Health and Safety
Executive / Commission
Health services
The main risk posed by needle-stick injury to workers is exposure of the worker to blood-borne viruses (BBV). The main viruses concerned are:
In the case of HBV an effective protective vaccine is available, but no such protection is available for other BBVs. These other infections are difficult to treat, the prophylaxis/treatment is unpleasant, may cause significant side effects, and there is no guarantee that treatment will be successful. However, as the prevalence/carriage rates of BBVs in the general UK population is generally low and the risk of infection from needlestick injuries remains low, The Health Protection Agency (HPA) website is a useful source of up to date epidemiological data, particularly the figures provided in the Health Protection Report.
The main group of workers at risk from needlestick injuries are those within the healthcare sector, but injuries also occur in other fields of work such as the prison service, police, parks constabulary, probation services, customs and excise, social work, youth work, funeral industry, body piercing/body art industry, car-breaking and the construction/demolition industry. Workers may acquire a BBV infection if they are exposed to infected blood or body fluids: this could be either via the mucous membranes (eyes, inside of the mouth and nose), through broken skin or through an inoculation injury route, where the skin is punctured or scratched by a needle or sharp device that has been used in a medical procedure: this final route of transmission is commonly referred to as a needlestick or sharps injury.
The standard safety procedures adopted in the UK for the prevention of needlestick injuries are know as standard or universal precautions, where all blood and body fluids regardless of its source are considered to contain infectious agents, and treated as such. Guidelines to this effect were published by the Department of Health in 1998 (Guidance for Clinical Health Care Workers: Protection against infection with Blood-borne viruses)
Some of the most straight-forward recommendations included are practices such as:
The incidence of RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995) reported incidents involving needle-sticks injuries has not constituted a significant proportion of total RIDDOR incidents reported to HSE. Of the RIDDORs reported in 2004-2005 resulting in major and over 3-day injuries, needle-stick incidents constitute 61 of 156 000 of incidents reported. That figure had remained steady over the previous 4 years (Figures from HSE RIDDOR statistics). However, these figures do not include the large number of minor sharps injuries that occur in the healthcare sector which are considered low risk, and which therefore are not RIDDOR reportable.
Recently a 7-year study conducted by HPA (Health Protection Agency, titled ‘Eye of the Needle’ published data collated data across 150 reporting centres on significant occupational exposure to BBVs (Blood Bourne Viruses) amongst HCWs (Health Care Workers). The study reported that needlestick injuries were the most commonly reported type of significant exposure, with 63% of those injuries caused by hollow bore needles. 45% of these occurred amongst nursing professionals and 37% amongst medical professionals. A much lower incidence was identified amongst professions allied to medicine and ancillary staff. Only 2% of the exposures occurred in ancillary staff, but most were sustained from inappropriately discarded needles in rubbish bags.
In the seven year period covered by the study, 2140 incidents of significant exposure were documented. Of these 2140 incidents, there were no documented seroconversions (positive immune responses) for HIV or HBV, but markers for HCV developed in 9 workers. All these 9 workers had received percutaneous (superficial) injuries with fresh blood from hollow-bore needles, and of these, 5 were the consequence of failure to comply with universal precautions, 6 of the cases involved blood from injecting drug users. Where HIV had been suspected or known in the source patient, rapid use of anti-HIV prophylactic drugs appeared to prevent infection developing.
In order to avoid occupational BBV infection, one has to prevent exposure to the infectious agent. The commonest cause of needlestick injury is non-compliance with universal precautions. The HPA (Health Protection Agency) study ‘Eye of the Needle’ found that when a needlestick injury was sustained whilst performing a procedure it was difficult to prevent the injury, as the contributory factors were varied and were dependent on factors such as location, nature and complexity of the procedure and the state of the patient. However, the study concurred that monitoring and analysis of these incidents was key in identifying common features and contributory factors associated with the accidents. This accurate surveillance ensures that the employer is able to develop and implement targeted interventions and control measures to reduce the risk of further exposures. Employers also have an obligation to ensure that they keep up to date with technological advances in safety devices so that new innovations can be fully assessed for us e within their different work areas.
When needlestick injuries are sustained after a procedure and during disposal, the majority of injuries have been found to be caused by failure to adhere to universal precautions. These incidents are therefore predominantly avoidable, and any reduction in is primarily dependent on high quality education and training and effective monitoring and audit. HCWs (Health Care Workers) should be familiar with the organisational procedures that protect them form exposure to BBV, and should know what to do in the event of an accidental exposure. The employer is obliged to provide effective and accessible services that meet these requirements.
The following are further references and web links that may provide further information:
Royal College of Nursing (2005) "Good Practice in Infection Prevention and Control Guidance for Nursing Staff" London: RCN Publication Code 002 741