(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.)
Provisions:
Requires revisions to the state's
bloodborne pathogen standard, including:
1. Adding safety devices to the definition of engineering controls;
2. Allowing waivers from safety device use under certain circumstances;
3. Including a process for identifying and selecting safety devices in the
written exposure control plan;
4. Updating the written exposure control plan periodically to take into
account changes in available technology;
5. Maintaining a sharps injury log;
6. Considering methods to increase use of vaccines and training, and
7. Developing and maintaining a list of safety devices.
Unique:
First state law related to safety
devices
Provisions:
1. Requires the Commissioners of Labor and Health to:
1. Review safety device technology and determine "those environments
where standards require that sharps injury prevention technology be
employed" and
2. Compile and maintain a list of safety devices
2. Requires employers to develop written exposure control plans.
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).
Provisions:
1. 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
2. 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.
Unique:
1. Mandatory consultation with private organizations, and
2. Study/report required.
Provisions: Requires state agencies
to:
1. Establish a requirement for a written exposure plan;
2. Consider provisions related to training, and measures to increase use of
personal protective equipment and vaccines;
3. Recommend that government entities implement needleless systems and
safety devices;
4. Provide waivers from safety device use under certain circumstances;
5. Require sharps injury logs and reporting of log information to the
department ( with a confidentiality provision), and
6. Implement a safety device registration program by manufacturers to be
used as basis for compiling list of available devices.
Unique:
1. Confidentiality provision regarding sharps injury log, and
2. Requiring manufacturers to register their devices and using this as a
basis for the safety device list.
Provisions:
1. 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";
2. 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;
3. 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;
4. 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
5. 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".
Unique:
1. Strict requirements for use of safety devices;
2. Requirements for tracking/reporting continued non-use of safety devices,
and
3. 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:
1. Making compliance a condition of licensure for the covered healthcare
facilities;
2. Requiring facilities to use needleless systems or other engineering controls;
3. Requiring use of sharps injury log;
4. Requiring an annual report of sharps injury log to Director;
5. Requiring the Director to develop and maintain a list of needleless
systems and sharps safety devices;
6. Requiring formation of a statewide needlestick injury prevention
advisory committee;
7. Allowing exemptions under certain circumstance, including patient safety
or employee safety issues;
8. Considering requirements for employee training and education regarding
safety device use;
9. Consider requirements for implementation of measures to increase the
utilization of vaccinations and protective equipment by employees, and
10. Consider requirements for strategic placement of sharps containers.
Unique: Annual report of sharps
injury log to state department.
Provisions:
Requires employers to:
1. Comply with the federal OSHA standard;
2. 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";
3. Establish an internal procedure to document sharps injuries, and
4. Have a safety committee that "must make advisory recommendations for
the use of effective engineering controls".
Provisions:
1. 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
2. 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.
Unique:
1. Survey requirement, and
2. Specific incorporation of OSHA Directive into state regulation.
Provisions:
1. Requires the adoption of a bloodborne pathogen standard applicable to
public employees and "at least as prescriptive" as the federal OSHA
standard;
2. 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;
3. Requires that the state develop and maintain a list of available safety
devices for employers using resources, including NIOSH;
4. 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
5. Requires that facilities:
1. 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");
2. Maintain a sharps injury log, and
3. Train workers on the use of all engineering controls before they are
used.
Unique:
Requires use of most effective
available technology.
Provisions:
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."
Unique:
1. Focus on existing laws, and
2. Mention of current NIOSH recommendations.
Provisions:
1. Establishes an advisory council on bloodborne pathogen issues
2. 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.
Provisions:
1. Requires employers to conduct evaluations of safety devices and to
include frontline workers in the process;
2. Requires the Department to adopt regulations regarding safety devices
and sharps injuries including:
1. Inclusion of safety devices as engineering controls;
2. Provision of waiver from safety device use in certain circumstances;
3. Inclusion of a safety device identification and selection process in the
written exposure plan;
4. Use of a sharps injury log;
5. Development and maintenance of a list of safety devices, and
6. 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.
Unique:
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
Provisions:
1. Requires the formation of an appointed needlestick injury prevention
committee;
2. 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";
3. Requires the committee to develop a list of existing safety devices;
4. Requires that the committee take cost, cost-benefit analysis and
availability into account;
5. Requires the committee to "determine whether there is sufficient
utilization of sharps prevention technology in the state in high risk
areas," and
6. 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.
Unique:
1. Focus on "high exposure areas" including first responders;
2. Public participation in rulemaking;
3. Study of existing use prior to implementing rules;
4. Use of "compliance thresholds" for safety devices, and
5. Cost-benefit analyses.
Provisions:
1. 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;
2. 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
3. Allows exemptions under certain circumstances.
Unique:
1. Requires training "in the proper method of using product evaluation
criteria";
2. Specifies that training for employees is to take place "before
potential for exposure";
3. Definition of "public health care worker" and
4. Specifically lists NIOSH as a potential source of information related to
the development of a list of safety devices.
Provisions:
1. 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);
2. Requires the Department to develop and to maintain a list of safety
devices for employers' use;
3. 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
4. Requires the appointment of an advisory committee to assist in
developing the regulation and list of safety devices.
Unique:
1. Mandated use of sharps injury log for continuous quality improvement
activities;
2. Sharps injury log confidentiality provision, and
3. Specific limited application to hospitals.
Provisions:
1. 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";
2. 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."
Provisions:
1. 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."
Provisions:
1. 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;
2. Requires Department of Health to develop of list of safety devices, and
3. Requires Department of Health to submit an annual report on use of
safety devices.
Provisions:
1. Requires documentation of consideration and implementation of safety
devices in exposure control plans and solicitation of frontline worker input,
and
2. Requires sharps injury log.
Provisions: Requires Department of
Health to establish bloodborne pathogens standard for public employees that
includes requirements for:
1. Inclusion of safer medical devices as engineering and work practice
controls.
2. Employee training prior to implementation of safer medical devices.
3. Employer implementation and updates of a written exposure control plan, including
development of a sharps injury log.
4. Employee involvement in safer medical device evaluation process.