OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov.
June 10, 1991
Patricia Seigel, RN
Assistant Nursing Supervisor
Garden State Medical Group, P.A.
1 Sears Drive
Paramus, New Jersey 07652
Dear Ms. Seigel:
Thank you for your letter of May 13, in which you requested clarification on the Occupational Safety and Health Administration (OSHA) requirements regarding recapping of used needles.
On February 27, 1990, OSHA issued a revised compliance directive to its field staff entitled OSHA Instruction CPL 2-2.44B, "Enforcement Procedures for Occupational Exposure to Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV)". A copy of this Instruction is enclosed for your information. On page 16, you will see that OSHA has clarified its prohibition against recapping by hand.
OSHA policy is that recapping of needles, in general, is not appropriate. Used needles are to be placed in sharps disposal containers without recapping. In certain instances in which recapping is unavoidable, such as the situations you describe, recapping by some method other than the traditional two-handed procedure is permitted. Acceptable methods include the use of self-sheathing needles or other auxiliary devices such as resheathing instruments or forceps. The properly performed one- hand scoop technique may also be used.
With regard to your proposal to set up containers in each room for "unused sharps", it is unclear why your facility would choose to segregate used sharps. While OSHA requires that used sharps be disposed of in regular sharps containers, the ultimate disposal method (landfilling, incinerating, and so forth) for medical waste falls under the purview of the U.S. Environmental Protection Agency (EPA) and possibly state and local regulations. It is our understanding of the EPA Medical Waste Tracking Act that, in New Jersey, used needles are considered regulated medical waste regardless of the presence of infectious agents. You may wish to contact your local EPA office for further information.
If you would like to further discuss the specifics of your facility with OSHA, we suggest that you contact OSHA's bloodborne disease coordinator for the New York Region at (212) 337-2325.
We hope this information is responsive to your concerns and we thank you for your interest in worker safety and health.
Gerard F. Scannell
May 13, 1991
Department of Labor
We are a multi-specialty HMO, located in Paramus, New Jersey. For the past three (3) days I have left messages at your office on Federal Plaza, New York City to no avail. Therefore, I have decided to write you for the information and guidance I need in order to comply with federal guidelines.
OSHA guidelines, which are based on CDC guidelines, states that we cannot recap needles. However, the question arises as to how one safely draws up a medication and then changes the needle on the syringe without recapping. There are numerous reasons why a needle would have to be changed after drawing up a medication ie; certain medication coat needle and if a needle is not changed can cause tissue necrosis, drawing up a medication and changing needle to butterfly, to name just a couple. I called CDC and spoke to a Dr. Tokars. After explaining my dilemma to him he stated that the CDC guidelines were set up to prevent the spread of blood borne pathogens. Therefore, one should not recap a needle after patient has been injected. A needle that has only been used to draw up a medication in not considered a "dirty" needle and therefore does not come under CDC guidelines. OSHA guidelines are for safety. It would certainly be unsafe practice for one to try and remove a needle from a syringe with a cap on it.
My proposal for my HMO is to set up a policy that would place a small sharps container in each room that would be marked "unused sharps". This would be the receptacle for recapped needles and would be classified as class VII for disposal purposes. Hopefully, this will be agreeable to you. We are trying to comply with USEPA, NJDEP, OSHA and CDC. We are also attempting to be practical and logical as well.
Your prompt attention to this matter will be greatly appreciated. If you have any questions, please feel free to call me at 201-599-4800.
Patricia Seigel, R.N.
Asst. Nrsg. Supervisor