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A Conversation With OSHA About Safe Sharps

By Dr. Sheila Dunn

Most noncompliance excuses won't fly with OSHA. Almost a year after OSHA's Directive (CPL 2-2 44D) requiring safety needles in all medical facilities, few physicians offices have replaced traditional needles with safer sharps, according to reports from distributors.

Why? Medical practice managers and distributor salespeople invariably cite the following reasons for not adopting safety sharps products:

  • They believe it is not required unless a state law is in place (16 states so far have laws.
  • No sharps injuries have ever been reported in their practice.
  • Safety products are cost prohibitive.
  • There is a negligible chance of an OSHA citation/penalty.

Will these excuses satisfy an OSHA compliance officer? Not according to a high-ranking spokesperson from OSHA's Office of Health Compliance Assistance in Washington, DC. The following are excerpts from an interview with an industrial hygienist from OSHA.

Dr. Sheila Dunn: Many physician offices do not feel compelled to evaluate safe sharps until there is a state law requiring it. What is your position on this?

OSHA spokesperson: Our Bloodborne Pathogens standard has been in effect for every state since 1991. It requires that employers provide engineering controls that eliminate or minimize employee exposure [i.e., safer medical devices, engineered safety sharps]. The Directive simply clarified and reemphasized this requirement. State laws act as a backup for enforcing this and may also take into account sectors that are not regulated by federal OSHA, such as public [government] employers.

Dr. Dunn: Specifically, would a citation be issued if an OSHA compliance officer inspected a medical practice that continues to use sharps without safety features and has not evaluated safety alternatives?

OSHA: First, the OSHA compliance officer would consult the practice's Exposure Control Plan (manual). If evaluations have not been performed and documented in their manual, they would absolutely be cited.

Dr. Dunn: What if this same physician office had no needlestick incidents to date, does this change your position?

OSHA: OSHA exists to protect the working public and prevention is one of our major focuses. For example: Imagine if an employer in another industry did not implement safety devices when employees worked with dangerous machinery simply because no hand amputations had yet occurred. It's not appropriate to wait until an employee has an injury for the employer to institute and ensure the use of engineering and work practice controls.

Dr. Dunn: A lot of medical practices consider safety needles to be cost prohibitive.

OSHA: Employers must document why it wouldn't be feasible, and not being able to afford a safety device alone isn't a good defense. A cost feasibility worksheet is included in Appendix B of the Directive.

Dr. Dunn: OSHA's website shows citations and penalties by type of industry. For medical practices, it appears that very few are inspected and fines are relatively low.

OSHA: We don't have data for total numbers of inspections since some states with their own OSHA plans have a different numbering system than ours. But our data, which includes only federally regulated states (about half of all states), indicates 299 violations in physician offices and clinics since 1997. These citations range from Bloodborne Pathogens violations (167 of 299) to general industry safety concerns such as fire extinguishers.

Dr. Dunn: Since many medical practices have fewer than 10 employees, OSHA does not routinely inspect them. Is it reasonable for medical practices to assume their chances of an OSHA inspection are one in a million?

OSHA: OSHA staff is limited, so the focus tends to be on larger medical facilities that have a history of OSHA violations which are specifically targeted for routine inspections. But for any medical facility, complaints are always taken seriously and always addressed.

Dr. Dunn: What about fines for noncompliance?

OSHA: Fines are adjusted based on the size of the facility and their history of violations. Most medical practices have no history and could receive a discount for this. Also, fines could be moderated based on a good faith effort by the practice where an effective OSHA safety and health plan has regularly been in effect.

Dr. Dunn: What may we expect from OSHA in the near future that could impact medical practices?

OSHA: We're expecting to release a revised recordkeeping standard, which would require additional injury reporting [i.e., needlesticks], but we don't have an exact date yet. We are also working on a Compliance Assistance Document, which will provide further guidance about all OSHA regulations, especially as they pertain to physician practices. Please periodically check our website [ www.osha.gov ] for updates.

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