Sticking point

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Sticking pointHealth care workers aren't the only ones facing hazards from needles. Restaurant employees also find themselves at the ...By E. Lindt, Intelligencer Journal StaffIntelligencer Journal

Published: Jan 26, 2006 8:19 AM EST

LANCASTER COUNTY, PA - Restaurant work isn't usually considered life-threatening, but a recent spate of needle sticks at area restaurants has a local physician raising red flags.

"We've had four people in the last five weeks, all in food service, who came in," said Dr. Rochester, medical director of Worknet Occupational Medicine, 2301 Columbia Ave."We need to educate people that there's a problem out there."Rochester said the four patients treated at Worknet all were pricked with syringes or lancets left on restaurant tables or in bathrooms. Lancets are small single-use needles often used by diabetics to test blood-sugar levels before meals.The workers were stuck by the "sharps" after customers wrapped them in napkins or left them on dishes, Rochester said. The unsuspecting workers were pricked when they cleared the tables.Sometimes-fatal viruses can be transmitted by blood left on syringes and sharps.While health care workers have long been trained to handle such medical waste, restaurant workers often are unaware they may be exposed to needle sticks on the job.And training on the proper handling of sharps may be lacking.Rochester said one woman he treated manages a local takeout restaurant. Although the store doesn't have a public bathroom, she allowed a woman to use the employee bathroom.About 20 minutes later, the manager stepped on a syringe on the bathroom floor as she was changing her clothes. Rochester said it most likely was left behind by an intravenous drug user.Because the store manager had no way of knowing whether the person who left the syringe carried a virus, she started a course of powerful, costly medications to reduce her chances of contracting Hepatitis B or C or HIV, as recommended by the Centers for Disease Control and Prevention.Even with preventative drugs, the manager still may contract the viruses if the user of the syringe carried them. And in the meantime, she's suffering the debilitating side effects of the preventative drugs, particularly the anti-viral HIV medications, which can cause inflammation of the liver and pancreas, stomach irritation, stunted red and white blood cell production and permanent organ damage, among other effects.She was hospitalized Tuesday with what Rochester believes is a severe reaction to the anti-viral HIV cocktail."I'm really worried about her," Rochester said. "She's in her mid-20s, and she's scared to death right now. ... It's just been an awful experience for someone who was just trying to be nice and let someone use the bathroom."If food service workers are stuck by needles or lancets, Rochester said, they should immediately wash the wound with soap and water. Every effort should be made to locate the source of the sharp object, either by credit card receipts or any other means.If that person has tested negative for HIV and hepatitis, a needle stick patient can avoid the cost and potential side effects of preventative drugs.Rochester said needle stick patients should go to the emergency department, where confidential HIV and hepatitis tests can be administered. Treatment should be sought within two hours of the needle stick.And although too little blood remains on syringes and lancets to test for viruses, the needles should be taken to the emergency department if they can be found.Preventative treatment is long and costly, but Rochester said the cost of treatment and disability resulting from a needle stick for workers in Pennsylvania is covered by their employers' insurance."When a worker is pricked by these devices, they require blood work, in some instances anti-HIV medications, follow-up and repeated blood testing at the initial visit, six weeks, three months, six months and one year (later)," Rochester said. "They take the anti-HIV medication for at least one month."Dr. Kirchner, director of the Comprehensive Care Clinic for HIV at Lancaster General Hospital, said the CDC reports a 1-in-300 chance of transmitting HIV via a needle stick in the workplace.Transmission of Hepatitis C only occurs in about one of every 50 people stuck with needles used by those infected. But Hepatitis B, the most contagious of the three viruses, is transmitted to about one person in four.There are no cures for the three infections that might be transmitted, and all pose life-threatening conditions.Needlesticks in health care settings are relatively common, with up to 1 million reported annually, resulting in at least 1,000 workers contracting serious infections, which also can include tuberculosis, syphilis, malaria and herpes, according to the American Nurses Association.The American Hospital Association reports one case of serious infection can cost up to $1 million in medical care, lost time and disability payments. The follow-up care alone for a high-risk exposure can cost nearly $3,000, even if the virus isn't transmitted.Well-organized health care worker groups have lobbied legislators and the Occupational Safety and Health Administration to tighten regulations