Needlestick Injuries, Legislation and More...

by Q Stat Safety Syringe

Needlestick Injuries (NSI)

* "Today alone over 2,100 health care professionals will incur a needlestick related injury." [NIOSH Study, 1999]
* There have been 57 documented cases of HIV seroconversion among healthcare personnel
* The cost of needlestick injury follow-up in the U.S. per incident is around $3,000.
* Accident follow ups cost the US medical industry $1.2 billion annually.
* Annual treatment for contracted diseases in the US is $1.8 billion.
* A total of $3 billion is spent annually in the US on needlestick injuries.
* In the United Kingdom the number of reported needlestick injuries has risen 49% from 2002 to 2005 (Article – The Times), presently estimated at more than 100,000 per year.
* Thousands of Australian hospital workers suffer needlestick injuries each year and the incidence is increasing.

Global Legislative Outlook

* The United States already has OSHA legislation in place requiring the use of safety injection technology.
* US military planning a policy shift to safety technology
* Spain has begun mandating use of safety technology with a 3-5 year implementation period.
* EU Legislation is pending due to a ground swell of protest from healthcare workers who are concerned about the risk of suffering bloodborne pathogen induced illnesses (eg: Hepatitis B, Hepatitis C and HIV / AIDS) as a direct result of needlestick injury.
* In the UK, the NHS is assessing all suitable safety technology. The transition to safety devices began in 2006.
* Australia and Canada are reviewing policies and are expected to mandate safety technology in the next two-three years.

Needlestick Injuries

A needlestick injury is a percutaneous piercing wound typically caused by a needle point, but possibly also by other sharp instruments or objects. Commonly sustained by people handling needles in the medical setting, such injuries are an occupational hazard in the medical community. These events are of concern because of the risk of transmitting blood-borne diseases such as hepatitis B virus (HBV), the hepatitis C virus (HCV), and the Human Immunodeficiency Virus (HIV), the virus which causes AIDS. Despite the potential for serious or life-threatening illness, needlestick injuries have been neglected - most go unreported and ICD-10 coding is not available. However, in the last decade as needlesticks have been recognized as an occupational hazard their prevention has become the subject of regulations in an effort to reduce and eliminate this preventable event.

Needlestick injuries are a common event in the healthcare environment. When drawing blood, administering an intramuscular or intravenous drug, or performing other procedures involving sharps, the needle can slip and injure the healthcare worker. This sets the stage to transmit viruses from the source person to the recipient. These injuries also commonly occur during needle recapping and as a result of failure to place used needles in approved sharps containers. Generally needlestick injuries cause only minor bleeding or visible trauma, however, even in the absence of bleeding the risk of viral infection remains. Needlestick injuries are not limited to the medical community. Any environment where syringes are encountered (eg: veterinary medicine, dentistry and biological research) carries a risk.

Frequency

The frequency of such events has been estimated to be about 800,000 cases in the USA alone (1999 report). Another investigation estimates the rates of injuries on a global level to affect about 3.5 million individuals. It is estimated that as much as 50% of needlestick events may go unreported as injured healthcare workers may not take the time to report, downplay the risk, or fear stigmatization and professional consequences. Needlestick injuries may occur not only with freshly contaminated sharps, but also, after some time, with needles that carry dry blood. While the infectiousness of HIV and HCV decrease within a couple of hours, HBV remains stable during desiccation and infectious for more than a week. Needlestick injuries are of significant concern to police workers. In San Diego 30% of police workers reported such injuries typically when searching suspects.
Risk

While needlestick injuries have the potential of transferring bacteria, protozoa, viruses and prions, from a practical point the risk of transmission of the hepatitis B and hepatitis C viruses and the Human Immunodeficiency Virus (HIV) is the most significant. It is estimated that annually as a consequence there are 66,000 infections with HBV, 16,000 with HCV, and 1,000 with HIV worldwide. In addition, a needlestick injury may lead to significant stress and anxiety for the injured person. Taking care of a needlestick injury is costly, estimated to be about $US 3,000 in the short term in the US. Estimates of the risk of a single injury indicate a risk of 300 HBV infections (30% risk), 30 HCV infection (3% risk) and 3 HIV infections (0.3% risk) per 1,000 respective exposures. While the vast majority of needlestick injuries occur when the source-person does not carry the HBV, HCV, and HIV and thus do not carry a risk of infection, these events nevertheless cause stress and anxiety and signal a breakdown in protocol and prevention.

Prevention

Preventive steps can be taken at several levels and include reduction or elimination of use of sharps as much as possible, engineering controls (i.e. needles with safety devices), administrative controls including training and provision of adequate resources, and work practice controls; the latter may include using instruments (not fingers) to grasp needles, load scalpels, and avoiding hand-to-hand passing of sharp instruments. Engineering advances include the development of safety syringes and needle removers. The adherence to "no-touch" protocols that eliminate direct contact with needles in their use and disposal greatly reduce the risk of injury.

Some countries have enacted legislation to protect healthcare workers. In the US, the Needlestick Safety Act was signed in 2000 and Bloodborne Pathogens Standard in 2001. These regulations mandate the use of safety devices with any sharps or needles.