You help. You help people get well and stay well. You help them cope with loss. You help them move on -- in the here and now or into the hereafter.

And the rest of us are grateful. Virtually everyone in America has benefitted from your caring. Infants who won't get diphtheria thanks to your vaccinations. Children who can run again on broken legs now mended. Teens with beautiful smiles thanks to dental care. Car crash victims who beat the odds through emergency treatment. The woman with the healthy new baby. The man with the repaired hernia. And all the survivors of battles with cancer or other life-threatening illnesses.

You are there. You care. You help us get well and stay healthy. You make a difference. We want you to know we also care about you. We don't want your care for us to result in sickness for you. And that's the point of this conference -- your health, your safety, your well-being.

In the late 1980s, OSHA recognized that bloodborne pathogens represented a significant occupational health risk for healthcare professionals. Hepatitis B was the big culprit. But HIV also posed a very real threat. And today Hepatitis C greatly concerns us as well.

Dr. Susan Harwood, to whom this conference is dedicated, stepped forward and spearheaded OSHA's effort to develop a standard to reduce the risks posed by a biological hazard. Regulating bloodborne pathogens was new territory. Not everyone was pleased that OSHA was focusing on a health industry issue. But the risks were clear.

So are the results. In 1987, there were 8,700 cases of Hepatitis B infection among healthcare workers. In 1995, just four years after publication of OSHA's standard, only 400 new cases related to occupational exposure were reported. This is a dramatic decline.

We salute Dr. Harwood for her persistence and perseverance in getting a bloodborne pathogens standard on the books. She made many valuable contributions to OSHA during her 17-year career with us. But the bloodborne pathogens standard that she and her team developed is truly her crowning achievement. We still miss her.

We're all pleased with the progress made in preventing Hepatitis B infections. But we're here today because we know we could do more. Specifically, we're focusing on needlesticks. And with good reason. The best estimates we have suggest that our nation's 5.6 million healthcare workers suffer as many as 800,000 exposure incidents -- mostly needlesticks -- each year. That's one out of seven workers. Every year. Even more telling is the fact that needlesticks account for up to 80% of the accidental exposures to blood.

I don't need to tell anyone here how serious needlesticks are. You know. And far too many of you know from painful personal experience. You know that needlesticks are not paper cuts. Or a nick when you're shaving. They can lead to life-threatening illnesses and sometimes even death.

Good data on needlesticks are hard to find. How many needlesticks are actually occurring? Our best estimates are extrapolations from small pools of data. And within the healthcare community, there is agreement that needlesticks are under-reported. Regardless of the exact number that occur, our primary focus must be on preventing these incidents. I am convinced that if we work together, we can find the ways to do that. This conference represents an excellent opportunity to share our experience and research findings.

We know that safer alternatives to standard syringes, IV equipment and suture needles exist. I keep some samples on my desk given to me by Andy Stern of SEIU. And some data from the Centers for Disease Control and Prevention indicate that most needlesticks occur when health professionals use standard devices without a safety feature.

Should the availability of newer technology make use of older equipment a violation of OSHA's bloodborne pathogens standard? We need to bear in mind that what was considered "safe" yesterday may not be considered "safe" today.

We also know that simply buying devices touted by manufacturers as "safer" alternatives is not enough. Generally, safer devices result in fewer needlesticks. But not always. Needlestick prevention involves more than sifting through rival manufacturers claims and purchasing new syringes. One size does not fit all. There is no magic formula nor any absolute guarantee.

OSHA believes the key to preventing needlesticks lies in a comprehensive strategy-a programmatic approach.

• Evaluate the problem at your specific facility.
• Involve employees in selecting safer devices.
• Train employees to use new equipment effectively and safely.
• Evaluate the results -- and make changes accordingly.

Under the bloodborne pathogens standard, employers must develop exposure control plans that detail the engineering controls and personal protective equipment to be used to prevent exposure to bloodborne pathogens. OSHA has developed several model exposure control plans. We may need to update these plans to stress the importance of preventing needlesticks. We need to know if you think this would be useful.

In addition, we've just published a new booklet for healthcare workers. It's a question and answer approach to needlestick prevention. Single copies are available at the OSHA exhibit at this conference. This easy-to-follow booklet is based on a needlestick prevention training program developed by our Office of Occupational Health Nursing. Training materials from that program­and much more­can be found on OSHA's needlestick page on the Internet. You will also get a chance to share your ideas with Elise Handelman, who heads occupational health nursing at OSHA, at one of your workshops tomorrow.

We believe a comprehensive strategy represents the best approach to preventing needlesticks. But we'd like to hear from you on the front lines. And we'd like to assess the state of the art on safer needle devices.

That's where we need to start. We've gotten a lot of suggestions for reducing needlesticks: Implement an emergency temporary standard mandating safer devices. Re-open the bloodborne standard. Re-write instructions to inspectors. Emphasize engineering controls. Look at exposure control plans. And we are examining each of these alternatives.

