San Francisco Chronicle; Monday, June 8, 1998
William Carlsen, Chronicle Staff Writer

At a meeting in San Francisco last week, officials with the California Occupational Safety and Health Administration said current regulatory language is too vague to require employers to purchase the safer needles. "We are in a position to do more inspections to push employers in the right direction," said Len Welsh, a special counsel for Cal OSHA who chaired the meeting.

The meeting was called in response to a series of Chronicle reports in April that described an epidemic of needle sticks -- more than 1 million a year -- that is striking down doctors, nurses, laboratory technicians and other medical workers at an alarming rate.

More than 40 health care experts, needle manufacturers and union representatives gathered at Cal OSHA's San Francisco headquarters on Wednesday to outline the scope of the needle stick problem and the difficulties they've had dealing with it.

Three manufacturers, including leading U.S. needle maker Becton Dickinson, described safety needles they produce that they say are capable of reducing the rate of accidental needle sticks.

The Chronicle series reported that such devices have been available for nearly a decade, but that high profit margins demanded by manufacturers, reluctance by health care employers to pay the extra expense, and lax or nonexistent government regulation have all but kept the devices out of the hands of health care workers.

Meanwhile, tens of thousands of medical workers have been infected with HIV, hepatitis and other diseases after being stuck by needles, and hundreds have died.

"We need an active program (by Cal OSHA)," said Dr. June Fisher, a San Francisco specialist in safe needle design who has pushed for the devices in hospitals for more than a decade.

She proposed that the agency "put teeth" in the current Cal OSHA requirement that now requires employers to evaluate annually the need for new "engineering controls" to protect their workers from exposure to infectious disease.

"And the agency should mandate needle stick committees in hospitals," she said.

Welsh explained that the current regulation requiring hospitals and other health care employers to use "engineering controls" to prevent needle sticks was too vague but could be rewritten to clearly specify the use of safe needle devices. However, the rule-making process would take a year or more, he explained.

In the interim, he said, Cal OSHA is considering issuing new "compliance" instructions to its inspectors interpreting the current regulation in a way that would help them cite employers who are not converting to safe needles. He added that the department was also considering a "special emphasis program" to focus resources on the problem. The agency needs at least three more weeks to draft a new plan of action, Welsh said.

Federal OSHA is also grappling with the enforcement problem, said agency representative Maggie Robbins. She said she ran a computer check of how many times U.S. OSHA inspectors had cited the "engineering controls" provision of the federal regulations over the past 18 months and came up with 11 cases.

"We certainly aren't going out and aggressively jumping on health care providers," she said, "as some newspaper articles have noted." "I can tell you that there is intense debate within the agency on whether the standard is enforceable."

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