Implementing Safe Needles Law
In an attempt to implement safe needle laws and comply with state and federal requirements, employers may be cutting corners.
As detailed below, CalOSHA cited a California hospital for:
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» Using an inferior "safer" needle from Becton Dickinson
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» Removing used needles from used blood tube holders
We believe that this is the first time that CalOSHA has cited a facility for using an inferior "safer" needle, and at least the second time they have cited a facility for removing used needles from used blood tube holders.
1. Becton Dickinson Eclipse Blood Collection Product — an Inferior "Safer" Needle
In an attempt to comply with state and federal safer needle requirements, employers may be cutting corners, simply buying the cheapest, and not the best more "passive" safer needle products. In many cases employers may also be limiting their purchases to the products preferred by their Group Purchasing Organizations (GPOs). Many of these devices can be better characterized as "retro-fitted" conventional needles, frequently requiring that workers put their hand or finger(s) into "harms way" to manually activate the safety feature; added onto many of these products almost as an afterthought.
This is why it is so critically important that non-managerial direct care health care workers be involved in the safer needle evaluation and selection process; now a requirement for all workers who are covered by OSHA as a result of passage of the Needlestick Safety and Prevention Act of 2000. There are so many other better, more passive, safer products in the marketplace. It is tragic that these better products are not being considered and used. This first citation illustrates what can happen when a breakdown occurs; when frontline health care workers are left out of, or ignored in the safer device selection process.
This first "Serious" citation involved the use of the Becton Dickinson Eclipse blood collection device. A number of workers have actually gotten stuck in the process of manually activating the safety mechanism. This device was featured in an expose which aired on 60 minutes in February 2001. The device is also known to spray blood when the safety mechanism is activated. At least one worker has been treated for a bloodborne exposure when blood splashed into their eye while activating the "safety" feature.
Under the section of the CalOSHA Bloodborne Pathogens Standard labeled: "Methods of Compliance. Engineering and Work Practice Controls- Specific Requirements. Needle Devices," CalOSHA in their citation stated that:
"The Becton Dickinson Eclipse blood collection device used in the Laboratory (Main and Outpatient) does not meet the definition of a needle with engineered sharp injury protection because it does not effectively reduce the risk of an exposure incident, and causes splashing, splattering and/or generation of droplets of blood in violation of subsection 5193 (d) (2) (D)."
The Becton Dickinson box label previously contained the warning "Activation may result in splatter of blood from the needle. For greatest safety, use thumb technique and activate away from self and others." Curiously, this warning appears to have been removed from newer boxes of the product.
2. Removing Used Needles from Used Blood Tube Holders
The second "serious" citation involves the dangerous, albeit common and age-old, practice of removing used needles from used vacuum blood tube holders. Employers seem to do this to save mere pennies on the cost of a new plastic blood tube holder for each patient. The far safer practice is to discard the needle and blood tube holder together in one piece, and get a new blood tube holder for each patient. In one study reported by the National Phlebotomy Association, 83% of reused blood tube holders where found to be contaminated with blood from previous patients. At least one worker now speaks publicly about how she contracted Hepatitis C as a direct result of a needlestick from this dangerous needle removal practice.
CalOSHA has previously cited at least one other employer on this dangerous practice and has issued a number of letters of interpretation to employers stating that this is a prohibited practice unless there is no feasible alternative to the practice.
Under the section of the CalOSHA Bloodborne Pathogens Standard labeled: "Prohibited Practices," CalOSHA in their citation stated that:
"The employer failed to ensure that contaminated sharps were not removed from devices. In the laboratory (Main and Outpatient) area, there was a practice of removing contaminated phlebotomy needles from the tube holders."
Even though this practice appears to clearly violates even the 1991 Bloodborne Pathogens Standard, to our knowledge, Becton Dickinson, the world's largest manufacturer of these products, has remained silent on this practice, and does not mention in their labeling that removing used needles from used blood tube holders is dangerous, and that this practice should stop.
However, as a result of these letters of interpretation and citations, it now appears clearly illegal to remove used needles from used blood tube holders, unless there is no feasible alternative.
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