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chapter 12 | Promoting a Healthy Workplace 183 CikguOnline
personnel were well aware of issues related to latex included in the review of safer devices as well as in
allergies. In recent years, the number of new cases of making recommendations for replacement devices.
latex allergy has decreased due to improved diag- (osha.gov/needlesticks/needlefaq;http://www.joint
nostic methods, improved education, and more commission.org/SentinelEvents/SentinelEvent
accurate labeling of medical devices. Although cur- Alert/sea_22.htm)
rent research does not demonstrate whether the
amount of allergen released during shipping and Your Employer’s Responsibility
storage into medications from vials with rubber clo- According to the current OSHA requirements,
sures is sufficient to induce a systemic allergic reac- your employer must provide you with the following
tion, nurses should take special precautions when (ANA, 1993; nursingworld.org/dlwa/osh/wp2):
patients are identified as high risk for latex allergies.
■ Free hepatitis B vaccine
The nursing staff should work closely with the
■ Protective equipment that fits you (gloves,
pharmacy staff to follow universal one-stick-rule
gowns, goggles, masks)
precautions, which assume that every pharmaceuti-
■ Immediate, confidential medical evaluation,
cal vial may contain a natural rubber latex closure,
treatment, and follow-up if you are exposed
and the nurse should remain with any patient at the
■ Implementation of universal precautions
start of medication and keep frequent observations
institution-wide
and vital signs for 2 hours (Hamilton et al., 2005).
■ Adequate sharps disposal
■ Proper removal of hazards from the workplace
Needlestick Injuries ■ Annual employee training
In 1997 a 27-year-old nurse, Lisa Black, attended Many states have enacted their own laws related to
an in-service session on postexposure prophylaxis blood-borne pathogen exposures. These laws may
for needlesticks. A short time later, she was include some of the following requirements:
attempting to aspirate blood from a patient’s intra- ■ Listing of safety devices as engineering controls
venous line. The patient, in the advanced stages of ■ Development of a list of available safety devices
acquired immunodeficiency syndrome, moved, and by the state for use by employers
the needle went into Lisa’s hand.Nine months later ■ Development of a written exposure plan by
she tested positive for HIV and 3 months after that employers and periodic review and updates
for hepatitis C. She continues to share her story ■ Development of protocols for safety device
with nurses everywhere in an effort to prevent this identification and selection by employers
unfortunate accident from happening to one more and involvement by frontline workers in the
nurse (Trossman, 1999a). process
On April 18, 2001, the Needlestick Act, or ■ Development of a sharps injury log and report-
revised Bloodborne Pathogens Standard, went ing log information
into effect. The revised OSHA Bloodborne ■ Development of methods to increase use of vac-
Pathogens Standard obligates employers to con- cines and personal protective equipment
sider safer needle devices when they conduct their ■ Waivers or exemptions from safety device use
annual review of their exposure control plan. under certain circumstances (including patient
Frontline employees must be included in the and/or worker safety issues, use of alternative effec-
annual review and updating of standards process. tive strategies, market unavailability, and so on)
Stricter requirements are now in effect for annual ■ Placement of sharps containers in accessible
review and updating to reflect changes in technol- positions
ogy that eliminate or reduce exposure to blood- ■ Training for workers regarding safety device
borne pathogens. JC surveyors are now asking if use (http://www.cdc.gov/niosh/topics/bbp/
health-care organization leaders are familiar with ndl-law.htm)
the Needlestick Safety and Prevention Act and
whether any action being taken to comply Your Responsibility
includes staff that use sharps and needles and are What are your responsibilities related to this revised
therefore at risk for injury. The law requires legislation? Each year your institution must review
that these health-care workers and other staff be and update its blood-borne pathogen standards.You