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231561468
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Issues - Healthcare Worker Safety
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231561468
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Issues - Healthcare Worker Safety
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Records of the National AIDS Policy Office (Clinton Administration)
Todd Summers' Files
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FOIA Number: 2018-0758-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
National AIDS Policy Office
Series/Staff Member:
Todd Summers
Subseries:
OA/ID Number:
21089
FolderID:
Folder Title:
Issues - Healthcare Worker Safety
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S
66
6
3
1
09/15/98 TUE 11:57 FAX
002
SENT DI INVOICE INCLO INVU, CLA
, 0-14-00 , 0:47FM ;
404 ass 0458-
912026906584;# 2/5
1
Cardo, Denise M. MD
From:
Jones, Marsha A.
Sent:
Tuesday, May 05, 1998 5:12 PM
To:
'Benjamin, Chris'
Cc:
Ramsey, Rosemary B.; Jarvis, William R. MD (Bill); Cardo, Denise M. MD
Subject:
FW: Needlestick Injury - Stark Proposal for HCFA
Attached Is the technical comment to address Congressman Stark's proposal. Thanks, maj
Marsha Janes
Hospital Infections Program, A07
(404)839-6402
[email protected]
Original Message
From:
Cardo, Denise M. MD
Sent:
Tuesday, May 05, 1998 4:56 PM
To:
Jonas, Marshe A.'
Cc:
Chiarello, Linda A.: Panillio, Adellsa L. MD
Subject:
FW: Nuedlestick Injury - Stark Proposal for HCFA
Marsha,
Attached Is our document in response to the request below.
CDC response,wpd
Thanks,
Denise.
1
09/15/98 TUE 11:57 FAX
4.
003
SENT
DI
TITLE
INVU,
MA
, 14 JO ;
404 000 0458-
512026906584 # 3/ 5
Attachment.
A
Our nation's 6 million health-care workers are at risk for acquiring serious occupational
bloodborne pathogen infections including those caused by hepatitis B virus (HBV), hepatitis C
virus (HCV), and human immunodeficiency virus (HIV).
Health care workers are at risk for occupational bloodborne pathogen infections through various
types of blood and body fluid contact, most importantly needlesticks and other sharps-related
injuries. Laboratory and epidemiological studies have suggested that exposure to a larger volume
of blood (e.g., injury from a hollow-bore needle used to withdraw blood from a vein or artery)
may increase the risk for bloodborne pathogen transmission.
The primary strategy to prevent the transmission of bloodborne pathogens is to prevent blood
contact and perculaneous injuries; other important strategies include hepatitis B immunization and
postexposure prophylaxis for hepatitis B virus and HIV.
Prevention of blood contact and percutaneous injuries requires a comprehensive approach,
including the development and implementation of improved engineering controls (e.g., safer
medical devices, sharps disposal containers), safe work practices (e.g., technique changes to
reduce handling of sharps), behavior modification (e.g., training to encourage compliance), and
the use of personal protective equipment (e.g., gloves).
Over the past few years many new safety devices to prevent percutaneous injuries have become
available. The Centers for Disease Control and Prevention has conducted studies that
demonstrated the effectiveness of phlebotomy devices with safety features and blunted suture
needles in reducing the number of health care workers' injuries. However, there are few data
regarding the efficacy of other safety devices, the feasibility of widescale implementation, and
their acceptability to health care workers. Also, because a variety of needles and sharp
instruments can cause injuries, there is no single device that can be used to prevent all injuries.
Ideally, a safety device should be automatically activated (i.e., the health care worker does not
need to activate the safety feature) and the safety feature should be an integral part of the device.
In addition, the device should not increase the risk of injury to health care workers or introduce
new risks to patients.
