Throughout history, health care workers have exposed themselves to illness and death in the care of the sick and injured. The control of often fatal infectious diseases—such as smallpox, diphtheria, poliomyelitis and others—by vaccination and public health measures has greatly reduced, but not eliminated, the risk to those who care for our patients.
Currently potential risks include hepatitis B, hepatitis C, human immunodeficiency virus (HIV), and less common pathogens such as malaria, human T-lymphoma virus and syphilis among others.
In recognition of this risk Occupational Safety and Health Administration (OSHA) first published guidelines in 1992 mandating the use of barrier protection against blood and body fluid exposure to health care workers in contact with patients. This included the wearing of masks, gowns and gloves when caring for patients, and also the safe disposal of these items as well as other contaminated materials. Even with these safeguards there remained the risk of skin puncture with various sharp instruments used in care.
In 1999, OSHA estimated that between 590,000 and 800,000 penetrating injuries occurred yearly in the United States. This reduces to 30 injuries per 100 beds, or about 355 injuries yearly among staff at area hospitals. Even if no illness resulted from these exposures the employee incurs a great deal of anxiety. If an illness does result, the costs as—well as the morbidity—are greatly increased.
OSHA addressed this problem in November l999—and wrote policy that became effective in April—directing hospitals and health care agencies to introduce safety engineered sharp devices where clinically appropriate, to train health care workers in their use, and to monitor the use of safety engineered devices in the workplace. In addition, hospitals are required to evaluate the further development of safety engineered devices and institute refinements as clinically appropriate.
The hospital equipment industry has been ingenious in its development of products designed to reduce the incidence of penetrating injuries and increase the safety of caregivers. Needle-less I.V. systems are currently in common use. Various methods of placing a protective cover over the sharp end of the needle after it has been used to penetrate the skin of a patient so that it is no longer a risk to the caregiver or those who dispose of used materials have been developed.
There is adequate evidence that such safety devices significantly reduce the frequency of penetrating injuries and hence increases the safety of the work place for the caregiver. Unfortunately, this is not accomplished without cost to the health care system in terms of dollars as the new devices are significantly more intricate, and add real cost to the care of patients. This cost is morally and ethically justified to protect the health of those who care for us during our illnesses, but does add to the economic burden of health care. IBI
