Mental health of healthcare workers who experience needlestick and sharps injuries

Healthcare workers (HCWs) are exposed daily to the risk of injury by needlesticks and other medical instruments. However, the psychiatric impacts of such injuries have not been evaluated. The aim of this study was to evaluate the mental health status of HCWs with experiences of needlestick and sharps injuries. A cross-sectional written survey was performed. The psychological symptoms before injury and current status were measured using the Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Perceived Stress Scale (PSS). The proportions of HCWs with and without needlestick and sharps injuries were 71.1% (n=263) and 28.9% (n=107), respectively. HAM-A and BDI scores were significantly higher among HCWs with injury experiences (p<0.01). HCWs with injury experiences exhibited higher PSS and BDI scores after the injury and higher levels of anxiety and depression. Particular attention should be directed towards the psychological consequences of needlestick and sharps injuries in HCWs.     

医务人员职业损伤的研究分析

目的：研究分析医务人员因针头或其他尖锐器具造成损伤的发生率及其原因。方法：对610名医务人员进行问卷调查，被调查人员包括医生，护士，技师和实验工作人员。被调查者通过回顾的方式，如实填写过去一年内皮肤损伤的原因，次数及所采取的预防措施，回收有效问卷581份（95％），结果：在581名被调查者中，共发生1811例次皮肤务污染事件，其中54％是被污染血液后的内孔针头引起的，医务人员清楚地了解，有13％的病人患有乙肝，丙肝，梅毒，艾滋病等可以通过血液传播的疾病，每名医师（技师）每年有2．85次皮肤损伤几率，每名护士每年有3．4次皮肤损伤几率,所有的损伤事故发生后，均采用强力碘等消毒伤口，并有针对性地采取大量盐水冲洗，注射乙肝疫苗，高效免疫球蛋白等措施，结论：医务人员的这种损伤与他们的特殊职业有密切的关联，54％的损伤是在内孔针头充满血液的情况下造成的，具有很高的传播疾病的危险性，因此，应采取针对性的防护安全教育，预防事故发生。     

Effect of the introduction of an engineered sharps injury prevention device on the percutaneous injury rate in healthcare workers.

OBJECTIVE: To evaluate the effect of introducing an engineered device for preventing injuries from sharp instruments (engineered sharps injury prevention device [ESIPD]) on the percutaneous injury rate in healthcare workers (HCWs). METHODS: We undertook a controlled, interventional, before-after study during a period of 3 years (from January 1998 through December 2000) at a major medical center. The study population was HCWs with potential exposure to bloodborne pathogens. HCWs who sustain a needlestick injury are required by hospital policy to report the exposure. A confidential log of these injuries is maintained that includes information on the date and time of the incident, the type and brand of sharp device involved, and whether an ESIPD was used. INTERVENTION: Introduction of an intravenous (IV) catheter stylet with a safety-engineered feature (a retractable protection shield), which was placed in clinics and hospital wards in lieu of other IV catheter devices that did not have safety features. No protective devices were present on suture needles during any of the periods. The incidence of percutaneous needlestick injury by IV catheter and suture needles was evaluated for 18 months before and 18 months after the intervention. RESULTS: After the intervention, the incidence of percutaneous injuries resulting from IV catheters decreased significantly (P<.01), whereas the incidence of injuries resulting from suture needle injuries increased significantly (P<.008). CONCLUSION: ESIPDs lead to a reduction in percutaneous injuries in HCWs, helping to decrease HCWs' risk of exposure to bloodborne pathogens.     

某大型综合医院医护人员针刺及其他锐器损伤情况

目的 了解医院医护人员针刺及其他锐器损伤情况,为进一步开展干预研究提供线索,并为干预措施效果评价提供基线数据.方法 采用白填式调查问卷对某大型综合医院1201名临床一线医护人员在2009年1月1日至2009年12月31日期间所发生的针刺及其他锐器损伤状况进行回顾性调查.结果 医护人员在过去1年中发生针刺及其他锐器损伤共4302人次,针刺及其他锐器损伤年人均发生次数为3.58人次,损伤发生率为78.85％.发生针刺及其他锐器损伤的高风险人群为妇产科、外科、重症监护室和急诊科医护人员,其接触发生率和年人均发生次数分别为94.67％和4.51人次、93.09％和4.46人次、85.44％和3.08人次、76.62％和4.55人次,引起医护人员针刺及其他锐器损伤的主要医疗操作是掰安瓿、输液结束拔针、整理用毕的锐器和手术中(缝合或切开),其接触发生率分别为46.96％ 、30.97％ 、25.73％和14.49％.医护人员针刺及其他锐器损伤主要是由安瓿瓶、头皮针、皮下注射针、缝合针和手术刀片引起,其损伤发生率分别为47.04％、37.22％、31.31％ 、17.65％和7.08％.结论 医护人员仍然面临较大的针刺及其他锐器损伤风险,不同工种、不同科室医护人员在不同医疗操作及医疗操作的不同阶段、使用不同医疗锐器、使用锐器的用途不同发生职业接触的风险不同,应积极采取有针对性的综合性预防控制措施,全面贯彻落实GBZ/T 213-2008《血源性病原体职业接触防护导则》.     

