Numerous workers who are occupationally exposed to bloodborne pathogens have contracted fatal and other serious viruses and diseases, including the human immunodeficiency virus (HIV), hepatitis B, and hepatitis C from exposure to blood and other potentially infectious materials in their workplace.

In 1991 the Occupational Safety and Health Administration issued a standard regulating occupational exposure to bloodborne pathogens, including the human immunodeficiency virus, (HIV), the hepatitis B virus (HBV), and the hepatitis C virus (HCV).

Compliance with the bloodborne pathogens standard has significantly reduced the risk that workers will contract a bloodborne disease in the course of their work.

Nevertheless, occupational exposure to bloodborne pathogens from accidental sharps injuries in health care settings continues to be a serious problem. In March 2000, the Centers for Disease Control and Prevention estimated that more than 380,000 percutaneous injuries from contaminated sharps occur annually among health care workers in United States hospital settings. Estimates for all health care settings are that 600,000 to 800,000 needlestick and other percutaneous injuries occur among health care workers annually. Such injuries can involve needles or other sharps contaminated with bloodborne pathogens, such as HIV, HBV, or HCV.

Since publication of the bloodborne pathogens standard in 1991 there has been a substantial increase in the number and assortment of effective engineering controls available to employers. There is now a large body of research and data concerning the effectiveness of newer engineering controls, including safer medical devices.

396 interested parties responded to a Request for Information (referred to as the "RFI") conducted by the Occupational Health and Safety Administration in 1998 on engineering and work practice controls used to eliminate or minimize the risk of occupational exposure to bloodborne pathogens due to percutaneous injuries from contaminated sharps. Comments were provided by health care facilities, groups representing health care workers, researchers, educational institutions, professional and industry associations, and manufacturers of medical devices.

Numerous studies have demonstrated that the use of safer medical devices, such as needleless systems and sharps with engineered sharps injury protections, when they are part of an overall bloodborne pathogens risk-reduction program, can be extremely effective in reducing accidental sharps injuries.

In March 2000, the Centers for Disease Control and Prevention estimated that, depending on the type of device used and the procedure involved, 62 to 88 percent of sharps injuries can potentially be prevented by the use of safer medical devices.

The OSHA 200 Log, as it is currently maintained, does not sufficiently reflect injuries that may involve exposure to bloodborne pathogens in health care facilities. More than 98 percent of health care facilities responding to the RFI have adopted surveillance systems in addition to the OSHA 200 Log. Information gathered through these surveillance systems is commonly used for hazard identification and evaluation of program and device effectiveness.

Training and education in the use of safer medical devices and safer work practices are significant elements in the prevention of percutaneous exposure incidents. Staff involvement in the device selection and evaluation process is also an important element to achieving a reduction in sharps injuries, particularly as new safer devices are introduced into the work setting.

Modification of the bloodborne pathogens standard is appropriate to set forth in greater detail its requirement that employers identify, evaluate, and make use of effective safer medical devices.

As mandated by the Needlestick Safety and Prevention Act, OSHA has revised its bloodborne pathogens standard to clarify the need for employers to select safer needle devices as they become available and to involve employees in identifying and choosing the devices. The updated standard also requires employers to maintain a log of injuries from contaminated sharps.

"These changes in the OSHA bloodborne pathogens standard reaffirm our commitment to protecting health care providers who care for us all," said Labor Secretary Alexis M. Herman. "Newer, safer medical devices can reduce the risk of needlesticks and the chance of contracting deadly bloodborne diseases such as AIDS and hepatitis C.  Employers need to consult their workers and use the safer devices when possible."

According to the Needlestick Act, in March 2000, the Centers for Disease Control and Prevention estimated that selecting safer medical devices could prevent 62 to 88 percent of sharps injuries in hospital settings.

"Our revised bloodborne pathogen standard sets forth clearly the importance of re-evaluating needle systems to identify safer devices every year. The new requirement to record all needlesticks will help employers determine the effectiveness of the devices they use and track how many needlesticks are occurring within their workplaces," said OSHA Administrator Charles N. Jeffress.

The revised OSHA bloodborne pathogen standard specifically mandates consideration of safer needle devices as part of the re-evaluation of appropriate engineering controls during the annual review of the employer's exposure control plan. It calls for employers to solicit frontline employee input in choosing safer devices. New provisions require employers to establish a log to track needlesticks rather than only recording those cuts or sticks that actually lead to illness and to maintain the privacy of employees who have suffered these injuries.

The information in the sharps injury log shall be recorded and maintained in such manner as to protect the confidentiality of the injured employee. The sharps injury log shall contain, at a minimum:

Passed unanimously by Congress and signed by President Clinton on Nov. 6, 2000, the Needlestick Safety and Prevention Act mandates specific revisions of OSHA's bloodborne pathogens standard within six months. The legislation exempted OSHA from certain standard rulemaking requirements so that the changes could be adopted quickly.

The revised bloodborne pathogens standard was published in the Jan. 18 Federal Register. The updated rules become effective April 18,2001.  The revised standard can be viewed at http://www.osha-slc.gov/needlesticks/index.html