San Francisco Chronicle; Wednesday, April 15, 1998
Willam Carlsen, Chronicle Staff Writer

Some hospitals have made great strides in converting to safe needle devices, and others are still trying to catch up.

Five years ago, Kaiser Permanente in Southern California moved quickly to switch to safe needles after two unions filed complaints with the California Occupational Safety and Health Administration.

The group of medical facilities, which employs 35,000 health care workers, set up a system to track needle sticks and evaluate safe needle products. By 1994, Kaiser was purchasing large supplies of safe needles, according to Enid Eck, the regional coordinator who led the effort.

At Northern California Kaiser, management claims that its sprawling system of hospitals and clinics is also using safe needles. But employees say the devices are only available in certain sections of Kaiser facilities.

Management acknowledged that its effort has not been coordinated regionwide, as it was in the south, but rather through committees in individual facilities that test and buy safe needle products.

Downsizing and the loss of key people have also affected the process, said Louise Musante, coordinator for the system's employee health services. She said a recent merger of the Northern and Southern California Kaisers will help remedy the problem by allowing the northern facilities to use much of the evaluation data gathered by Eck.

Other Bay Area hospitals have been moving cautiously and are just now meeting the OSHA requirements. At St. Francis Hospital in San Francisco, infection control officer Fred Deneau said the hospital was in the process of fully converting to a needleless intravenous line system, something commonly used in hospitals across the nation.

"It's not necessary to buy the first edition of anything unless you collect books," Deneau said. "You just don't bring in any product. You need to look at them closely to be sure they're effective and safe."

Officials at California Pacific Medical Center, San Francisco's largest hospital, say they started in 1990 to switch to needleless IV systems and to test safety needles, which they now use.

"I'm proud of what we've done," said Barbara de Baun, the hospital's occupational safety officer.

But de Baun was surprised to learn that employees at Visiting Nurses Association, an agency owned and operated by California Pacific, were not supplied with safe syringes.

Home health nurses are particularly vulnerable to needle sticks, experts say, because they draw blood and give injections in uncontrolled environments, frequently with children or animals underfoot and other domestic distractions.

And as insurers limit hospital stays to contain costs, home health care is the fastest growing area of medicine.

"I knock on wood every day that I don't get stuck," said an employee of Visiting Nurses who goes into patients' homes every day -- often to treat HIV-infected patients -- without safety syringes. "It's scary."

John Mehring, an official with the Service Employees International Union, said that in many hospitals too much of the decision to purchase safer needles depends on particular individuals willing to fight upper management.

"If that manager leaves or moves to a different position," he said, "the whole effort sometimes comes to a halt."

"Kaiser (in Northern California) forced us to deal with each individual hospital. It was an incredible burden."

Cal OSHA, the agency charged with enforcing federal and state safety regulations, has conducted only 13 inspections for violations in California's nearly 500 hospitals since 1992.

"We're a complaint-driven agency," explained Cal OSHA spokesman Rick Rice, noting that the agency targets only "high hazard" industries for regular inspection. The health care industry does not fall into that category, he said.

Dr. Les Michaels, a senior industrial hygienist for the agency, said the federal regulation was vague on the need for safe needles. "It's not hard-line, and any control measures can be used to address the (needle stick) problem," he said.

But Michaels was so unfamiliar with the regulation that he said safe needles did not exist when it was issued in 1991, even though they had been on the market for several years. They are specifically mentioned as an example of "engineering controls" required to prevent needle sticks.

California hospital officials voiced frustration at the lack of national evaluation data for safe needle devices, forcing each institution to test equipment on its own.

They also complained that needle manufacturers have not produced easy-to-use safe devices that allow medical workers to switch from standard needles with minimal problems.

Eck, for example, said evaluators at Kaiser in Southern California rejected by a ratio of 2 to 1 the sliding shield safety syringe produced by Becton Dickinson, the organization's major supplier. The evaluators concluded that the product was poorly designed, she said.

"They own the market," she said of Becton Dickinson, "so they don't work as hard to come up with responsive products. They simply say, `Here's what we've got.' "

Dr. June Fisher, a San Francisco occupational safety expert, has conducted federally funded workshops for several years, sometimes matching manufacturers with front-line health care workers to come up with better designs.

Last month, she worked with a group of Bay Area home health nurses to determine their special needle-handling problems. What is needed, she says, not just in home health but in all health care, is a "passive" needle device that works automatically to shield the medical worker from being stuck.

"I'm discouraged this hasn't gone faster," she said, looking back on almost a decade of work. "We can go to the moon, but we still haven't produced a good, passive needle design. We've done it in other areas where solutions were needed to save lives. Why not to protect health care workers?"

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