Collaborative effort results in new safety protocols

The Report: August 2006 vol.27 num.4


xposure to potentially infectious blood and other body fluids is a serious occupational hazard for many health care workers. HSA and other health care unions have beenworking with frontline workers, employers, BCs Occupational Health andSafety Agency for Health Care (OHSAH) and WorkSafeBC (formerly WCB), tofind and implement effective measures to minimize this hazard.

On June 11, 2001, the WorkSafes Prevention Division imposed three administrative penalties, with fines totaling $34,000, against the Capital HealthRegion (CHR - now part of the Vancouver Island Health Authority) for failing to take adequate measures to protect its laundry workers from needle stick and puncture injuries. CHR appealed the imposition of these penalties to WorkSafes Appeal Division, and the three health care unions ... HSA, HEUand BCNU ... intervened in the appeal as interested stakeholders.

After several meetings, agreement was reached to establish a joint union/employer BBF subcommittee of the joint occupational health and safety committee at one of the Victoria-area hospitals.

OHSAH was asked to assist in the design, development, implementation and evaluation of an exposure control plan. Most of the money from the administrative penalty ($30,000), was earmarked to help develop the exposure control plan.

-We believed the employer had a sincere desire to address this hazard, and decided there was a better chance of making a real difference by using this opportunity to create a structure that would have a good chance of tackling this complex issue, rather than simply punishing the employer with a fine.

OHSAH definition of blood and body fluid exposure

Blood and body fluid (BBF) exposure is a term used when blood or otherpotentially infectious body fluid comes into contact with the skin, subcutane-ous tissue (i.e. tissue under the skin), or mucous membranes (i.e. tissue liningthe eyes, nose, mouth, vagina, rectum and urethra). Exposure to BBF is amajor concern for health care workers because of the potential for acquiringdisease and the related psychological stress that can occur.

Despite the massive restructuring that occurred as CHR became part ofthe new Vancouver Island Health Authority, the joint committeecontinued its work, conducting worksite safety audits and implementinguse of the internationally used EPINet (Ex-posure PreventionInformation Network) for reporting and tracking BBF exposures.

VIHA has now implemented the BBF exposure control plan throughout the health authority. Theplan includes improved training in minimizing exposure, the use of safer needle/sharps devices and replacing glass specimen tubes and containers with plastic ones.

Other health authorities are at various stages of implementing a safe needle/sharps program and/ora broader BBF exposure control plan.

Where requested, OHSAH has provided information about best practices and has worked to ensure that all health authorities have a consistent wa of tracking exposure incidents. OHSAH hopes to start collecting data soon to evaluate the effectiveness of the exposure control plan thats been implemented in VIHA.

OH&S Regulation

Section 6.34 Exposure control plan
The employer must develop and implement an exposure control planmeeting the requirements of section 5.54, if a worker has or may haveoccupational exposure to a bloodborne pathogen, or to other biohazardousmaterial as specified by the [Workers Compensation] Board.

Although significant progress is being made in some health authoritiesto address this important occupational hazard, more needs to be done.The Service Employees International Union (SEIU) is currently heading acampaign urging provincial governments to enact legislation making theuse of safety-engineered needles and medical devices mandatory.Manitoba and Saskatchewan are the only Canadian jurisdictions that havepassed such legislation so far. Manitobas act came into effect January1 of this year. Saskatchewans act is scheduled to come into force onJuly 1. A safe needles bill passed first reading in Nova Scotia in May,2006, before a provincial election was called, and a private membersbill on safe needles in Ontario passed first reading last November.

HSA is supporting SEIUs campaign for such legislation in BC. More information about the campaign is available at

In BC, WorkSafe has proposed amendments to the Occupational Health and Safety Regulation governing sharps.

These amendments would include provisions making it mandatory for employers to replace regular hollow-bore needles used for vascular access,with safety-engineered needles. The amended regulation would also -encourage" further upgrading,to replace safety-engineered needles with needle-lessdevices, which reduce the risk of injury and exposure even further.

Although the proposed amendment is an improvement over current regulatory requirements,many labour organizations believe it does not go far enough.

WorkSafe recently invited public feedback on the proposed amendments. HSAs submission stressed that the regulation should be expanded to include all medical sharps, not just vascular needles, and that the workplace OH&S Committees should participate in the selection of appropriate devices.

Jackie Spain, HSA Region 9 Director and Chairof HSAs provincial OH&S Committee, emphasizes that frontline workers must be involved in deciding what types of equipment and devices are the safestand most effective for carrying out their work. -The people performing each type of task that carries arisk of BBF exposure have the best idea of what sort of needle system or other device will decrease the risk of a puncture or other type of BBF exposure,"Spain said. She added that employers also need to listen to these employees to ensure that the new equipment or device doesnt create a different type of hazard.

-Members at some facilities have told me theyve been given a ‘safety needle to use that requires them to use their thumb to flip a cover over the needle tip, and that its so difficult to do this, their thumb is stiff and painful by the end of their shift.

Post-exposure follow-up

Every health care worker should be aware of their facilitys procedurefor medical treatment and reporting following a blood and body fluidexposure. In most hospitals, this means reporting to the ER as soon aspossible. Members who are unsure whether filling in an internal -IncidentReport" is sufficient, or whether they should file a workers compensationclaim, should contact the HSA office for assistance.

"Spain also stressed the need for facilities to look beyond the issueof needlestick injuries, and to implement measures to eliminate alltypes of BBF exposure.

-HSA members in many differentprofessions face a risk of BBF exposure, from a variety of sources."Exposure can occur not only through punctures caused by needles, cutsfrom other types of sharps, or broken glass, but also from directcontact with patients who are coughing, sneezing, bleed-ing, etc.

-Employers need to ensure there are control measures in place for every type of BBF hazard,"Spain said.