BLOODBORNE INFECTIOUS DISEASES: HIV/AIDS,
HEPATITIS B, HEPATITIS C
State-by-State Provisions of State Needle Safety Legislation
(Revised June 2002)
(NOTE: This is not intended to be an all-inclusive list of the legislative provisions of each state, but rather an overview of recent legislative developments. Health care providers must consult their own state and local regulatory agencies for the complete scope of regulations applicable to them at the state level.)
Select a state for specific details:
Alaska - Arkansas - California - Connecticut - Georgia - Iowa - Maine - Maryland - Massachusetts - Minnesota - Missouri - New Hampshire - New Jersey - New York - Ohio - Oklahoma - Pennsylvania - Rhode Island - Tennessee - Texas - West Virginia
Requires revisions to the state's bloodborne pathogen standard, including:
- Adding safety devices to the definition of engineering controls;
- Allowing waivers from safety device use under certain circumstances;
- Including a process for identifying and selecting safety devices in the written exposure control plan;
- Updating the written exposure control plan periodically to take into account changes in available technology;
- Maintaining a sharps injury log;
- Considering methods to increase use of vaccines and training, and
- Developing and maintaining a list of safety devices.
First state law related to safety devices
- Requires the Commissioners of Labor and Health to:
- Review safety device technology and determine "those environments where standards require that sharps injury prevention technology be employed" and
- Compile and maintain a list of safety devices
- Requires employers to develop written exposure control plans.
(2000 MD HB 360)(Signed into law 5/00) AND (1999 MD HB 287)(Signed into law 5/99)
2000 MD HB 360
Provisions: Requires the Maryland Commission of Labor and Industry , in conjunction with the Department of Health and Mental Hygiene, to develop recommendations for implementing the federal bloodborne pathogen standard (and including the 11/99 directives).
1999 MD HB 287
- Required Department of Health and Mental Hygiene to conduct a health care worker needlestick study and hold hearings and prepare a report on the establishment of a bloodborne pathogen standard, and
- Required Department to consult with private organizations, including the Maryland Hospital Association, Maryland Nurses Association, Maryland State Dental Association and the Service Employees International Union of Maryland.
- Mandatory consultation with private organizations, and
- Study/report required.
Provisions: Requires state agencies to:
- Establish a requirement for a written exposure plan;
- Consider provisions related to training, and measures to increase use of personal protective equipment and vaccines;
- Recommend that government entities implement needleless systems and safety devices;
- Provide waivers from safety device use under certain circumstances;
- Require sharps injury logs and reporting of log information to the department ( with a confidentiality provision), and
- Implement a safety device registration program by manufacturers to be used as basis for compiling list of available devices.
- Confidentiality provision regarding sharps injury log, and
- Requiring manufacturers to register their devices and using this as a basis for the safety device list.
- Requires licensed healthcare facilities to "use only needles and other sharp devices with integrated safety features, which needles and other sharp devices have been cleared or approved for marketing by the federal Food and Drug Administration and are commercially available for distribution";
- Requires the facilities to establish a safety device evaluation committee (including health care workers), to train its workers as to use of safety devices, to continually review its selection process, to establish a waiver procedure and to maintain a sharps injury log;
- Requires the facilities to provide the commissioner of the Department of Health and Senior Services with quarterly reports related to the sharps injury log and non-safety device waivers and emergency uses. In turn, requires the commissioner to review the reports, to make recommendations to the facility to reduce the number of sharps injuries and to make an annual report to the Senate;
- Requires the commissioner of the Department of Health and Senior Services to "develop evaluation criteria for use by an evaluation committee [at facilities] in selecting needles and other sharp devices" and to develop a standardized form for facilities to use for providing waivers for health care workers and "for reporting [within five days] the use of a needle or other sharp device without integrated features in an emergency situation by a health care professional," and
- Provides for an exemption if there is no FDA-approved device, allowing facilities to "continue to use the appropriate needle or other sharp device that is available, including any needle or other sharp device with non-integrated, add- on safety features, until such time as a product with integrated safety features is cleared or approved for marketing and is commercially available for that specific patient use".
- Strict requirements for use of safety devices;
- Requirements for tracking/reporting continued non-use of safety devices, and
- Reports to the commissioner and Senate and ongoing role of Commissioner in reviewing reports and making recommendations to decrease sharps injuries.
