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Needlestick injury: awareness and prevention

Graham Mobbs
MEDILINK (North West) Limited
301 Glossop Rd
Sheffield
S10 2HL
T:07946 393629
F:0114 2730058
E:g.mobbs@medilink.co.uk

Second only to back injuries as a cause of occupational injury amongst NHS workers, an ongoing RCN surveillance project suggests that as many as 100,000 needlestick accidents occur in the UK every year.(1) Available statistics possibly underestimate the seriousness of the problem, because many healthcare professionals do not report injuries, making it difficult to know exactly how many injuries occur and the seriousness of the problem.
It has been 10 years since the first documented case in the UK of a healthcare worker acquiring HIV following an occupational exposure. Since that first case in 1984, five UK healthcare workers are known to have contracted HIV following a needlestick injury at work. Four of them have subsequently died. There are a further 12 cases of "probable" occupationally acquired infection in the UK.(2)
Blood exposure and needlestick injuries continue to be commonplace in clinical environments. Five primary activities have been associated with the majority of injuries:

  • Administering injections.
  • Taking blood.
  • Needle disposal.
  • Recapping needles.
  • Handling rubbish and dirty linen.

Effects of needlestick injuries
There are more than 20 different  types of pathogen (eg, viruses, bacteria), which have been transmitted from infected patients to healthcare workers via needlestick injuries. The average risk of transmission of bloodborne pathogens following a single exposure has been estimated to be:(3)

  • Hepatitis B virus (HBV) 33.3% (1 in 3).
  • Hepatitis C virus (HCV) 3.3% (1 in 30).
  • Human immunodeficiency virus (HIV) 0.31% (1 in 319).

After a needlestick injury, the wait for test results is a worrying time for the healthcare professional involved, as the knowledge of the risk can be very disturbing and stressful. There are also the potential significant emotional and psychological costs to a recipient of a sharps injury, as well as the unpleasant side-effects ­experienced with many of the treatment regimens.
An example: A nurse sustained an injury from a needle that had been used in the care of a patient who had full-blown AIDS; the patient died 3 weeks later. The nurse was placed on postexposure prophylaxis (PEP) treatment, taking three separate drugs four times a day for 1 month, causing severe side-effects, including nausea, diarrhoea, vomiting, insomnia and lethargy. The nurse developed a depressive disorder and now has angina and high blood pressure, which may be associated with the incident.(4)
To treat one high-risk sharps injury from which no infection transmission results costs approximately £2,000, with there being no ceiling to costs in the event of infection transmission. PEP costs approximately £3,000, with a 48-week course of interferon and ribavirin (HCV treatment cocktail) costing £10,000 per year. In addition, the loss of experienced, skilled staff due to sickness caused by a sharps injury should never be underestimated.(5)
In compensation terms, the cost of needlestick injuries is high. In 2002, a healthcare worker received an award of £58,000 for a needlestick injury. While assisting a consultant anaesthetist a senior operating departmental assistant was injured when a tray of needles flipped over. One stuck in his arm, and in attempting to shake it off it penetrated his toe, through his shoe. The needle was contaminated and the assistant suffered severe shock and trauma.(6) The highest UK award was to a junior doctor receiving nearing £5,000,000 in compensation for a claim resulting from an injury.(7)

