartisan success resulted from a shared concern about this 
health hazard, and a shared belief of how to resolve it, among myself, 
and Senators Enzi, Kennedy and Reid. I must also thank our dedicated 
staffs, and also Representatives Cass Ballenger, and Major Owens, and 
their staffs. Senators Enzi, Kennedy, Reid, and I have also worked 
together on a Joint Statement of Legislative Intent. I ask unanimous 
consent that it be printed in the Congressional Record. I also ask 
unanimous consent that a letter from Charles N. Jeffress, Assistant 
Secretary for Occupational Safety and Health, to Senator Jim Bunning, 
and a letter from Representatives Ballenger and Owens, addressed to me, 
be made a part of the Record.
  I thank all my colleagues who have joined in helping to adopt this 
important legislation. It is a vital step in ensuring worker safety in 
health care settings.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

           Joint Statement of Legislative Intent on H.R. 5178

       The legislation derives from the convergence of two 
     critical circumstances which have a profound effect on the 
     safety of health care workers in the United States. The first 
     circumstance is the increased concern over accidental 
     needlestick injuries 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 
     engineering controls that can be used in the workplace to 
     help protect health care workers against sharps injuries. 
     Because of the convergence of these two circumstances--and 
     because of increasing concern over the public health issue 
     related to the spread of hepatitis C, it is appropriate to 
     take this action at this time.
       Section 1 of the Bill provides the title the ``Needlestick 
     Safety and Prevention Act.'' Section 2 of the bill provides 
     the Congressional findings.
       Section 3 of the bill directly modifies the Bloodborne 
     Pathogens Standard, 29 C.F.R. Sec. 1910.1030, one of the 
     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 Bloodborne Pathogens Standard--the 
     revision in November 1999 to OSHA's Compliance Directive on 
     Enforcement Procedures for the Occupational Exposure to 
     Bloodborne Pathogens (``Compliance Directive'').
       In modifying the Bloodborne Pathogens Standard (``BBP 
     standard'') this bill makes narrowly-tailored changes to the 
     BBP standard. It makes clear in the BBP standard the 
     direction already provided by OSHA in its Compliance 
     Directive: namely, that employers who have employees with 
     occupational exposure to bloodborne pathogens must consider 
     and, where appropriate, use effective engineering controls, 
     including safer medical devices, in order to reduce the risk 
     of injury from needlesticks and from other sharp medical 
     instruments (``sharps''). This bill is not intended to change 
     the existing application of OSHA's BBP standard to all 
     employees who are reasonably anticipated to have occupational 
     exposures to blood or other potentially infectious materials, 
     including health care workers, laboratory personnel, 
     housekeepers and waste disposal employees, among others.
       The bill accomplishes this in several ways. First, the BBP 
     standard is modified so that the definition of ``engineering 
     controls'' at 29 C.F.R. Sec. 1910.1030(b) includes as 
     additional examples of such controls, ``safer medical 
     devices, such as sharps with engineered sharps injury 
     protections and needleless systems.'' Following that step, 
     the BBP standard is amended so that both ``sharps with 
     engineered sharps injury protections'' (``SESIPS'') and 
     ``needleless systems'' are added to the definitions of the 
     standard.
       The citing of these examples should not be considered an 
     endorsement or preference of a specific product or assurance 
     of a specific

[[Page S11043]]

