Healthcare workers have good reason to feel anxious about needlestick injuries (NSIs). New research reveals that NSIs are among the most common accidents reported by hospital staff, including doctors, nurses and non-clinical staff. The high frequency of NSIs is particularly alarming because of the associated risk of transmission of blood borne viruses (BBV) such as HIV and Hepatitis C (HCV). Researchers have concluded that current preventative measures are not adequate to reduce the incidence of NSIs. This can only be achieved through better design and engineering. In particular, widespread use of retractable needles, needle-free IV systems and safety cannulae would prevent the majority of NSIs. Hospitals should not be deterred by the higher cost of such devices, because NSIs themselves are a significant drain on funds. By preventing NSIs, hospitals would avoid the costs of administration, medical treatment, laboratory investigations and loss of staff productivity.
Two decades ago, at the height of the HIV crisis, the issue of NSIs was brought to the attention of Australian healthcare workers. The risk of transmission of BBVs was first perceived after the diagnoses of HIV in the early 80s. Since then, a range of measures have been used to reduce the incidence of NSI. Despite these efforts, the rate of NSIs in Australian hospitals remains unacceptably high. A recent study at Princess Alexandra Hospital in Brisbane found that NSIs occurred on average once every two days. This means healthcare workers can expect to have a NSI at least once every couple of years. Nursing staff are the most vulnerable, accounting for 63% of all NSIs over the 10 year period. It appears the risk of infection after an NSI is quite low.2 However, the health and safety of healthcare workers should be of paramount importance. Therefore, preventative measures are justified because of the catastrophic consequences for staff members who contract a serious disease after an NSI. According to the research, staff tend to overestimate the risk of contracting HIV and underestimate the risk from HCV. Unfortunately, staff cannot be immunized against HCV and there is no post exposure prophylaxis (PEP) available. Some procedures, equipment and specialties pose a more serious risk of NSI to healthcare workers. For example, the study at Princess Alexandra Hospital found that that hollow bore injuries from hypodermic needles and winged butterfly needles were overrepresented in the data.2 The incidence of NSIs is higher for staff working in haemodialysis, because it involves the use of large calibre puncture needles. Consequently, larger volumes of blood are likely to be transmitted in an NSI, increasing the risk of infection. Haemodialysis is also a high risk area because HCV is often endemic in HCV patients.1Since the issue first came to light two decades ago, a range of approaches have been used in Australia to protect healthcare workers from NSIs and the associated risk of BBV. It is impossible to eliminate the risk at the source because patients with infectious diseases must still receive appropriate medical treatment. Immunisation against Hepatatis B and PEP against HIV has been used to reduce the risk of infection. However, it is clear that a more effective approach would be to use primary prevention to reduce the rate of NSIs themselves, rather than focusing on reducing transmission of BBVs. Education campaigns have been used to increase awareness about NSI. Other measures have included safe recapping devices for needles and sharps bins so that needles can be disposed of immediately. Needle free IV systems are also becoming more common in Australian hospitals.2 Despite efforts to prevent NSIs, the incidence remains high. The general consensus now is that we should turn our attention to improving the technology. Retracting needles are highly effective because the needle automatically retracts into the barrel of the syringe. After conducting a study at Princess Alexandra Hospital, researchers concluded that 62% of the NSIs could be prevented by using retracting needles. Replacing butterfly needles would further reduce the risk by 10%. NSIs could also be reduced through widespread use of safety cannulae and needle free IV systems.2 Hospitals may be deterred from introducing these safety devices because they tend to be more expensive than conventional ones. However, researchers have done a cost-benefit analysis to show that using retractable needles would have some financial benefit. Researchers estimated that it would cost approximately $365,000 to introduce retractable needles into Princess Alexandra Hospital. This was thought to be a conservative figure because it does not take into account the savings that would be made. For example, there would be less staff time lost due to medical appointments after an NSI. Laboratory equipment could also be put to other uses rather than for testing staff and patients. The lower incidence of NSI would also reduce administration costs associated with reporting procedures. There would be substantial non-financial benefits such as lower anxiety amongst staff.3 In conclusion, the high incidence of NSIs in Australian can no longer be ignored. Retractable needles and other safety devices are a cost effective solution because they will significantly reduce the rate of NSIs and the risk of BBVs in healthcare workers. Hospitals would benefit financially because they would avoid administration costs, loss of staff productivity and the costs associated with medical testing after NSIs. Importantly, hospital staff would also feel less anxious because they would be working a safer environment. References
- Wittmann A, Hofmann F, Kralj N. Needle stick injuries – risk from blood contact in dialysis. Journal of Renal Care 2007; XXXIII2.
- Whitby M, McLaws ML. Hollow-bore needle stick injuries in a tertiary teaching hospital: epidemiology, education and engineering. MJA 2002; 177: 418-22.
- Slater K, Whitby M, McLaws ML. Prevention of needlestick injuries: the need for strategic marketing to address healthcare worker misperceptions. Am J Infect Control 2007; 35: 560-2.