An employee has just reported a needlestick injury. What are the employer's responsibilities under the OSHA Bloodborne Pathogens Standard? Who will insure that the employee gets the proper follow-up? The following list of actions will help you determine if you are in compliance.

• Document the route of exposure and circumstances surrounding the exposure
• Document the type and brand of device involved in the exposure
• Identify the resident who is the source of the exposure
• Test the source individual¹s blood as soon as feasible, include HIV, hepatitis B and C. Obtain the necessary consent.
• Test the exposed employee¹s blood as soon as feasible, include HIV, hepatitis B and C. Obtain the necessary consent.
• The employee should be seen by a healthcare professional (MD, NP or PA). This can be done in-house or the employee can be sent to an outside provider.
• The healthcare provider must have the following information:

  - A copy of the OSHA Bloodborne Pathogens Standard
  - A description of the exposed employee¹s duties as they relate to the exposure
  - Documentation of the route of exposure and circumstances under which the exposure occurred
  - Results of the source blood tests, when available
  - All medical records needed to treat the employee, including their hepatitis B vaccination record.

• The healthcare professional must provide written follow-up recommendations with 15 days of the evaluation to the employee. The recommendation must include:

  - That the employee has been informed of the results of the examination
  - That the employee has been told about medical conditions that may result from the exposure, including follow-up blood testing
  - All other findings should not be included in the report

• The written report must remain confidential and stored for the duration of employment plus 30 years.

Copies of the OSHA Bloodborne Pathogens Standard and sample Exposure Control Plan can be obtained from your State or Federal OSHA consultation office.

San Diego 619-279-3771
Sacramento 916-263-2855
San Mateo 415-573-3862
Santa Fe Springs 310-944-9366
Fresno 209-454-1295

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Needlesticks in Skilled Nursing Facilities

The incidence of needlstick injuries in skilled nursing facilities is unknown. One article written on the subject appeared in J Am Geriatr Soc 1990 Jul;38(7):793-796 Needlestick injuries and needle disposal in Minnesota nursing homes. Crossley K, Willenbring K, Thurn J .Department of Medicine, St. Paul-Ramsey Medical Center, MN

This article examined needle use and disposal, needlestick injuries and their management, and employee education regarding the bloodborne pathogens and needle use by means of a questionnaire sent to all long-term care facilities certified for skilled care in Minnesota. Responses were received from 297 of 349 (85.1%) homes. Nearly all homes (271 of 293; 92.5%) provided education for new nursing employees about use and disposal of needles. Disposal of needles and sharps was generally consistent with current recommendations for acute care hospitals. Needlestick injuries were usually related to recapping and were most common in registered and licensed practical nurses but were infrequent (i.e., less than 1 injury per home per employee-year) probably because parenteral therapy is infrequently used in long-term care settings. Only slightly over half (166 of 286; 58%) of the homes had protocols for management of needlestick injuries. Although Minnesota nursing homes properly dispose of needles and sharps, many of these institutions need to develop policies for management of needlestick injuries that are consistent with current recommendations.

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James Marx © 1998