Legislation - United States

Introduction

Healthcare workers and the public at large face the potential dangers of infections, illness, and death from accidental needlesticks. The magnitude of this issue is illustrated by the following statistics:

- Injury from a medical needle is reported every 30 seconds in the United States.

- Each year, 600,000-1,000,000 accidental needlesticks are reported in the United States alone. Even more alarming is that knowledgeable experts estimate that only 1/3 of all needlestick incidents are reported.

A Public Health Issue

Diseases resulting from accidental needlesticks can infect anyone involved in the delivery of healthcare, including patients, physicians, nurses, and other caregivers, as well as support personnel ranging from housekeeping to employees of sanitation and environmental service firms.

As many as 20 bloodborne diseases can be spread through accidental needlesticks, including Hepatitis B, HIV (which can lead to AIDS), diphtheria, gonorrhea, typhus, herpes, malaria, rocky mountain spotted fever, syphilis and tuberculosis.

As noted earlier, estimates from various credible sources regarding the number of needlestick injuries do vary. However, it is also generally recognized that actual numbers of such injuries are much higher because many incidents go unreported. All sources agree that an increased number of individuals will die unnecessarily as a result of this common workplace injury and many more will become ill.

The Costs

Devices that can significantly lower the risk of accidental needlesticks save lives and ultimately reduce costs.

For example:

- The California Occupational Safety and Health Standards Board estimates that the use of safety syringes and devices would result in savings of approximately $215 million to $365 million per year in California alone.

- For a single needlestick injury, the direct costs for medical evaluation and follow-up treatment range from $200 to $1,200, according to the American Hospital Association. Costs involved in treating an HIV-infected healthcare worker total more than $500,000.

- According to industry reports, costs for treating accidental needlesticks exceed $3 billion per year in the United States. While these costs are far greater than world market sales for all needles and syringes, they do not include the costs resulting from loss of life, loss of income, civil suit awards, litigation expenses and higher insurance premiums.

In short, safer needle devices are clearly cost-effective.

Public Policy

Due to rising concerns about needlestick injuries, the Federal Occupational Safety & Health Administration (Fed OSHA) originally adopted regulations in 1991 requiring precautions to prevent contact with blood and other potentially infectious materials. In November 1999 Fed OSHA issued a revised compliance directive aimed at strengthening the earlier regulation. Federal legislation directed toward mandating the use of safety devices was introduced in the House of Representatives in May 1999, but by the year's end no federal mandate requiring use of specific devices designed to protect against accidental needlesticks was in place, even though such technologies have existed for several years.

At the state level there has been significant activity, prompted in August 1998, when the California legislature approved a measure (Bill Number AB 1208) requiring the state's Occupational Safety and Health program (Cal/OSHA) to revise its bloodborne pathogen standards to mandate the use of needleless systems and needles with engineered sharps injury protection.

Since California's landmark legislation there has been legislative activity in over 35 states. Texas and Tennessee passed laws in 1999 mandating the use of safer technologies. Twelve additional states passed laws in the first half of 2000.

References

The New England Journal of Medicine, US Department of Health and Human Services, The American Hospital Association, OSHA, Theta Corporation, American Journal of Public, Health Centers for Disease Control, American Journal of Public Health, RN, San Francisco Chronicle, The American Journal of Medicine, The Western Journal of Medicine, American Journal of Emergency Medicine, Infection Control and Hospital Epidemiology, Nursing Management, Advance for Physician Assistants, American Health Consultants, Biomedical Safety & Standards, The Wilkerson Group.

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