for handling used syringes and sharps to reduce needlesticks.Other industries also fall under OSHA regulations, which require employers to identify bloodborne pathogen hazards, such as needle sticks and design ways to reduce them.In the hotel industry, housekeeping staff often are trained to safely handle syringes and sharps commonly found in rooms.A local resort manager said his housekeeping staff typically finds at least one syringe or sharp a week. Staff are trained to dispose of them in a receptacle that keeps workers from being stuck or coming into contact with blood.The same manager, though, said he hadn't heard any reports of restaurant staff coming across medical waste. Pat Conway, CEO of Pennsylvania Restaurant Association, also said he hadn't heard of the problem among members of the state's largest food and beverage lobby.And Lancaster General Hospital's Occupational Medicine hasn't treated restaurant workers for needle sticks.That's precisely why Rochester is worried. Needle sticks in a workplace can be reduced, and perhaps prevented, if workers know to avoid them."It's drilled into the heads of health care workers from the time they start work to take protective measures (against being pricked)," Rochester said."But food service workers might not be expecting it. They might not know they should be careful when busing tables and grabbing those napkins. That's why I'm concerned."How syringes and sharps are discarded is a public health concern, so the U.S. Environmental Protection Agency set standards for disposing of needles in special receptacles that reduce needle sticks.Some communities make receptacles available for public use so medical waste doesn't end up in the trash, which exposes the public to needle sticks while trash waits at the curb to be hauled. It also puts trash handlers at risk for needle sticks.Kirchner said he is unaware of a public receptacle in the Lancaster area, although about half a dozen of his clinic's HIV patients also are diabetics and use and dispose of several syringes daily that may carry the HIV virus.Lancaster County Solid Waste Management Authority provides receptacles for medical waste to county residents free of charge. The authority also provides complimentary Safe Clips, a device that clips off needles and safely stores up to 1,000 of them.The authority will mail the devices to residents, or they can be picked up at the authority's main office, 1299 burg Pike. Residents may return the receptacles and Safe Clips to the authority for free disposal.For more information about the receptacles or Safe Clips, call the authority at 397-9968 or send an e-mail to info@...."Food service workers might not be expecting it. They might not know they should be careful when busing tables and grabbing those napkins. That's why I'm concerned."Dr. RochesterWorknet Occupational Medicine "We've had four people in the last five weeks, all in food service, who came in," said Dr. Rochester, medical director of Worknet Occupational Medicine, 2301 Columbia Ave."We need to educate people that there's a problem out there."Rochester said the four patients treated at Worknet all were pricked with syringes or lancets left on restaurant tables or in bathrooms. Lancets are small single-use needles often used by diabetics to test blood-sugar levels before meals.The workers were stuck by the "sharps" after customers wrapped them in napkins or left them on dishes, Rochester said. The unsuspecting workers were pricked when they cleared the tables.Sometimes-fatal viruses can be transmitted by blood left on syringes and sharps.While health care workers have long been trained to handle such medical waste, restaurant workers often are unaware they may be exposed to needle sticks on the job.And training on the proper handling of sharps may be lacking.Rochester said one woman he treated manages a local takeout restaurant. Although the store doesn't have a public bathroom, she allowed a woman to use the employee bathroom.About 20 minutes later, the manager stepped on a syringe on the bathroom floor as she was changing her clothes. Rochester said it most likely was left behind by an intravenous drug user.Because the store manager had no way of knowing whether the person who left the syringe carried a virus, she started a course of powerful, costly medications to reduce her chances of contracting Hepatitis B or C or HIV, as recommended by the Centers for Disease Control and Prevention.Even with preventative drugs, the manager still may contract the viruses if the user of the syringe carried them. And in the meantime, she's suffering the debilitating side effects of the preventative drugs, particularly the anti-viral HIV medications, which can cause inflammation of the liver and pancreas, stomach irritation, stunted red and white blood cell production and permanent organ damage, among other effects.She was hospitalized Tuesday with what Rochester believes is a severe reaction to the anti-viral HIV cocktail."I'm really worried about her," Rochester said. "She's in her mid-20s, and she's scared to death right now. ... It's just been an awful experience for someone who was just trying to be nice and let someone use the bathroom."If food service workers are stuck by needles or lancets, Rochester said, they