Reducing Occupational Exposure to Bloodborne Pathogens: Where Do We Stand a Decade Later?

It has been 12 years since the first case of needlestick-transmitted human immunodeficiency virus (HIV) was reported in the medical literature' and 10 years since the Occupational Health and Safety Administration (OSHA) began the process of enacting a standard for the protection of healthcare workers from exposure to bloodborne pathogens.2 These seminal events triggered widespread efforts to educate healthcare workers, to improve workplace conditions, and to eliminate the causes of exposure risk. After a decade of sustained effort, there is little doubt that important advances have been made in creating a safer healthcare setting and in increasing awareness of workplace risks. Healthcare workers whose careers have spanned the past decade can remember practices and equipment that once were commonplace but that are unacceptable, or even shocking, by today's standards. A decade ago, one could find an array of makeshift or poorly designed needle disposal containers, such as paper cups, flimsy plastic jugs, or thin-walled cardboard pop-up boxes, from which needles regularly spilled or protruded. In most hospitals, disposal containers were located far from the point of use, forcing healthcare workers to travel the corridors of patient-care areas carrying used, exposed needles. Recapping of contaminated needles was a standard, even recommended, practice. Blood generally was not thought of as a hazardous substance, and frequent hand contact with blood was viewed as just part of the caregiver's job. A surgeon's red badge of honor was the blood-saturated surgical gown. And, the abs nt-minded act of leaving a used needle at a pa ient's bedside drew little attention. Today, the same act could be grounds for a lawsuit. In addition to better disposal systems, safer w rkplace practices, and the increased use of personal protective equipment that occurred with the implem ntation of the OSHA Bloodborne Pathogen Standard,2 medical product manufacturers have re pond d to the need for new products designed to prevent exposure to blood and other potentially infectious body substances. A new array of barrier products with greater fluid resistance and improved garment design are available. Advances in the design of n edle devices and sharp instruments finally have gone b yond the issue of patient safety and have addressed the problems of user safety. Clear evidence of the response of inventors and manufacturers can be found in the records of the US Patent and Trademark Office. Since 1984, more than 1,000 patents have been issued for devices designed to prevent needlesticks.3 There has been a parallel introduction of new safety devices into the healthcare marketplace. Although the acceptance of this new technology varies among hospitals, most healthcare orkers in the US have had the opportunity of evaluating o using one or more safety devices now on the market. Of the new generation of devices, needleless or protected-needle intravenous (IV) systems are the