Maryland regulators have cited the Maryland Shock Trauma Center with two health and safety violations for failing to enforce procedures aimed at protecting workers from on-the-job exposure to the AIDS and hepatitis B viruses.
In a series of inspections that began last February, inspectors with the Maryland Occupational Safety and Health office saw employees working on critically injured patients without required gloves, masks and goggles.
Inspectors also reported that 47 employees had been exposed to blood or other body fluids in job-related accidents last year. Many of the employees, said the inspectors, were stuck by used needles that protruded from overstuffed disposal containers or by old hypodermics that lay on patient beds and other surfaces.
MOSH levied fines of $1,500 against Shock Trauma for the two violations; the legal maximum was $2,000. Specifically, the citations faulted the hospital for failing to require employees to adhere to its established health and safety procedures and for failing to ensure that workers attended training programs that deal with prevention.
Yesterday, nursing director Angela Janik said the administration had just received the citations that day and did not yet know whether it would dispute the findings and request a hearing. But she acknowledged that the center began responding to the inspections on July 1, when training procedures were tightened up to ensure that nurses avoid needle sticks and other accidents involving blood.
For instance, she said, training sessions will be held in every nursing unit in Shock Trauma -- a switch from the old practice of holding the sessions in one central place. Although she said attendance has always been mandatory, she acknowledged that it may have been less than total.
Only 96 of 700 employees who come into regular contact with blood and other body fluids attended training sessions in 1989, according to MOSH records.
Injury reports filed with the state Workers Compensation Commission cite numerous instances in which employees were discarding used syringes in designated disposal boxes and accidentally got stuck by other needles overflowing from the seldom-emptied containers.
One employee described an injury this way: "Helping patient back to bed, needle lying on patient's bed uncapped."
Ms. Janik said she did not know if any of the 47 employees actually contracted the human immunodeficiency virus, HIV, which causes acquired immune deficiency syndrome, or the hepatitis B virus from a needle stick. The federal Centers for Disease Control has recorded 24 cases nationally of health-care employees who contracted the AIDS virus while working.
The hepatitis B virus, however, is far more infectious. The CDC estimates that about 10,000 health-care workers each year contract the virus from needle sticks and other occupational exposures. Some 3,000 of the workers get sick with hepatitis, and as many as 200 die.
Dr. Howard Belzberg, a Shock Trauma internist, said some accidental exposures are inevitable at centers that treat severely injured patients.
"I think that the more training you do, the better off you are," he said. "But you will never reduce it [exposures] to zero."