Guidance on reducing needlestick injuries
There is a growing awareness within the health service of the impact of needlestick injuries and the need to introduce policies and procedures in conjunction with the use of antineedlestick devices that will reduce needlestick injuries. Both the Department of Health (DH) and professional organisations have issued or will be issuing guidelines on the handling of those medical devices that can cause potential career- and life-threatening injuries to healthcare professionals.
After continually receiving reports of sharps injuries that have occurred as a result of the inappropriate use of sharps and the way they have been disposed, the Medical Devices Agency (MDA) issued SN2001(19) - "Safe Use and Disposal of Sharps". This was to reiterate the available guidance on the safe use and disposal of sharps (see Resources).
Liz Pearson, Senior Buyer from the NHS Purchasing & Supply Agency (PASA), has been working with key stakeholders to contribute to the minimisation of sharps and needlestick injuries in the NHS. Liz exchanges information on the development and availability of innovative product solutions, and collates feedback from trials and evaluations of products. The PASA website (see Resources) provides relevant information and offers assistance and advice on supply issues and is an excellent source of product news, including suppliers of safer devices and the evaluation of safer devices. It also has some excellent links to organisations working together for the reduction of needlestick injuries.
The DH has committed to issuing guidance that will require NHS trusts to ensure proper data collection and surveillance of needlestick injuries. It is in the process of producing new guidance on the management of occupational health and safety services in the NHS, including comprehensive new guidelines on the management of needlestick injuries. The guidelines are due to be published in 2004 and will be available at the safer needles website (see below and Resources).

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"Safer needles now!"
The "Safer needles now!" campaign was launched in February 2004 at Guy's and St Thomas' Hospital NHS Trust by Beverley Malone, General Secretary of the RCN, together with Karen Jennings of Unison and the British Medical Association, and former nurse and political campaigner on the issue Laura Moffatt, MP for Crawley.
"Safer needles now!" has been established by the Safer Needles Network to promote the full implementation of the new DH guidance designed to minimise needlestick injuries in the NHS. The Safer Needles Network aims to assist in the reduction in the number of needlestick injuries.
Karen Jennings said: "Unison wants to see an end to the terror of needlestick injuries. It is impossible to put a cost on the human misery and suffering caused by infection through these injuries, and we want the government to take action now before another healthcare worker dies."
There are a wide range of safer needles and devices that reduce injuries. The term "safer needles" is broad and includes those where the needle retracts into the syringe after use, those that have a protective shield over the needle and some that do not use needles at all. These have reduced injuries dramatically in the USA and would do the same here. Research from the USA has shown that safer devices can reduce injuries by between 27 and 76% - depending on the type of device and where it is used.(8)  
In the UK there are over 20 companies that provide "safer devices" for the reduction of injuries, including a wide range of "safe sharp management" devices and  innovative storage tray for scalpels that could greatly reduce injuries.
MEDILINK (North West) Limited will supply healthcare workers with the free Sharps Injury Prevention Manufacturers Alliance Information Pack.  The aim of the pack, launched in August 2001, is to notify healthcare workers about the issues involved and familiarise healthcare workers with the safer devices that can help reduce injuries. To receive a free copy of the SIPMA Information Pack please contact the author.

Conclusion
We must applaud organisations such as UNISON, the RCN and the Safer Needles Network for bringing this issue to the attention of people at all levels, government, healthcare management and the end user.
The vast majority of needlestick injuries are preventable. Today's healthcare professionals do not have to accept the risks of a potential life-threatening injury while carrying out their everyday duties. Safer devices, adequate training and reporting procedures can reduce the risk to healthcare professionals of suffering injuries. There is the support, in terms of training and safer technology, to help you reduce the risk of an injury. It is now up to you to use those resources!

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References

  1. UNISON website. www.unison.org.uk/needlesticks
  2. Press release. Needlestick injuries in health care settings can be reduced. Health Protection Agency. 25 Mar 2004.
  3. Public Health Laboratory Service AIDS & STD Centre. Occupational Transmission of HIV. London: PHLS; 1999.
  4. Sharp end.  Hazards 2000;70:4-5.
  5. Wilson J. Safe Sharps Management Booklet. 4th ed. 2002.
  6. House of Commons. Public Accounts; Forty Second Report. 17th September 2003.
  7. Irwin A. £500,000 damages for doctor terrified of needles. The Daily Telegraph  10 Oct 1998.
  8. Nursing Times 11 Jan 2001;97(2):23

Resources
MDA
W:www.medical-devices.gov.uk
NHS PASA
W:www.pasa.nhs.uk/sharps
"Safer needles now!"
W:www.saferneedlesnow.net