New Standards To Prevent Needle-stick Injury

ecent legislation revising the Occupational Safety and Health Administration’s (OSHA’s) regulations on preventing needle-stick injuries (NSI) became mandatory in April 2001 and impacts managed care providers and their members in interesting ways. The most immediate impact requires the consideration of the use of sharps that employ safety features; if alternatives to the use of sharps exist, these too should be employed. Say “occupational hazard” and most people will envision hard hats, safety glasses, and heavy industrial equipment. But carpal-tunnel syndrome and back strain have largely displaced mangled limbs as occupational hazards. Consequently, workplace hazards don’t seem as dangerous. Workers routinely develop healthy respect for certain tools, and circumstances command appropriate precautions. For health care workers, the hypodermic syringe is one such tool. Federal interventions address all types of sharps (any device that has a needle or sharp device attached to it). Syringes, however, are of most importance to managed care pharmacy. Certain questions arise regarding their use. Why are syringes and needles such a problem? In an era in which cost containment is an increasing challenge, what budget impact will new safety devices have? How will the switch to non-injectable alternatives affect the formulary or the multi-tiered payment structure? Will legislation, particularly at the state level, eventually extend to outpatient dispensing of syringes? Should these safety devices be covered for members who use injectable drugs at home now? Unquestionably, syringes and needles save lives and are a staple in our arsenal of medical devices, but we have known for decades that injury with a contaminated needle can transmit disease. For years, our main concern was hepatitis. Today, more than 20 blood-borne pathogens have been transmitted via a needlestick-related injury. Three are of particular concern: hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Table 1, page 350, describes the perils associated with each of these. In 1983, 17,000 workers acquired hepatitis B; today experts estimate that better work practices have reduced the number remarkably—to 800 annually. Better work practices, education, and personal protective equipment have successfully reduced transmission of all blood-borne pathogens over the past decades. They have, however, reached the limits of their efficacy. Changes in equipment design are now necessary to further decrease NSI.