This site is intended for health professionals only

Healthcare workers still at risk from needlestick injuries

Roy Bridges
MBA
Vice President
Regulatory Affairs and Public Policy Europe
Chairman
Eliminating Sharps Injuries Group
Eucomed(European Medical Technology Industry Association)
Brussels, Belgium

Every day, healthcare workers risk potentially life-threatening infections as a consequence of needlestick injuries. Yet the majority of these injuries are avoidable.
In the USA, healthcare workers have benefited from the introduction of the Needlestick Safety and Prevention Act, which requires all healthcare facilities to evaluate, purchase and provide medical devices incorporating needle protection for their staff. European nurses are calling for the urgent implementation of ­similar measures across the EU.

Background statistics
The work-related accident rate in the healthcare sector is 34% higher than the EU average.(1) High on the hazards list is exposure to biological agents. More than 20 dangerous bloodborne pathogens can be transmitted by contaminated needles, including hepatitis B, hepatitis C and HIV.
Percutaneous injury from hollow-bore blood-filled sharp objects is the primary route through which healthcare workers acquire bloodborne and potentially fatal diseases occupationally. High-risk procedures include blood collection, IV cannulation and percutaneous placement of syringes. The majority of sharps injuries are suffered by nurses, but doctors and other medical staff are often victims too. Ancillary staff such as cleaners and laundry staff, as well as other downstream workers, are also at risk. Furthermore, medical devices incorporating needles are frequently used for self-treatment outside the conventional healthcare setting, which can create dangers for the general public.
It is estimated that one million needlestick injuries occur in Europe each year.(2) Between 60% and 80% of incidents go unreported.(3) Figures from the trade union Unison and the Royal College of Nursing indicate that there are over 100,000 such injuries each year in the UK alone. The National Audit Office report on health and safety in the NHS confirms that needlestick injuries remain the second most common cause of occupational injury in the UK health service.(4)
The prevalence of both hepatitis C and HIV is growing fast. The World Health Organization (WHO) reports that HIV is approaching 40 million cases worldwide, and it is estimated that more than five million Europeans have now been infected with hepatitis C.
The risk of transmission of infection for workers suffering an injury from a contaminated needle or other medical sharp is 1 in 3 for hepatitis B, 1 in 30 for ­hepatitis C and 1 in 300 for HIV.(5)
It has recently been reported that four healthcare workers in Britain have died after being infected with HIV through hospital accidents involving needles. Nine others have also contracted the AIDS virus after suffering similar injuries while working in hospitals but are still alive.
In a German study it was shown that 1 in 15 needlestick injuries involved blood from a hepatitis C-positive source.(6) Applying this data to the estimated 500,000 needlestick injuries that occur each year in Germany(7) would mean over 32,500 exposures to hepatitis C. In addition to the risks facing healthcare workers, this statistic also raises serious questions about the potential for cross-infection of hepatitis C to patients.

Routes to reducing injury rates
Independent studies show that solutions are available today that can prevent more than 80% of needlestick injuries. A combination of training, safer working practices and the use of medical devices incorporating needlestick protection technology can prevent many of these potentially fatal injuries. There is a wide range of medical devices available today that incorporate needle protection features, including needle shielding, retractable needles and needle blunting features.
A recent independent study showed that safety education together with the adoption of safer procedures, including disposal, and the use of medical devices incorporating needlestick/sharps protection technology can lead to an 84-100% reduction (depending upon application) in the number of needlestick injuries.(8)
 
The situation in the USA
In the USA, Congress was prompted to take urgent action in response to concerns over bloodborne pathogen exposure from sharps injuries and in recognition of technological developments that increased employee protection. On 6 November 2000 the Needlestick Safety and Prevention Act was signed into law,(9) requiring all US healthcare facilities to evaluate, purchase and provide medical devices incorporating needle protection for their staff.
Healthcare employers in the USA are also now required to maintain a sharps injury log and to involve nonmanagerial potentially exposed healthcare workers in the evaluation and implementation of work practice controls and devices incorporating needle protection.
 
The situation in Europe
Unfortunately, European healthcare workers do not yet have the benefit of the kind of protection enjoyed by their US equivalents. So far, there has been progress in just a small number of EU Member States. In Germany, TRBA 250 (Technical Rules for Biological Agents), which includes specific requirements that must be introduced to protect healthcare workers from needlestick injury, was introduced in October 2003. In the UK, following the recent National Audit Office report on safety in the NHS,(4) the Department of Health has publicly acknowledged ­concern at the number of needlestick injuries that take place within the NHS each year, and has committed itself to introducing specific measures to combat needlestick injury.

A call for action
Europe still has a long way to go before healthcare workers can enjoy the level of protection from needlestick injury that is already available in the US and which they deserve. The European Agency for Safety and Health at Work has recommended preventive measures that have been proved effective in reducing needlestick injuries, but these have yet to be universally adopted across the EU.
The most directly applicable EU directive is 2000/54/EC, which concerns biological agents. A group of European and international organisations representing nurses, doctors, healthcare workers, industry and patients has called for this directive to be amended urgently to include specific requirements to protect workers from needlestick and other medical sharps injuries.
At a symposium on nurses' and midwives' contribution to health policy in Europe, held in Dublin in June 2004, Ria von Bönninghausen, President of the Standing Committee of Nurses of the EU (PCN), presented Health Commissioner David Byrne with a dossier entitled "European Healthcare Workers at Risk!" This was published as a joint PCN/Eucomed initiative on International Nurses' Day (12 May), and both Commissioner Byrne and the Commissioner for Employment and Social Affairs, Stavros Dimas, have been urged to take action to ensure that healthcare workers are protected from needlestick injuries.
Healthcare workers in Europe should not have to face avoidable occupational injuries. We have to hope that all concerned will recognise that healthcare workers are the healthcare system's most valuable asset and that this asset needs to be protected. After all, there is both a legal and a moral obligation to do so.

A version of this ­article first appeared in: Garel P. Edwards B, editors. Hospital Healthcare Europe 2004/05. London: ­Campden Publishing; 2004.

References

  1. European Agency for Safety and Health at Work. Safety and health good practice online for the healthcare sector. FACTS 2002; issue 29.
  2. May D. EPINet sharps injury ­surveillance pilot project: preliminary report. Jan 2002 (cited Jul 2004). Available at:http://www.pasa.doh.gov.uk/
    medsurg/intravenous/needlestick/EPINET_preliminary_report_Jan_2002.doc
  3. Benitez Rodriguez E, et al. Underreporting of percutaneous ­exposure accidents in a teaching ­hospital in Spain. Clin Perform Qual Health Care 1999;7:88-91.
  4. National Audit Office. A safer place to work - improving the management of health and safety risks to staff in NHS trusts. London:?NAO; 2003.
  5. CDC recommendations for ­prevention and control of hepatitis (HCV) infection and HCV-related chronic disease. MMWR Morb Mort Wkly Rep 1998,47:1-40.
  6. Hofmann F, et al. Needlestick injuries in healthcare: frequency, causes and preventive strategies.  Gesundheitswesen 2002;64:259-66.
  7. Hofmann F. Kanülenstichverletzungen im Gesundheitsdienst: Häufigkeit, Ursachen und Präventionsstrategien. Georg Thieme Verlag; 2002.
  8. GERES Study. Advances in Exposure Prevention 2001;3(4).
  9. US Federal Register; 2001.