Each health care facility should promote the safety of its hcalth care workers by determining how
injuries occur in the facility (e.g., what devices contribute to injuries, what procedures were being
performed when injuries occur, as well as other circumstances) and implementing prevention
strategies. These strategies include a) eliminating the use of unnecessary needles and sharps; b)
evaluating and implementing engineering controls, such as needles with safety features, and sharps
disposal containers: c) changing work practices to avoid injuries; d) providing safety education;
and e) monitoring the effectiveness and compliance of the prevention program. In summary,
prevention of occupational injuries requires a institutional commitment to providing a safer work
place that includes, but is not limited to, the use of safety devices.
09/15/98 TUE 11:57 FAX
004
SENT 'DT PROSE INTLU INOU, CDC
;
0-14-08
;
5:47PM
;
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312026806584 # 4/5
CCD:
FVI
DEPARTMENT OF HEALTH & HUMAN SERVICES
Jim James Hughe
Health Care Financing Administration
Liaputy Administrator
Washington, D.C. 20201
Steve 0
MAY 20
we MS
this Benjam
FAX copy to
The Honorable Pete Stark
Deary
House of Representatives
Washington, D.C. 20515
file this
Dear Mr. Stark:
HCFA file
It was a pleasure to mcct and talk with you at the Ways and Means Health Subcommittee
hearing on April 23, 1998. Nancy-Ann Min DeParle and I appreciate your strong support
for the Health Care Financing Administration (HCFA), and I look forward to working
with you as we strive to improve the Medicare program.
At the conclusion of the April 23 hearing on Medicare appcals, you asked a question
Denice
relating to the Medicare Conditions of Participation (CoP). Specifically, you asked
whether the various Medicare statutory CoP provisions permit HCFA to require the use
of a particular safety device that accompanies hollow-bore needles so as to mitigate the
risk to health care workers of acquiring occupational blood bome infections caused by
F4L
needle sticks.
Bill
The Medicare statutory requirements include broad CoP authority that would allow
HCFA to mandate, by regulation, that hospitals and other providers use a particular kind
of safety device when hollow-bore needles are used for venipuncture. We are
concerned, however, that such an action would be counter-productive to our philosophy
of encouraging provider flexibility in meeting quality standards. HCFA is committed,
under the Administration's regulatory reform initiatives, to revising many of its quality
regulations to focus on outcomes of care and eliminate unnecessary, burdensome, and
costly procedural requirements. Although our current regulations rely heavily on
structure and process requirements to achieve quality, the direction we are taking in our
revised CoPs is to focus on health care outcomes and encourage flexibility in meeting
standards, while eliminating outdated measures where possible.
The proposed hospital CoP. for example, are designed to give hospitals maximum
flexibility to assimilate innovations in health care practice. We will impose specific
process requirements only where there is industry-wide consensus or empirical evidence
that these processes are predictive of desired outcomes for patients or safety for hcalth
care workers.
09/15/98 TUE 11:58 FAX
4
005
SENT BY HOSP INFEC PROG. CDC ; 9-14-98 ; 5:48PM
;
404 OJJ 0458-
312026306584 i# SI 5
Page 2 - The Honorable Pete Stark
Over the past few years, many new safety devices to prevent percutaneous injuries have
become available. Studies conducted by the Centers for Disease Control and Prevention
havc demonstrated the effectiveness of certain phlebotomy devices with safety features in
reducing the number of health care workers' injuries. However, there are few data
regarding the efficacy of other available safety devices, or their acceptability to health
care workers.
Prevention of occupational injuries requires an institutional commitment to provide я
safer work place that includes, but is not limited to, the use of safety devices. HCFA is
committed to working with hospitals and other providers to foster safe environments for
workers and patients, and we believe our more flexible CoP are the best means to ensure
that providers promote the safety of their health care workers and patients.
HCFA shares your goal of protecting the safety of our Nation's health-care workers and
the beneficiaries served by our programs. I appreciate your inquiry and encourage you to
contact me if 1 can be of further assistance.
Sincerely,
Michael M. Hash
Deputy Administrator