chapter 12 | Promoting a Healthy Workplace 183personnel were well aware of issues related to latex
allergies. In recent years, the number of new cases of
latex allergy has decreased due to improved diag-
nostic methods, improved education, and more
accurate labeling of medical devices. Although cur-
rent research does not demonstrate whether the
amount of allergen released during shipping and
storage into medications from vials with rubber clo-
sures is sufficient to induce a systemic allergic reac-
tion, nurses should take special precautions when
patients are identified as high risk for latex allergies.
The nursing staff should work closely with the
pharmacy staff to follow universal one-stick-rule
precautions, which assume that every pharmaceuti-
cal vial may contain a natural rubber latex closure,
and the nurse should remain with any patient at the
start of medication and keep frequent observations
and vital signs for 2 hours (Hamilton et al., 2005).
Needlestick Injuries
In 1997 a 27-year-old nurse, Lisa Black, attended
an in-service session on postexposure prophylaxis
for needlesticks. A short time later, she was
attempting to aspirate blood from a patient’s intra-
venous line. The patient, in the advanced stages of
acquired immunodeficiency syndrome, moved, and
the needle went into Lisa’s hand. Nine months later
she tested positive for HIV and 3 months after that
for hepatitis C. She continues to share her story
with nurses everywhere in an effort to prevent this
unfortunate accident from happening to one more
nurse (Trossman, 1999a).
On April 18, 2001, the Needlestick Act, or
revised Bloodborne Pathogens Standard, went
into effect. The revised OSHA Bloodborne
Pathogens Standard obligates employers to con-
sider safer needle devices when they conduct their
annual review of their exposure control plan.
Frontline employees must be included in the
annual review and updating of standards process.
Stricter requirements are now in effect for annual
review and updating to reflect changes in technol-
ogy that eliminate or reduce exposure to blood-
borne pathogens. JC surveyors are now asking if
health-care organization leaders are familiar with
the Needlestick Safety and Prevention Act and
whether any action being taken to comply
includes staff that use sharps and needles and are
therefore at risk for injury. The law requires
that these health-care workers and other staff be
included in the review of safer devices as well as in
making recommendations for replacement devices.
(osha.gov/needlesticks/needlefaq;http://www.joint
commission.org/SentinelEvents/SentinelEvent
Alert/sea_22.htm)Your Employer’s Responsibility
According to the current OSHA requirements,
your employer must provide you with the following
(ANA, 1993; nursingworld.org/dlwa/osh/wp2):
■Free hepatitis B vaccine
■Protective equipment that fits you (gloves,
gowns, goggles, masks)
■Immediate, confidential medical evaluation,
treatment, and follow-up if you are exposed
■Implementation of universal precautions
institution-wide
■Adequate sharps disposal
■Proper removal of hazards from the workplace
■Annual employee training
Many states have enacted their own laws related to
blood-borne pathogen exposures. These laws may
include some of the following requirements:
■Listing of safety devices as engineering controls
■Development of a list of available safety devices
by the state for use by employers
■Development of a written exposure plan by
employers and periodic review and updates
■Development of protocols for safety device
identification and selection by employers
and involvement by frontline workers in the
process
■Development of a sharps injury log and report-
ing log information
■Development of methods to increase use of vac-
cines and personal protective equipment
■Waivers or exemptions from safety device use
under certain circumstances (including patient
and/or worker safety issues, use of alternative effec-
tive strategies, market unavailability, and so on)
■Placement of sharps containers in accessible
positions
■Training for workers regarding safety device
use (http://www.cdc.gov/niosh/topics/bbp/
ndl-law.htm)
Your Responsibility
What are your responsibilities related to this revised
legislation? Each year your institution must review
and update its blood-borne pathogen standards. You