We all look to history for lessons and perspective and to learn and progress. We celebrate special historic dates—and November 6, 2010, promises to be another very important date worthy of nurses’ recognition. That day will mark the 10th anniversary of the signing of the Needlestick Safety and Prevention Act (NSPA).
My memory of that event is very clear, since I was there—along with past ANA president Mary Foley, PhD, RN—to witness President Bill Clinton sign this important legislation into law. NSPA is so important because it provides nurses with workplace rights and protections. As enacted, the law requires the use of safer engineered needle and sharps devices within patient care environments and requires employers to maintain a log of injuries from contaminated sharps, develop and update exposure control plans annually, and involve direct-care workers—who use sharps in patient care—in the evaluation and selection of safety devices.
How did this legislation come about? ANA provided critical leadership for this much-needed health and safety reform through its “Safe Needles Save Lives” campaign. Through this campaign, ANA strategically mobilized support from nurses, policymakers, and other stakeholders across the country and, as a direct result, secured passage of the legislation within the first year after the campaign’s launch.
One might wonder why this legislation was even needed when we already had the Occupational Health and Safety Administration’s 1991 Bloodborne Pathogen Standard. That standard had been adopted to reduce the number of healthcare workers infected by bloodborne pathogens through occupational exposure. Despite explicit guidelines within that standard—including recommendations that safer devices be made available to front-line workers—devices were being made available only on a relatively limited basis. Hence, needlesticks and other sharps injuries continued to occur at alarming rates across the country. It became clear, based on ANA’s assessment, that more stringent legislation and regulation was necessary to protect nurses and other healthcare workers from these largely preventable injuries.
At this 10th anniversary of the NSPA, it’s important to acknowledge that nurses and the healthcare community at large have made significant progress in reducing bloodborne pathogen exposures. The availability of safer engineered devices is now commonplace within practice settings. Workers are more aware of the risks of bloodborne pathogen exposure and, one hopes, of protections and rights afforded by the federal legislation.
At the same time, nurses must not become complacent. Healthcare workers as well as their employers must promote safety-driven, blame-free cultures. Nurses at risk for potential exposure in their practice should take advantage of free access to the hepatitis B vaccine—an extremely effective preventive tool. Proper training should be provided to direct-care staff before they use newly adopted or unfamiliar safety devices. Not least, nurses and other direct-care workers should take advantage of the opportunity afforded by the law to participate in the evaluation and selection of safety devices.
When injuries do occur, healthcare workplace practices should encourage and facilitate reporting. Employers must provide access to prompt, compassionate care for injured nurses and other healthcare workers. Employers are responsible for instituting standardized care protocols, particularly relative to timely risk assessment and prompt access to postexposure prophylaxis (PEP), as indicated. It’s critical that employers also make injured or exposed workers who are prescribed PEP aware of the opportunity for paid work accommodation if side effects necessitate absence from work. Post-injury source patient testing as well as follow-up testing for the affected worker are critical to ensure no occupational infection was acquired as a result of the exposure.
Moving forward, nurses must not lose sight of the work of ANA, nurse advocates, and others who made it possible for widespread reforms that improve worker health and safety in this arena. Preventing these injuries requires that every nurse, healthcare worker, and employer remain vigilant and committed to playing an active role in promoting safety cultures within patient-care settings. Nurses owe that much to themselves and those they love as they endeavor to provide the best possible patient care.
On November 6, 2010—the anniversary of the NSPA—remember those who’ve led the way in efforts to reduce these injuries and honor them by committing to continued advocacy for health and safety.
Karen Daley, PhD, MPH, RN, FAAN
President, American Nurses Association