Provisions: Requires the Director of Division of Health to propose rules to implement the law, including:
- Making compliance a condition of licensure for the covered healthcare facilities;
- Requiring facilities to use needleless systems or other engineering controls;
- Requiring use of sharps injury log;
- Requiring an annual report of sharps injury log to Director;
- Requiring the Director to develop and maintain a list of needleless systems and sharps safety devices;
- Requiring formation of a statewide needlestick injury prevention advisory committee;
- Allowing exemptions under certain circumstance, including patient safety or employee safety issues;
- Considering requirements for employee training and education regarding safety device use;
- Consider requirements for implementation of measures to increase the utilization of vaccinations and protective equipment by employees, and
- Consider requirements for strategic placement of sharps containers.
Unique: Annual report of sharps injury log to state department.
Requires employers to:
- Comply with the federal OSHA standard;
- Review exposure control plans at least annually to "document consideration and implementation of appropriate commercially available and effective engineering controls, for example, needleless systems and sharps with engineered sharps injury protection";
- Establish an internal procedure to document sharps injuries, and
- Have a safety committee that "must make advisory recommendations for the use of effective engineering controls".
- Requires the Board of Occupational Safety and Health adopt public sector rules at least as protective as the OSHA bloodborne pathogen compliance directive of 11/99, and
- Requires the Departments of Labor and Health and Safety to "conduct a survey of public and private health care providers and field providers, including, but not limited to, emergency medical technicians, to collect information about" employee use of safety devices and employer efforts to comply with federal and state rules regarding use of engineering controls.
- Survey requirement, and
- Specific incorporation of OSHA Directive into state regulation.
- Requires the adoption of a bloodborne pathogen standard applicable to public employees and "at least as prescriptive" as the federal OSHA standard;
- Requires consideration of inclusion of specific standard sections related to training, education, increasing vaccination and personal protective equipment use and strategic placement of sharps containers;
- Requires that the state develop and maintain a list of available safety devices for employers using resources, including NIOSH;
- Requires the use of the "most effective available needleless systems and sharps with engineered sharps injury protection be included as engineering and work practice controls" except under certain circumstances, including unavailability and objective evidence presented to an evaluation committee (including frontline workers) of patient or employee safety issues, and
- Requires that facilities:
- Develop a written exposure control plan, including a safety device selection/evaluation procedure (including inclusion of frontline workers and training for the committee "in the proper method of utilizing product evaluation criteria");
- Maintain a sharps injury log, and
- Train workers on the use of all engineering controls before they are used.
Requires use of most effective available technology.
Requires that "the Iowa department of public health, in cooperation with the labor committee, shall conduct a study of state and federal laws and regulations relating to protection of persons who may be at risk of needlestick injuries in the course of employment. The study shall include the review of the current NIOSH of the CDCP recommendation to reduce workplace needlestick injuries. The department shall submit a report to the governor and the general assembly by December 15, 2000, which shall include any recommendations for changes in state law or rules, which are not in conflict with federal law or regulations, to improve protective measures related to needlestick injuries."
- Focus on existing laws, and
- Mention of current NIOSH recommendations.
- Establishes an advisory council on bloodborne pathogen issues
- Requires the council to develop rules "to protect health care workers in the public sector from occupational exposure to blood or other potentially infectious materials [which] shall not be inconsistent with the [OSHA bloodborne pathogen standard]" and to provide technical assistance as needed to the labor commissioner related to health care worker bloodborne pathogen issues.
Unique: Establishment of a council to develop the rules rather than using an existing government agency.
- Requires employers to conduct evaluations of safety devices and to include frontline workers in the process;
- Requires the Department to adopt regulations regarding safety
devices and sharps injuries including:
- Inclusion of safety devices as engineering controls;
- Provision of waiver from safety device use in certain circumstances;
- Inclusion of a safety device identification and selection process in the written exposure plan;
- Use of a sharps injury log;
- Development and maintenance of a list of safety devices, and
- Possible revisions to the bloodborne pathogen standard, such as training/education requirements, measures to increase vaccination and personal protective equipment use and strategic sharps container placement.
Dental procedure exemption: "does not apply to an employer or supervised employee who primarily uses needles and other sharps for intraoral procedures".
Provisions: Requires state-licensed health care facilities that employ public workers to "use only injectable equipment having self-contained secondary precautionary type sheathing devices or alternate devices designed to prevent accidental needlestick injuries" and requires that private state-licensed health care facilities do the same "if advised by the federal Occupational Safety and Health Administration."
