North America (U.S. and Canada) - Policy and Legislation
to protect healthcare workers from occupational exposures to bloodborne pathogens
Summary: The U.S. passed the Needlestick Safety and Prevention Act in November 2000. To date, this is the only national-level legislation mandating the use of safety-engineered devices in healthcare settings to reduce the risk of sharps injuries and blood exposures to healthcare workers. A summary of U.S. legislative and policy developments regarding bloodborne pathogen exposure and needlestick prevention can be found here.
In Canada, four provinces (Alberta, Manitoba, Ontario, and Saskatchewan) have passed laws or regulations pertaining to sharps safety and use of safety-engineered devices; others are expected to follow.
Policy and legislation, by country:
- UNITED STATES
U.S. Needlestick Safety and Prevention Act - text of bill
U.S. Bloodborne Pathogens Standard - Occupational Safety and Health
Administration (revised 2001)
Register text of revised Bloodborne Pathogens Standard with
supplementary information explaining the reasons for the revision
Bloodborne Pathogens Standard Compliance Directive (guidance for OSHA
inspectors who enforce the standard)
- Overview of U.S. regulations and legislation for Preventing Occupational exposures to bloodborne pathogens
Canada's occupational safety and health programs are organized and administered at the provincial level; accordingly, regulations relevant to sharps safety and needlestick prevention have been promulgated by provincial authorities. Those provinces that have passed some type of needle safety legislation as of March 2009 are listed below. Provinces and territories that have not passed legislation are: New Brunswick, Newfoundland/ Labrador, Prince Edward Island, and Quebec; and Yukon, Nunavut and Northwest territories.
The Alberta government promulgated a provincial-level Occupational Health and Safety Code (OHS Code) in November 2003 which set standards for protecting the health and safety of workers. Two sections specifically address the hazard of bloodborne pathogen exposures in healthcare workers:
Part 2, "Hazard Assessment, Elimination and Control," states that employers must conduct a hazard assessment to identify existing or potential hazards (including biological hazards) within the workplace, and that employers must then implement measures to eliminate or control the hazards. Engineeruring controls are specified as the preferred method to eliminate or minimize hazards. Part 35, "Health Care and Industries with Biological Hazards," requires employers to ensure that: (1) sharps containers are available and used; (2) workers do not recap needles; (3) all biological hazards are included in the hazard assessment; (4) written policies and procedures governing the storage, handling, use and disposal of biohazardous materials are established; (5) protocols for post-exposure management of exposed workers are in place.
These requirements were effective April 2004; the Code was updated in 2006.
In 2007, British Columbia's WorkSafe BC, the provincial body governing occupational safety, amended the Occupational Health and Safety Regulation [Guidelines Part 6 - Biological Agents;6.33-6.40] to require safety-engineered needles for any procedures involving use of hollow-bore needles (e.g., withdrawing blood or body fluids, accessing a vein or artery, administering medications or fluids). This requirement applies to all workplaces, including physicians' offices and clinics, patients' homes, and long-term care facilities, in addition to hospitals). Facilities with potential employee exposure to blood and body fluid are also required to have in place an exposure control plan. The revised requirement took effect January 1, 2008. On October 1, 2008, a broader requirement took effect requiring the use of safety-engineered devices for any medical procedure; it covers non-hollow-bore sharp device categories, such as suture needles, scalpels, and lancets. For more information, click here.
The Manitoba government passed Bill 23, the Workplace Safety and Health Amendment Act (Needles in Medical Workplaces), on June 9, 2005 (S.M. 2005, c. 15; 3rd Session, 38th Legislature). The law requires that all healthcare workplaces protect workers by implementing safety-engineered needles whenever feasible. Safe work practices in relation to needle use is also required.
The Safer Needles in Healthcare Workplaces Act, passed in 2006, came into effect in January 2007. Under this act, healthcare facilities in Nova Scotia are required to implement safety-engineered needles, with certain exceptions, and to provide instruction and training in their use. Compliance was required no later than one year after the law took effect.
Ontario Regulation 474/07 Needle Safety
Under the Ontario Occupational Health and Safety Act, the regulation requires hospitals to use safety-engineered needles and needleless devices to replace conventional hollow-bore needles by September 1, 2008. A Ministry of Labour (MOL) news release, dated August 23, 2007, states, "The government intends to mandate the use of safety-engineered needles or needle-less systems in long-term care homes, psychiatric facilities, laboratories and specimen collection centres in 2009 and in other health care workplaces (home care, doctor's offices, ambulances, etc.) in 2010."
Needle Safe Devices and Improved Exposure Control Plans (Document ID 12283) -Saskatchewan's Occupational Health and Safety Act was revised on October 19, 2005, to mandate the use of safer needles in health care and correctional facilities. The revised regulations require employers or contractors to develop and implement an exposure control plan to eliminate or minimize worker exposure if workers are required to handle, use or produce an infectious material or organism or are likely to be exposed at a place of employment. For tasks and procedures in which it is reasonably anticipated that a worker or self-employed person may incur a percutaneous injury from a contaminated hollow bore needle, the employer or contractor must: (a) identify, evaluate and select needles with engineered sharps injury protections or needleless systems, in consultation with representatives of those workers or self-employeed persons who will use the selected device; and (b)ensure that the needles with engineered sharps injury protections and needleless systems selected pursuant to clause (a) are used. An employer or contractor must maintain an injury log for all exposures involving a percutaneous injury with a sharp that may be contaminated. The requirements took effect July 1, 2006.