When Montefiore Medical Center in New York received a $9,000 fine last fall from the federal Occupational Safety and Health Administration for noncompliance with federal requirements to use safety devices to reduce risk and exposure to bloodborne pathogens, other providers took notice.
The penalty, which is under appeal by the hospital, emphasized that even hospitals that have implemented safety devices and found success in creating a culture of safety in the workplace can receive fines for continuing to use conventional devices in some areas when safety alternatives are available.
While Montefiore was not the first provider to be cited since OSHA revised its bloodborne pathogens standards in 2001, the citation broke new ground for its scope, said Jane Perry of the University of Virginia's International Healthcare Worker Safety Center. She said Montefiore's citation and other recent fines by OSHA are evidence of tougher enforcement on the issue by the agency and draw attention to the need for better compliance in the industry.
OSHA also fined Beaver Valley Nursing and Rehabilitation Home and its parent company, Northern Health Facility in Beaver Falls, Pa., for violations of the bloodborne pathogen standards last year. The facility's fine of $92,500, including $70,000 for failure to use safety devices, was the highest for a healthcare provider.
"Awareness has increased as a result of this and we've seen better public dissemination of information (to providers) and through the professional associations in particular," said an industrial hygienist and director of enforcement programs at OSHA. "Employers are required by our standards to evaluate new devices annually and manufacturers are also keeping them informed about what's on the market."
OSHA is one of several government agencies and private organizations that have stepped up efforts in recent months to share technical information and best practices for control of bloodborne pathogens and needlestick hazards and to educate employers including hospitals about improving workplace safety.
In April, the Atlanta-based Centers for Disease Control and Prevention released a workbook to assist healthcare administrators in developing safety programs to reduce the number of preventable injuries to healthcare personnel from needles and other sharp medical instruments. Other such safety initiatives are under way at the National Alliance for the Primary Prevention of Sharps Injuries, or NAPPSI, a group of healthcare providers and medical device manufacturers, and the American Nurses Association. The American Hospital Association has also sent out numerous advisories to its members to draw attention to the issue.
Linda Chiarello, an epidemiologist at the CDC who has developed much of the agency's sharps-safety campaign material for providers, said the CDC is piloting its new workbook with three Massachusetts hospitals that are having success in implementing recommended control and prevention strategies.
"They have found that the baseline assessment activities were very useful and important for giving them a sense of where they are and for targeting interventions," she said.
Since Jan. 1 of this year, OSHA said it has completed 41 inspections of acute-care hospitals and other specialty and psychiatric-care facilities and had at least one additional violation at a hospital of its engineering controls standard, which applies to sharps safety. The number of citations issued by OSHA for bloodborne pathogen standards violations has "increased dramatically" since 2001 when the standard was revised to include the requirement to use safety devices to reduce exposure to bloodborne pathogens, Perry said.
In 2001, the government passed the federal Needlestick Safety and Prevention Act, which was chiefly lobbied by the ANA and amended OSHA's bloodborne pathogen standards that requires employers to use devices that reduce needlestick risk. According to OSHA documents, Montefiore was cited for three violations of the standard: failure to make available or to use personal protective equipment; improper handling of contaminated reusable sharps; and failure to use engineering controls, including more than two dozen specific instances of failure to use safety-engineered devices.
Montefiore's medical residents filed the complaint last fall and urged the AHA in a follow-up letter to reiterate to its member hospitals that conditions similar to those at Montefiore "likely exist at most hospitals in the U.S.," and that "many AHA members currently risk OSHA sanctions." The residents who filed the complaint said there are safer alternatives to many of the devices currently in use in U.S. hospitals, and that nurses, residents, medical students and other hospital staff are placed at unnecessary risk of acquiring potentially fatal infections because of needlestick injuries.
A spokesman for Montefiore told Modern Healthcare that the provider, which includes its 745-bed Moses Division Hospital and Weiler/Einstein Division Hospital in New York, was appealing the violations from OSHA. Montefiore has a "long-standing and exceptional program to protect its employees from occupational exposure to bloodborne pathogens," he said, adding that ongoing discussions and interactions with OSHA, which may include hearings, would "significantly alter any reported preliminary findings."
NAPPSI is campaigning especially to protect medical residents and interns from accidental needlesticks. Executive Director Brad Poulos said the initiative represents an opportunity to catch young residents at the beginning of their careers and educate them for life.
"This is a unique group that is in training, and also they have the potential to stumble through things sometimes as opposed to a physician or clinician who has years of experience," he said. "For a 24-year-old medical student who gets a needlestick at the beginning of their career and (contracts a bloodborne disease) their whole life can change."
The CDC estimates that hospital workers sustain more than 1,000 injuries a day from needles and other sharp devices, and up to 385,000 of these injuries occur each year. At least 65% of the injuries could be prevented by using safer devices and by taking appropriate safety precautions. However, the CDC said the true magnitude of the problem is difficult to assess because information has not been gathered on the frequency of injuries among healthcare personnel in long-term care, home healthcare and physicians' offices.