But the first step in this process is gathering information. And that's what we plan to do. This month we will be issuing in the Federal Register a formal Request for Information on needlestick prevention. That's a call for public comments and research results. Our RFI will include about a dozen questions on preventing needlesticks.

Underlying all those specific queries is one basic question: What works? This is a chance for you to tell us. Which strategies are making a difference at your hospital, your nursing home, your clinic? I hope that many of you will share your expertise and your experience in various healthcare settings with us.

I am committed to finding ways to reduce needlesticks among healthcare workers. And I have promised Senator Barbara Boxer and others that as we identify what works, we will share that information broadly.

I appreciate the work that Senator Boxer; Cal-OSHA; the Service Employees International Union; the American Federation of State, County and Municipal Employees; the American Nurses Association; the Joint Commission on Accreditation of Healthcare Organizations; the American Hospital Association and others have done in drawing attention to this issue. We share the goal of preventing injury and disease, and we need to find ways to move forward together in preventing needlesticks among healthcare workers.

We accomplish more when we work side by side. At OSHA, we are continually looking for opportunities to join hands on issues of mutual concern. Two years ago, we formed an educational partnership with the Joint Commission on Accreditation of Healthcare Organizations. Together we are promoting effective employee safety and health programs. The Joint Commission's accreditation manual includes a section that identifies ways to meet OSHA standards along with accreditation requirements. I'd like to see us develop other similar partnerships. I welcome your suggestions.

We know that others are moving forward, too. The American Hospital Association is publishing a new book on the subject to educate and update their members. We applaud their efforts.

Although we're focusing on needlesticks at this frontline healthcare workers conference, there are other occupational risks to healthcare workers that concern OSHA as well. Latex allergies is one. Workers who become sensitized to natural rubber latex on the job can face a life-threatening allergic reaction to an ordinary birthday balloon. Together with our federal partners in the Food and Drug Administration and the National Institute for Occupational Safety and Health, we are working to expand information and to reduce risk. At the same time, we need to maintain appropriate protection against bloodborne pathogens.

In May OSHA joined with other federal agencies interested in this issue to share information through a video conference. The American Nurses Association, the American Hospital Association and many other professional groups participated in this forum. We're also working on a second draft of a Hazard Information Bulletin on this issue. We will be soliciting final stakeholder comments before we distribute this information. The document outlines ways to minimize worker risk for developing latex allergies and to protect those who are already sensitized.

In addition, OSHA is concerned about occupational transmission of tuberculosis. Last October we published a proposal that we estimate would prevent occupational transmission of TB, with its potentially life-threatening consequence to healthcare workers and their families, at more than 100,000 facilities nationwide. The OSHA proposal is based on CDC's guidelines, but would be enforceable once it is final. We've held hearings around the country on the TB proposal, and we're evaluating the public comments and testimony.

Recently, healthcare workers have been facing a different kind of hazard in their workplaces -- violence. For some, this is a spillover from the high crime areas where patients live or healthcare facilities are situated. For others, the patients themselves represent a threat. Two years ago, OSHA published guidelines for healthcare and social service workers to minimize the risk of assault on the job. The guidelines encouraged employers to evaluate threats and establish violence prevention programs. OSHA listed a wide variety of measures that healthcare providers have found successful in thwarting violent behavior on the part of patients and reducing the risk of criminal assault on healthcare workers.

Another major problem for frontline healthcare workers is musculoskeletal disorders. MSDs account for one-third of all lost-workday injuries and illnesses in the U.S. That is painful, and it is costly. In 1996, more than 600,000 American workers experienced injuries due to overexertion or repetitive motion on the job. Workers' comp for these workers cost their employers about $20 billion, and indirect costs added billions more.

Many MSDs are back injuries, and far too many of them occur in health care. The good news is that most work-related MSDs can be prevented by a sound ergonomics program. OSHA is working on an ergonomics standard that calls for employers to develop such programs. One of the focuses of this effort will be manual lifting, which will cover many of you in the healthcare field.

We have been meeting with stakeholders to discuss the difficult issues we're grappling with on this rulemaking. We shared a document that outlines our thinking at meetings in Kansas City and Atlanta last month. If you would like to weigh in on these issues, you'll find a copy of this information on our website. That's www.osha.gov. Just choose ergonomics.

Already we've identified some ways to minimize the risks to healthcare workers. OSHA has developed a general video on ergonomics and also a special video devoted to nursing homes. You can borrow a copy from our public affairs office or purchase one from the National AudioVisual Center. If MSDs haven't been effectively addressed at your facility, you may want to start with one of these videos.

I am encouraged by the progress we are making in improving occupational safety and health in the healthcare industry. We are moving forward. This conference is certainly a step in the right direction.

Frontline health care workers take good care of us. We need to take better care of you. You deserve protection against workplace hazards. My job and OSHA's is to work with you and your employers to see that you get it. I am proud to make common cause with you.