ATLANTA – The Centers for Disease Control and Prevention (CDC) is investigating as many as four more potential cases of laundry and housekeeping workers infected with HIV, the virus that causes AIDS, as a result of needlestick injuries they suffered at work.
While the most recent new case of occupationally acquired HIV infection among healthcare personnel was reported to the CDC in 2000, “several cases are in various stages of investigation,” the agency says in its most recent report, Surveillance of Occupationally Acquired HIV/AIDS in Healthcare Personnel, as of December 2006, issued last September.
There are usually delays between the time an employee suffers a needlestick exposure and the reporting of the case to the CDC.
The seriousness of these injuries has attracted the attention of the Occupational Safety and Health Administration (OSHA) in Washington.
In 2007, the federal agency issued 270 citations to hospitals for violations of its Bloodborne Pathogens Standard, up from 196 in 2006, according to Dionne Williams, a senior industrial hygienist for OSHA.
“It appears that there are a lot of injuries among laundry and housekeeping personnel, due to needles and other contaminated sharp objects left in soiled goods,” says Williams. “The number of infractions is up.”
Between 1981 and 2006, the CDC documented two cases of laundry and housekeeping employees who were infected with HIV as a result of occupational exposure to blood and identified 13 more possible cases.
Those employees were among a total of 57 documented cases and 140 possible cases of HIV-positive healthcare workers in the States “who have not reported other risk factors for HIV infection and who report a history of occupational exposure to blood, body fluids or HIV-infected materials,” according to the CDC. Twenty-six of those workers have converted to AIDS.
However, both the CDC and the National Institute for Occupational Safety and Health (NIOSH) warned that the number of laundry and housekeeping employees infected with HIV as a result of needlestick injuries could potentially be much higher.
NIOSH estimates there are as many as 800,000 needlestick injuries among healthcare, laundry and housekeeping employees each year, of which at least half aren’t reported.
“Because of the voluntary nature of the reporting system, there will always be some degree of under-reporting of cases of HIV infection,” says Dr. Adelisa Panlilio, a medical epidemiologist for the CDC in Atlanta. “There is much reluctance among employees to come forward and report these cases.”
Panlilio estimates perhaps only 40% of all such needlestick injuries and HIV infections are reported to the CDC, largely because of concerns over confidentiality.
“Our reporting system is passive,” Panlilio says. “When there are such reports, we conduct investigations. But we have no way of actually knowing how many injuries there are among these employees.”
In December 1995, Laundry News reported that at least one person and possibly as many as seven other people in laundry and housekeeping had contracted HIV infections as a result of occupational exposure to blood in a healthcare laundry setting, according to the CDC.
The CDC attributed the downstream injuries to needles, syringes or other sharp objects carelessly discarded in soiled linen and shipped to laundries.
Since that time, OSHA has stepped up its enforcement activities against hospitals in which employees have reported injuries resulting from needlesticks or other sharp objects.
OSHA issued $130,000 in fines to hospitals for these violations in 2007, according to Williams. The agency has the power to fine a hospital up to $5,000 for a serious violation. A third violation of the same OSHA standard would be considered serious, or willful.
“A lot of our activities in this area are complaint-driven,” says Williams. “We are responding to more complaints from employees.”
However, the reality remains that OSHA surveillance reports are capturing only a percentage of all HIV infections caused by needlestick injuries among laundry and healthcare employees, according to Jane Perry, director of communications for the International Health Care Worker Safety Center at the University of Virginia Health System in Charlottesville, Va.
“We know that there is a high percentage of under-reporting of these injuries,” says Perry. “We believe that the percentage of employees who are occupationally infected is significantly higher and that the CDC statistics don’t capture the true percentage of needlestick injuries in hospital laundries. The statistics certainly don’t reflect all the injuries, because many employees are afraid to report them and don’t report them.”
The prevalence of sharp objects found in soiled linen “remains a problem in many facilities,” according to Perry. To combat the problem, she says, many laundries now take photos of the sharp objects and send them to the departments from which they originated.
“They will say: ‘This is what we found,’” says Perry. “‘Now, there needs to be some policy and follow-up over this.’”
OSHA is still discovering “problems with work practices” in laundries, according to Williams. Laundry management must enforce OSHA’s Bloodborne Pathogens Standard and adhere to their institution’s infection control plan, she says.
These problems also exist in laundries beyond U.S. borders, in places such as the Regina Qu’Appelle Health Region’s laundry in Regina, Saskatchewan, Canada.
Every three months, the laundry returns 50 pounds of instruments and sharp objects to their points of origin. In addition to bags of blood, the laundry reports finding sharp objects, including needles, scalpels, scissors and pieces of silverware.
On one occasion, a butcher knife fell out of a bag of soiled linen on an overhead monorail and stuck in a table at which employees were sorting goods. When a pair of scissors punctured a piece of laundry equipment, it cost the region $50,000 in parts and lost production and labor.
An education campaign resulted in a 50% reduction in the number of sharp objects reaching the laundry over a five-month period in 2007. “There really is nothing new being done since these issues were raised last year,” says Mark Torjusen, a spokesman for the health region.
Panlilio recommends that laundries adhere to universal precautions, in which all soiled linen and other objects are treated as if they are contaminated. She also says laundries need to closely follow OSHA’s Bloodborne Pathogens Standard.
OSHA’s Williams agrees, adding, “Hospitals should develop a safety culture that encourages employees to discuss potential problems in a nonpunitive environment and to be vigilant about what they see.”
Have a question or comment? E-mail our editor Matt Poe at [email protected].