Workplace Virus Hazards Cited : Health: Witnesses at hearing urge OSHA to strengthen protections for health-care workers. They tell of dangers of contracting blood-borne hepatitis or HIV diseases in hospitals and labs.

LaVonne Wilenken on Tuesday told of coming home from her job as a nurse soaked to the skin with blood.

Don Jewett, an orthopedic surgeon, told of having blood seep through his mask and protective goggles during surgery. Jewett said he concluded that he would be safer wearing a respirator.

The two were among the first in what is expected to be a weeklong parade of witnesses supporting the federal government’s first proposed crackdown on biological hazards in the workplace.

The Occupational Safety and Health Administration is gingerly stepping outside its traditional confines of factory floors and construction sites by proposing that hundreds of thousands of the nation’s employers spend $850 million a year to better protect 4.7 million health-care workers against contracting blood-borne viruses such as hepatitis B and HIV, the virus that causes AIDS.

The agency on Tuesday began the last in a series of regional public hearings on a proposal that has drawn more public interest than any in OSHA’s 20-year history, generating 3,000 pieces of correspondence, both pro and con.

The proposed rules, expected to be completed early next year, are aimed primarily at the 12,000 people--from nurses to lab technicians to hospital janitors--who are infected with hepatitis B on the job each year, often by accidentally puncturing their skin with needles that have been used to draw blood from infected patients.

Nearly 3,000 of these hepatitis cases became acute, resulting in 600 hospitalizations and 200 deaths a year. There have been only 19 reported and documented cases involving health-care workers who have been infected with HIV through job-related exposure. The HIV virusis far less easily transmitted than hepatitis B.

In addition to health-care workers, the regulations would cover another 600,000 people in law enforcement.

The largest number of workers identified by OSHA as “at risk” are 2 million nurses, doctors and janitors who work in 5,000 hospitals. Other major targets include workers in 180,000 doctors’ offices, 12,000 medical and dental labs and 20,000 residential care facilities.

The regulations would require that employees receive free hepatitis B vaccinations, formal periodic training in the risks of their job and extensive protective equipment, including disposable gloves, gowns, leak-proof containers, fluid-proof aprons, face masks and goggles. About half of the extra cost would go for equipment.

The rules would apply to any worker who is likely to be exposed to a virus carrier once a month or more.

Many hospitals, blood banks and medical offices already voluntarily follow “universal precautions” recommended by the Centers for Disease Control. Under the CDC guidelines, all blood is treated as potentially infectious.

However, organized labor, which has pressured OSHA for years to require and enforce such procedures, has contended that employee awareness of the CDC recommendations and of the general danger of contacting viruses is low.

Officials of the 925,000-member Service Employees International Union, which first asked OSHA in 1983 to require free hepatitis B vaccinations for health-care workers, conducted a survey of 40 hospitals in 1987 and found that compliance with CDC recommendations was “spotty at best.”

According to OSHA’s own estimates, hospitals provide gloves to at-risk workers 90% of the time but provide other protective equipment only 60% to 80% of the time.

Wilenken, director of family health studies for the Santa Monica-based American Assn. of Women, testified Tuesday that an informal poll by her group of 50 nurses and doctors at several Los Angeles County-run hospitals found that three-quarters of the workers did not report all needle-puncture incidents and that one-third did not know the proper procedure for reporting them.

Wilenken, who also works as a nurse at Los Angeles County’s Olive View Medical Center, objected to the amount of money being spent to educate drug addicts and prostitutes about the dangers of AIDS compared to what she characterized as “the pitiful excuses for protective eye wear, paper scrub suits and barely waterproof surgical gowns found in every L.A. County-operated medical facility.”

“Millions of health care workers in this country, both union and non-union alike, are employed in the practice of what can only be described as ‘battlefront’ medicine. They are like the proverbial sacrificial lambs to the slaughter,” she said.

The women’s group last week filed a complaint with Cal/OSHA alleging a lack of training.

“Many times when the evening or night people arrive there are no linen garments,” Wilenken said. “What’s left are paper scrub suits. . . . I go home sometimes soaked to the skin with blood.”

The hospital industry, which the government estimates would have to spend an extra $194 million a year to comply with the regulations, opposes the mandatory rules.

Jim Karpiak, a staff specialist for the American Hospital Assn., said in a telephone interview from Chicago that the regulations improperly go beyond the CDC standards and suggested that OSHA was venturing into the health-care field with an overly rigid approach.

Hepatitis inflames the liver. The type known as hepatitis B, formerly called serum hepatitis, is transmitted sexually or by blood-to-blood contact. Of several types of viral hepatitis, it is by far the kind most likely to be contracted by health-care workers. Between 7% and 30% of health-care workers sustaining needle-stick puncture wounds from hepatitis B-infected patients become infected, OSHA said.

While health-care workers have been recognized as suffering from high rates of hepatitis B since the 1970s, and while a vaccine against the virus has been available since 1982, it was not until the more recent furor over AIDS that OSHA began to fashion rules for hospitals, nursing homes, labs and other work sites

As recently as 1987, OSHA turned down a petition from the American Federation of State, County and Municipal Employees asking the agency to set an emergency regulation requiring hepatitis B vaccinations for at-risk workers.

Joanne Santangelo, a representative of the California Nurses Assn., was among several speakers Tuesday who urged that vaccinations be made available to all health-care workers, not merely those whose exposure is predictable.

Santangelo also urged that OSHA require confidentiality for infected workers who seek workers compensation through local governments. A nurse who accidentally stuck herself with an AIDS-infected needle at San Francisco General Hospital in 1987 fought a two-year battle over confidentiality before reaching a settlement in which the city’s workers compensation system agreed to process her claim without revealing her name.

Other speakers called on OSHA to strengthen the proposed rules by requiring engineering improvements in hospital needles and other sharp hospital instruments to reduce the incidence of accidental punctures.

Jewett, a professor of orthopedic surgery at UC San Francisco, urged OSHA to add to the regulations a requirement for operating room personnel to wear respirator-like devices in surgery where power tools are used.

Jewett said the large amount of blood produced during such surgery makes traditional protection ineffective. Blood can splatter under masks and goggles, he said.