[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.
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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.
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