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They are armed with latex gloves, goggles and face masks. Many have been vaccinated against communicable infections. A box for biohazardous waste is placed alongside the tools of their trade.
But some say that's not enough to protect them against the risks of their profession.
It sounds like a page from science fiction, but it is reality for American health care workers. The risk of infection through needlestick with deadly diseases such as Hepatitis B or C, or HIV, the virus that causes AIDS, is inherent in many health care job descriptions. Nurses and phlebotomists who routinely use needles to draw blood and start intravenous catheters are especially susceptible.
Despite the risks, it is widely agreed that many needlestick injuries are unreported. Statistics gathered through the International Health Care Worker Safety Center in the University of Virginia Health Sciences Center found underreporting to be as high as 39%. When a needlestick injury occurs, a health care worker may make a decision not to report the injury for a variety of reasons.
These reasons are motivated by different emotions, and they range from inconvenience to fear of losing or endangering one's livelihood if it were known that the worker was stuck by a needle used on an infected patient, said Dr. Janine Jagger, director of the Charlottesville, Va.-based International Health Care Worker Safety Center. Often workers make their own risk assessments.
"If they think it's a low-risk event, they may not report it. . . .The hospital needs to adopt a safety philosophy. . .that reporting is an important part of promoting safety in the hospital, that the hospital will use the information to make the environment safer," Dr. Jagger said.
To better track such health care risks, Dr. Jagger developed a computer system called EPINET that records pertinent data and allows users to input and exchange information about needlesticks and other incidents.
By not documenting a needlestick, no matter how low the risk may appear at the time of the injury, health care workers who try to claim occupational infection years later may find the claim denied, risk managers say. The worker who does not report is also unable to receive counseling and education about post-exposure treatments that curb the risk of infection when prescribed immediately after injury -- a measure that many hospital risk managers find reduces the number of claims filed because fewer workers become infected.
Sara Critchley, a nurse with the federal Centers for Disease Control and Prevention hospital infections program in Atlanta, said workers are more willing to report needlestick injuries when post-exposure treatments are available. She stressed that not all exposures are the same, however, and that health care employers should have well-communicated plans for injured employees to follow.
The CDC publishes guidelines to assist health care workers and employers to determine whether post-exposure drugs are needed after evaluating the type of fluid exposure that occurred and the degree to which the worker was exposed.
A vaccine exists for Hepatitis B, which is the easiest of the three deadly diseases to contract through needlestick. And post-exposure treatment is available for exposure to HIV, which is the most difficult to contract through a needlestick injury, with a transmission rate of 0.3%. Hepatitis C poses the largest threat to health care workers because nothing can be done for exposed workers, and the transmission rate ranges from 1% to 10%.
A needlestick infection can also take years to manifest into a disease.
Dr. Edward Bernacki, chairman of the joint committee on health and safety at Johns Hopkins University and Hospital, said the hospital established a 24-hour needlestick hot line two years ago that is known to employees as 5-STIX. The Baltimore hospital, which employs about 10,000 workers, has approximately 240 needlesticks per year. In 10 years, the hospital has had only two reports of occupationally acquired disease, both from Hepatitis C.
"It's not a community hospital in rural Iowa," Dr. Bernacki quipped, noting that 17% of medical patients at the hospital are HIV-positive and 2% to 7% are infected with Hepatitis C.
Phoenix-based Samaritan Health System takes a proactive approach with needlesticks, said Dale Schultz, vp-business health. That's necessary, he explained, because such accidents are covered by the workers compensation system only if the worker contracts a disease. Samaritan pays for post-exposure treatment from self-insurance funds set aside for workers comp claims.
Mr. Schultz said it makes good sense to use the funds for helping prevent claims rather than to haggle over payment later. "Being self-insured, I try to do what insurance companies won't," he said, noting that the 11,000-employee system has yet to have a worker develop occupationally any of the three infections.
Many state statutes don't require post-exposure intervention, however, and that confuses employers, which may wonder if they are responsible for paying for such treatments, said Mark Hubbard, vp-risk and human resource management at Loma Linda Medical Center in Loma Linda, Calif.
Mr. Hubbard's health care facility also provides post-exposure treatment after needlestick injuries to its 5,500 employees, but the reasoning is based more on philosophy than on financial considerations. "In spite of the fact we may not be obliged, we felt we had a moral obligation," he said. "There is not enough time to spend two or three days to determine if this is compensable."
Most of the needlestick injuries in the facility occur before the needles have been used on patients, Mr. Hubbard said. In the 20 years the facility has tracked needlestick injuries, only one needlestick infection claim was filed, and it was denied due to problems verifying causality. "It's by far the largest single source of employee injury in terms of frequency but one of the lowest in severity," he said.
Dr. Jagger and others argue that providing post-exposure treatment is not enough. They say that safer devices, such as needles designed to retract after injections, should be used to reduce needlesticks. Some of these devices cost more than their traditional counterparts and that it can be difficult to track their effectiveness.
But David D. Dodge, president and chief executive officer of PHT Services Ltd., a workers compensation self-insurance pool based in Columbia, S.C., noted that workers comp claims would decrease if hospitals made the necessary investment in safer devices. "There's a very direct link between the risk and the claims that you have."
To track the effectiveness of new safety devices and needlestick injury patterns, Connie Steed, a nurse and epidemiologist with The Greenville Hospital System in Greenville, S.C., adopted Dr. Jagger's EPINET system.
Ms. Steed, who has used EPINET for about five years, said it gives her a breakdown of each new device, tracks how injuries occur and helps the hospital make equipment purchasing decisions.
"When you get into health care and are saturated in it, some of the hazards and concerns are shadowed or buffed over. . . .The key to making changes in managed care is to have data" that can validate these decisions, Ms. Steed said.
Two months ago, Charles Jeffress, assistant secretary of labor for the federal Occupational Safety and Health Administration, announced that OSHA was taking suggestions on ways to reduce needlesticks.
Reed Franklin, associate director of government affairs for the Washington-based American Nurses Assn., said he is encouraged that OSHA is getting involved. "I don't feel employers are doing enough on their own," Mr. Franklin said.
But Loma Linda's Mr. Hubbard isn't convinced that OSHA will handle the issue efficiently, and he said he believes his facility would try to act in the best interest of its staff "absent any mandate."
Others are disheartened that OSHA is willing only to take suggestions instead of taking action. "We've been providing OSHA with information on this for years," complained Dr. Jagger. "It seems more like an opportunity to delay.'