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By Michele Drayton

Nurses and other health care workers are supporting legislation requiring safer needles in the workplace to lessen the risk of accidents that can lead to HIV and hepatitis. At least 20 states introduced bills after a groundbreaking law took effect in California in July 1999. Only a fraction of states have enacted laws, but nurses say they plan to keep the pressure on because safer alternatives to conventional needles are on the market.

Experts say as many as one million health care workers are injured in needle stick accidents each year. The chances of contracting AIDS from a needle stick are low - 0.3 percent, according to some reports. However, health care workers face great risk of contracting hepatitis B and hepatitis C, a potentially fatal liver disease.

Health Care Workers at Risk
Nurses, phlebotomists, housekeepers and janitors have rallied around the issue of bringing safer needles to the workplace. Needle pricks can occur in a variety of situations - when needles are recapped or when they're left in linens, for instance.

"It's very easy, unfortunately, to get stuck," said Kathryn Duesman, a registered nurse and clinical services director for a Texas company that makes retractable needles. "I hear of bizarre situations where the health care worker isn't doing anything dramatic."

Injured health care workers face months of testing and treatment to prevent infection. For HIV and hepatitis C, testing can last up to a year. Hospitals and health care facilities found liable for such injuries can face substantial legal costs. The University of California, San Francisco, cited a 1995 study that tabbed costs of treating a health care worker who contracted hepatitis C in excess of $600,000.

"It's a major national issue of the American Nurses Association, as well as other labor unions that represent nurses and other health care workers," said Evelyn Bain, an associate director and occupational safety and health specialist for the Massachusetts Nurses Association. Healthcare workers are most concerned about HIV, but hepatitis C - a major cause of liver transplants and liver cancer - is also a frightful risk, she said.

Other groups representing health care workers agree. "We're glad that it's happening, because phlebotomists are on the front lines when it comes to needles and needle stick injuries," said Diane C. Crawford, head of the National Phlebotomy Association. Phlebotomists draw blood in a variety of settings, including doctors' offices, private labs, the Red Cross, insurance companies and government facilities.

Crawford is concerned about workers in hospitals that still buy conventional needles because they're cheaper than safer alternatives, such as needleless systems and retractable needles. "Everybody is concerned about cost, but there's very little concern when it comes to injury," Crawford said.

Bills are under consideration in several states, including Illinois, Michigan, New York, New Jersey, Ohio, Pennsylvania and Oregon. Bain isn't discouraged about lawmakers dropping bills in other places: "They're not forever dead. Nursing and organized labor won't let the issue drop. This issue is here to stay."

California Leads Pack
In California, OSHA has already taken action against hospitals for possible violations of the needle safety law. More than a dozen hospitals were investigated in September 1999. According to news reports, one hospital was fined $5,100 after inspectors found conventional needles being used to administer medication. OSHA inspectors also cited the hospital for lacking an implementation plan and for keeping incomplete records of needle stick incidents.

Maryland, Tennessee, Hawaii and Texas also have needle safety laws, ranging from requiring hospitals to supply safe needles to commissioning studies on health care worker exposure to blood and potentially infectious materials, according to the National Conference of State Legislatures. OSHA has also put pressure on hospitals and health care facilities nationwide to improve safety measures. In November, it released employer guidelines emphasizing the importance of using safer medical devices.