should immediately wash the wound with soap and water. Every effort should be made to locate the source of the sharp object, either by credit card receipts or any other means.If that person has tested negative for HIV and hepatitis, a needle stick patient can avoid the cost and potential side effects of preventative drugs.Rochester said needle stick patients should go to the emergency department, where confidential HIV and hepatitis tests can be administered. Treatment should be sought within two hours of the needle stick.And although too little blood remains on syringes and lancets to test for viruses, the needles should be taken to the emergency department if they can be found.Preventative treatment is long and costly, but Rochester said the cost of treatment and disability resulting from a needle stick for workers in Pennsylvania is covered by their employers' insurance."When a worker is pricked by these devices, they require blood work, in some instances anti-HIV medications, follow-up and repeated blood testing at the initial visit, six weeks, three months, six months and one year (later)," Rochester said. "They take the anti-HIV medication for at least one month."Dr. Kirchner, director of the Comprehensive Care Clinic for HIV at Lancaster General Hospital, said the CDC reports a 1-in-300 chance of transmitting HIV via a needle stick in the workplace.Transmission of Hepatitis C only occurs in about one of every 50 people stuck with needles used by those infected. But Hepatitis B, the most contagious of the three viruses, is transmitted to about one person in four.There are no cures for the three infections that might be transmitted, and all pose life-threatening conditions.Needlesticks in health care settings are relatively common, with up to 1 million reported annually, resulting in at least 1,000 workers contracting serious infections, which also can include tuberculosis, syphilis, malaria and herpes, according to the American Nurses Association.The American Hospital Association reports one case of serious infection can cost up to $1 million in medical care, lost time and disability payments. The follow-up care alone for a high-risk exposure can cost nearly $3,000, even if the virus isn't transmitted.Well-organized health care worker groups have lobbied legislators and the Occupational Safety and Health Administration to tighten regulations for handling used syringes and sharps to reduce needlesticks.Other industries also fall under OSHA regulations, which require employers to identify bloodborne pathogen hazards, such as needle sticks and design ways to reduce them.In the hotel industry, housekeeping staff often are trained to safely handle syringes and sharps commonly found in rooms.A local resort manager said his housekeeping staff typically finds at least one syringe or sharp a week. Staff are trained to dispose of them in a receptacle that keeps workers from being stuck or coming into contact with blood.The same manager, though, said he hadn't heard any reports of restaurant staff coming across medical waste. Pat Conway, CEO of Pennsylvania Restaurant Association, also said he hadn't heard of the problem among members of the state's largest food and beverage lobby.And Lancaster General Hospital's Occupational Medicine hasn't treated restaurant workers for needle sticks.That's precisely why Rochester is worried. Needle sticks in a workplace can be reduced, and perhaps prevented, if workers know to avoid them."It's drilled into the heads of health care workers from the time they start work to take protective measures (against being pricked)," Rochester said."But food service workers might not be expecting it. They might not know they should be careful when busing tables and grabbing those napkins. That's why I'm concerned."How syringes and sharps are discarded is a public health concern, so the U.S. Environmental Protection Agency set standards for disposing of needles in special receptacles that reduce needle sticks.Some communities make receptacles available for public use so medical waste doesn't end up in the trash, which exposes the public to needle sticks while trash waits at the curb to be hauled. It also puts trash handlers at risk for needle sticks.Kirchner said he is unaware of a public receptacle in the Lancaster area, although about half a dozen of his clinic's HIV patients also are diabetics and use and dispose of several syringes daily that may carry the HIV virus.Lancaster County Solid Waste Management Authority provides receptacles for medical waste to county residents free of charge. The authority also provides complimentary Safe Clips, a device that clips off needles and safely stores up to 1,000 of them.The authority will mail the devices to residents, or they can be picked up at the authority's main office, 1299 burg Pike. Residents may return the receptacles and Safe Clips to the authority for free disposal.For more information about the receptacles or Safe Clips, call the authority at 397-9968 or send an e-mail to info@...."Food service workers might not be expecting it. They might not know they should be careful when busing tables and grabbing those napkins. That's why I'm concerned."Dr. RochesterWorknet Occupational Medicine

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