Unique: Mandated use of safety devices
- Requires the formation of an appointed needlestick injury prevention committee;
- Requires the committee to evaluate needlestick injuries in "high exposure areas" and to develop guidelines for the use of safety devices in "high exposure areas" defined as "an operating room, an ambulatory surgical center, an emergency room, an intensive care unit, an ambulance or an area or scene at which a first responder performs or provides emergency medical services";
- Requires the committee to develop a list of existing safety devices;
- Requires that the committee take cost, cost-benefit analysis and availability into account;
- Requires the committee to "determine whether there is sufficient utilization of sharps prevention technology in the state in high risk areas," and
- If the committee determines that such rules are necessary, requires state agencies to promulgate rules (after public notice/comment and meetings) including requirements for a written control plan, effective identification/selection of safety devices and sharps log.
- Focus on "high exposure areas" including first responders;
- Public participation in rulemaking;
- Study of existing use prior to implementing rules;
- Use of "compliance thresholds" for safety devices, and
- Cost-benefit analyses.
- Requires formation of a statewide subcommittee to protect public healthcare workers (the statute's definition includes firefighters and emergency medical technicians but excludes dental providers) from needlesticks by studying various methods, including evaluating safety devices, developing a safety device list, developing training/education requirements, developing methods to increase vaccination use and use of personal protective equipment, and regulating sharps container placement;
- Requires employers to have a written exposure control plan, to incorporate safety devices as engineering controls, to have a safety device identification/selection process, to train workers before they have potential for exposure and to keep a sharps log, and
- Allows exemptions under certain circumstances.
- Requires training "in the proper method of using product evaluation criteria";
- Specifies that training for employees is to take place "before potential for exposure";
- Definition of "public health care worker" and
- Specifically lists NIOSH as a potential source of information related to the development of a list of safety devices.
- Requires the Department of Public Health to develop regulations requiring hospitals to use "only such devices which minimize the risk of injury to health care workers from needlesticks and sharps" except in certain circumstances approved by the state (including where the hospital can prove that use of the safety device would interfere with a medical procedure or patient/employee safety issues exist or alternative equally effective measures are in place);
- Requires the Department to develop and to maintain a list of safety devices for employers' use;
- Requires hospitals to develop written exposure control plans, include a procedure for selecting safety devices, include safety devices as engineering controls, maintain a confidential sharps injury log (to be used for continuous quality improvement activities and to be reported to the Department annually), and
- Requires the appointment of an advisory committee to assist in developing the regulation and list of safety devices.
- Mandated use of sharps injury log for continuous quality improvement activities;
- Sharps injury log confidentiality provision, and
- Specific limited application to hospitals.
- Requires development of regulations to "prohibit the use of sharps that do not incorporate engineered sharps injury protections" with certain allowable exceptions when "(a) appropriate engineered sharps are not available in the market; (b) the use of sharps without engineered sharps injury protections is essential to the performance of a specific medical procedure; or (c) based on objective product evaluation, sharps with engineered injury protections are not more effective in preventing exposure incidents than sharps without engineered injury protections";
- Requires studies of "effectiveness of the regulations in reducing sharps injuries and exposure incidents, the level of compliance, and the need for any modifications or revisions to the regulations."
- Requires hospitals to "begin purchasing needleless systems or sharps with engineered sharps injury protections or both for use in high risk areas with the goal of ensuring that within eighteen (18) months after the effective date [6/1/01] ...all high risk areas [emergency departments, operating rooms and intensive care units at acute care hospitals] shall be supplied exclusively with needleless systems or sharps with engineered sharps injury protection, or both."
- Requires Department of Health to develop bloodborne pathogen standard for employers of public employees that: (a) meets federal OSHA standard; (b) requires use of ‘most efficient needleless systems' except in certain circumstances; (c) mandates sharps injury logs; (d) requires evaluation committees with certain makeup, and (e) provides that employers who violate the standard be subject to reduction or loss of state funding;
- Requires Department of Health to develop of list of safety devices, and
- Requires Department of Health to submit an annual report on use of safety devices.
- Requires documentation of consideration and implementation of safety devices in exposure control plans and solicitation of frontline worker input, and
- Requires sharps injury log.
Provisions: Requires Department of Health to establish bloodborne pathogens standard for public employees that includes requirements for:
- Inclusion of safer medical devices as engineering and work practice controls.
- Employee training prior to implementation of safer medical devices.
- Employer implementation and updates of a written exposure control plan, including development of a sharps injury log.
- Employee involvement in safer medical device evalution process.
- National Institute for Occupational Safety and Health (NIOSH)
- Centers for Disease Control and Prevention
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