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November 6, 2003
Mr. Dick Davidson
President
American Hospital Association
One North Franklin
Chicago, Ill. 60606
Re: Support of residents’ request to notify AHA members of
OSHA violations
Dear Mr. Davidson:
The National Alliance for the Primary Prevention of Sharps Injuries
(NAPPSI) is a non-profit organization that works to protect America’s
healthcare workers against medical sharps injuries. We emphasize
primary prevention of needlesticks, through technologies and approaches
that reduce or eliminate the use of sharps. While our focus is on
primary prevention, we also support other effective means to reduce
the frightening toll that needlesticks take on America’s healthcare
workers.
Accordingly, NAPPSI urges AHA to comply with the request you recently
received from medical residents at Montefiore Medical Center, the
American Medical Students Association, and Public Citizen’s
Health Research Group. Their request – that you notify your
membership of recent OSHA violations found at Montefiore –
has the potential to significantly advance the cause of needlestick
safety. We believe that you and your membership are committed to
needlestick safety, and the OSHA findings are significant enough
to merit the special attention of your members. In particular from
the standpoint of primary prevention, OSHA noted the medical center’s
failure to use needleless devices and engineering controls to draw
blood from central lines and to secure catheters and tubes.
NAPPSI does not advocate the use of particular brands of devices.
We do, however, strongly encourage healthcare facilities to first
use primary prevention technologies when implementing needlestick
safety. For example, in addition to its Bloodborne Pathogens Standards
(covering technologies such as needleless access devices), OSHA
has clarified the requirement for healthcare facilities to consider
sutureless securement devices, in ruling issued in January 2003
(www.osha.gov/SLTC/bloodbornepathogens/index.html, under "New
Interpretation Letters").
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NAPPSI has developed two resources that we believe can be of significant
value to your members. First, we created and maintain the most comprehensive
and current compilation of needlestick safety devices, categorized
by the kind of device and whether it offers primary or secondary
prevention. This NAPPSI list is based upon the respected device
compilation by the International Healthcare Worker Safety Center,
at the University of Virginia, and is updated monthly. Please note
that while our membership includes device manufacturers –
along with more than 3,000 individual clinicians and most of the
leading clinician organizations in the field – membership
in NAPPSI is not required for a device to be included on the Safety
Device List.
Second, our Clinician Advisory on needlestick safety builds upon
the general direction provided by NIOSH and other safety authorities.
This advisory has been widely disseminated by clinician organizations
and government safety authorities. Both the device list and advisory
are available at www.nappsi.org/safety.shtml.
Based on feedback from our members, NAPPSI has recently launched
a special campaign to target the epidemic of suture needle injuries
among interns and residents. The campaign is known as PAIRSS (Protecting
America’s Interns and Residents from Suture-needle Sticks).
According to the University of Virginia authorities, suture needlesticks
are most common sharps injuries suffered by interns and residents
in teaching hospitals. We encourage AHA members to do everything
they can to reduce the toll taken by suture sticks, which are documented
sources of hepatitis and AIDS.
Specifically, we recommend AHA encourage its member institutions
to implement the following four measures to drive down suture needlestick
injuries:
1) The use of surgical glues instead of suture where applicable;
2) The use of safety surgical instruments that render traditional
suturing either
safer or unnecessary;
3) Discontinuation of the use of straight (Keith) suture needles;
4) Use of sutureless safety securement devices for catheters and
tubing.
Thank you for your careful attention to these vitally important
issues. Please let me know if NAPPSI can assist in any way, as AHA
moves forward with what we hope will be an aggressive effort to
prevent sharps injuries, by providing your members with information
on how they can best avoid the consequences of noncompliance with
OSHA’s needlestick safety mandates.
Sincerely,
Steven F. Bierman, M.D.
President
National Alliance for the Primary Prevention of Sharps Injuries
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