     product's effectiveness. Rather, it is the intent of this 
     legislation to reflect innovation and evolving technology in 
     the marketplace, in particular development in safer medical 
     devices such as SESIPS and needleless systems. This 
     legislation anticipates that hospitals and other employers, 
     in crafting their Exposure Control Plans, will adopt 
     procedures and use devices that have been proven to reduce 
     the risk of needlestick injuries. Employers use their 
     Exposure Control Plans to evaluate appropriate practices and 
     devices for reducing occupational exposure. To focus 
     attention on the need for employers to look at changes in 
     technology, this legislation further modifies the BBP 
     standard by adding to the existing requirements concerning 
     Exposure Control Plans at 29 C.F.R. Sec. 1910.1030(c)(1)(iv). 
     Through these modifications, employers will be required to 
     demonstrate in the review and update of their Exposure 
     Control Plans that their Exposure Control Plans reflect 
     changes in technology and also that they document annually 
     the consideration and implementation of appropriate, 
     commercially available and effective safer medical devices.
       It is through an employer's Exposure Control Plan that 
     engineering controls, including safer medical devices, are 
     considered and deployed in the workplace. It is not the 
     intent of this legislation to disturb OSHA's existing 
     determination that to the extent that specific types of 
     devices, such as catheter securement devices or sharps 
     destruction devices can reduce the risk of needlestick 
     injuries, such devices could be appropriate components of an 
     employer's comprehensive exposure control plan. OSHA 
     expressed its understanding of and agreement with this intent 
     in a letter to Senator Jim Bunning, dated October 13, 2000. 
     The letter is submitted as an attachment to this joint 
     statement.
       It is also not the intent of this legislation to disturb 
     the underlying flexible, performance-oriented nature of the 
     Bloodborne Pathogens Standard. For example, this 
     legislation's reference to 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. Moreover, all of the 
     affirmative defenses available to an employer under the 
     current BBP standard remain intact with this legislation. It 
     is not the intent of this legislation to alter OSHA's current 
     enforcement of the BBP standard in these circumstances. 
     Attached to this Joint Statement is a letter from 
     Representatives Ballenger and Owens, the co-sponsors of H.R. 
     5178, expressing their full support for the views expressed 
     in this statement.
       The drafters are aware that some of the newer most 
     effective technologies are more expensive than others and may 
     create higher costs for health care facilities. Because some 
     entities largely dependent on Medicare and/or Medicaid, such 
     as long term care providers, will be required to comply with 
     this legislation, we encourage the Health Care Financing 
     Administration to examine the costs of the new technologies 
     and consider these costs when determining 
     Medicare reimbursement rates. Similarly, we hope that the 
     states will examine these costs and determine whether the 
     costs should be reflected in the Medicaid reimbursement 
     rates.
       Section 3 of the bill amends the BBP standard in two 
     additional ways. First, it adds a requirement that in 
     addition to the recordkeeping requirements already found in 
     the BBP standard, employers must record percutaneous injuries 
     from contaminated sharps in a sharps injury log. The 
     legislation sets out the minimum information to be included 
     in such a log, namely the type of device used, an explanation 
     of the incident, and where the injury occurred. Employers are 
     free to include other information should they find it 
     helpful. However, this legislation does require that in 
     recording the information and maintaining the log, the 
     confidentiality of the injured employee is to be protected.
       The requirement for a sharps injury log is consistent with 
     current OSHA recordkeeping in two specific ways. First, the 
     sharps injury log requirement does not apply to any employer 
     who is not already required to maintain a log of occupational 
     injuries and illnesses under 29 C.F.R. Sec. 1904. Second, 
     employers are not required to maintain the sharps injury logs 
     for a period of time beyond that currently required for the 
     OSHA 200 logs.
       The sharps injury log is to be used as a tool for employers 
     so that they may determine their high risk areas for sharps 
     injuries and use it as a means to evaluate particular devices 
     that may or may not be effective in reducing sharps injuries. 
     At a House Subcommittee on Workforce Protections hearing in 
     June, representatives of the American Hospital Association 
     testified that many health care settings, particularly 
     hospitals, already have in place some type of ``surveillance 
     system'' for tracking needlestick and other sharps injuries. 
     The AHA witness noted that hospitals have found this to be an 
     effective tool to provide necessary information to help 
     reduce such injuries.
       The second way in which Section 3 amends the BBP standard 
     is by specifying that employers must solicit input from non-
     managerial employees responsible for direct patient care who 
     are potentially exposed to injuries from contaminated sharps 
     in the identification, evaluation and selection of effective 
     engineering and work practice controls. Employers are also to 
     document this in the Exposure Control Plans. The intent of 
     this section is simple--to involve in the selection of 
     engineering controls those workers who are potentially 
     exposed to needlestick injuries.
       Section 4 of the legislation explains that the 
     modifications as delineated by Section 3 of the bill can be 
     changed by a future rulemaking by OSHA on the Bloodborne 
     Pathogens Standard.
       Finally, Section 5 of the bill directs that the 
     modifications to the BBP standard are to be made without 
     regard to the standard OSHA rulemaking requirements or the 
     requirements of the Administrative Procedures Act. 
     Admittedly, preemption of the OSHA rulemaking procedures is 
     not an action to be undertaken lightly. Indeed, the 
     requirements of this bill are driven by the unique 
     circumstances surrounding this narrow and particular public 
     health issue. Although there is no such thing as binding 
     precedent for Congress, it is not the intent of this 
     legislation, through the process used here, to diminish the 
     carefully constructed requirements and procedures for OSHA 
     rulemaking.
       The legislation does prescribe, however, that the changes 
     to the BBP standard are to be made by the Secretary of Labor 
     and published in the Federal Register within six months of 
     enactment and that the changes will take effect 90 days after 
     such publication.
       Submitted October 25, 2000.
       James M. Jeffords, Edward M. Kennedy, Michael B. Enzi, 
     Harry Reid.
                                  ____

         U.S. Department of Labor, Assistant Secretary for 
           Occupational Safety and Health,
                                 Washington, DC, October 13, 2000.
     Hon. Jim Bunning,
     U.S. Senate,
     Washington, DC.
       Dear Senator Bunning: Thank you for your inquiry regarding 
     OSHA's enforcement of the bloodborne pathogens standard and 
     the effect of OSHA's November 1999 Compliance Directive on 
     Enforcement Procedures on Occupational Exposure to Bloodborne 
     Pathogens.
       OSHA has long required employers to protect employees from 
     exposure to bloodborne pathogens through the use of 
     engineering controls, which include sharps disposal devices 
     such as sharps destruction devices. To the extent that 
     specific types of engineering controls such as sharps 
     destruction devices can reduce the risk of needlestick 
     injuries, such controls could be appropriate components of an 
     employer's comprehensive exposure control plan. OSHA has 
     allowed, and intends to continue to allow, employers to use 
     sharps destruction devices to help reduce the risk of 
     needlestick injuries in appropriate circumstances, as set 
     forth in OSHA's November 1999 Compliance Directive.
       It is my understanding that S. 3067, like the House 
     companion bill, is entirely compatible with and closely 
     tracks the language of OSHA's November 1999 Compliance 
     Directive and will not change in any way OSHA's treatment of 
     needle destruction devices or OSHA's enforcement of the 
     bloodborne pathogens standard's obligation that employers use 
     engineering controls.
       I hope that this letter is responsive to your inquiry. 
     Thank you for your interest in occupational safety and 
     health.
           Sincerely,
                                              Charles N. Jeffress,
     Assistant Secretary.
                                  ____

         Committee on Education and the Workforce, U.S. House of 
           Representatives,
                                 Washington, DC, October 25, 2000.
     Hon. Jim M. Jeffords,
     U.S. Senate,
     Washington, DC.
       Dear Chairman Jeffords: Thank you for your sponsorship of 
     The Needlestick Safety and Prevention Act and for your work 
     on this important legislation. We appreciate your sharing 
     with us the Senate Joint Statement of Legislative Intent and 
     want to express our full support for the views expressed in 
     the Senate statement. We want to reiterate that it is not the 
     intent of this legislation to alter OSHA's current 
     enforcement of the Bloodborne Pathogens Standard.
           Sincerely,
     Cass Ballenger,
       Chairman, Subcommittee on Workforce Protections.
     Major R. Owens,
       Ranking Member, Subcommittee on Workforce Protections.

  Mr. JEFFORDS. Mr. President, I ask unanimous consent that the bill be 
read the third time and passed, the motion to reconsider be laid upon 
the table, and that any statements relating to the bill be printed in 
the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The bill (H.R. 5178) was read the third time and passed.

[[Page S11044]]



                          ____________________