Needlestick injuries to the feet of Japanese healthcare workers: a culture-specific exposure risk.

A comparison of needlestick injury surveillance data from Japan and the United States revealed a higher proportion of foot injuries to Japanese healthcare workers (HCWs), compared with US HCWs. This study investigates the underlying factors that contribute to this difference and proposes evidence-based prevention strategies to address the risk, including the use of safety-engineered needle devices, point-of-use disposal containers for sharp instruments and devices, and closed-toe footwear.     

广东省39所医院医务人员锐器伤调查

目的了解广东省医务人员血源性职业暴露的发生情况,为制定预防措施提供科学的依据。方法采用问卷调查方法,对广东省39所医院医务人员2011年6月锐器伤的发生情况进行横断面调查。结果发放调查表32 617份,回收32 297份,回收率为99.02%;实际有效问卷32 007份,有效率为99.10%。发生锐器伤1 460例,1 909例次,锐器伤发生率为4.56%,例次率为5.96%,平均月发生密度为0.06次/（人月）。发生污染锐器伤1 495例次,污染锐器伤例次发生率为4.67%（1 495/32 007）;污染锐器伤占锐器伤总例次的78.31%（1 495/1 909）,其中61.67%(922/1 495)能追踪到暴露源,38.33%（573/1 495）不能确定其是否具有传染性。血源性污染器械中,81.71%（67/82）为乙型肝炎暴露源,14.63%（12/82）为梅毒暴露源,3.66%（3/82）为丙型肝炎暴露源,无艾滋病暴露源。锐器伤发生的地点主要为普通病房（47.72%）与手术室(20.27%);频率最高的操作是加药(15.92%),其次为医疗废物处置(12.78%)和拔除动（静）脉针（12.21%）;主要医疗器具为一次性注射器 (35.99%)、头皮钢针 (19.43%)和手术缝针(13.41%)。医务人员职业暴露相关知识培训率为93.25%。结论锐器伤是导致血源性传播疾病感染的主要职业因素, 医疗机构应建立健全职业病防治组织机构和规章制度,规范医务人员的血源性职业暴露预防与控制行为,降低血源性职业暴露伤害风险。     

Prevalence and prevention of needlestick injuries among health care workers in a German university hospital

Objective Health care workers (HCWs) are exposed to bloodborne pathogens, especially hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) through job-related risk factors like needlestick, stab, scratch, cut, or other bloody injuries. Needlestick injuries can be prevented by safer devices. Methods The purpose of this study was to investigate the frequency and causes of needlestick injuries in a German university hospital. Data were obtained by an anonymous, self-reporting questionnaire. We calculated the share of reported needlestick injuries, which could have been prevented by using safety devices. Results 31.4% (n = 226) of participant HCWs had sustained at least one needlestick injury in the last 12 months. A wide variation in the number of reported needlestick injuries was evident across disciplines, ranging from 46.9% (n = 91/194) among medical staff in surgery and 18.7% (n = 53/283) among HCWs in pediatrics. Of all occupational groups, physicians have the highest risk to experience needlestick injuries (55.1%—n = 129/234). Evaluating the kind of activity under which the needlestick injury occurred, on average 34% (n = 191/561) of all needlestick injuries could have been avoided by the use of safety devices. Taking all medical disciplines and procedures into consideration, safety devices are available for 35.1% (n = 197/561) of needlestick injuries sustained. However, there was a significant difference across various medical disciplines in the share of needlestick injuries which might have been avoidable: Pediatrics (83.7%), gynecology (83.7%), anesthesia (59.3%), dermatology (33.3%), and surgery (11.9%). In our study, only 13.2% (n = 74/561) of needlestick injuries could have been prevented by organizational measures. Conclusion There is a high rate of needlestick injuries in the daily routine of a hospital. The rate of such injuries depends on the medical discipline. Implementation of safety devices will lead to an improvement in medical staff’s health and safety.     

Occupational blood and body fluid exposure in an Australian teaching hospital

To examine work-related blood and body fluid exposure (BBFE) among health-care workers (HCWs), to explore potential risk factors and to provide policy suggestions, a 6-year retrospective study of all reported BBFE among HCWs (1998-2003) was conducted in a 430-bed teaching hospital in Australia. Results showed that BBFE reporting was consistent throughout the study period, with medical staff experiencing the highest rate of sharps injury (10.4%). Hollow-bore needles were implicated in 51.7% of all percutaneous injuries. Most incidents occurred during sharps use (40.4%) or after use but before disposal (27.1%). Nursing staff experienced 68.5% of reported mucocutaneous exposure. Many such exposures occurred in the absence of any protective attire (61.1%). This study indicated that emphasis on work practice, attire, disposal systems and education strategies, as well as the use of safety sharps should be employed to reduce work-related injuries among HCWs in Australia.     

Implication of the prevalence of needlestick injuries in a general hospital in Malaysia and its risk in clinical practice

Objectives  To determine the prevalence of cases and episodes of needlestick injury among three groups of health care workers in the past one-year, the level of knowledge on blood-borne diseases and universal precautions and the practice of universal precautions. Other factors associated with the occurrence of needlestick injuries and the reporting of needlestick injuries were also analysed. Methods  A cross-sectional study was conducted in May 2003 to study the needlestick injuries among 285 health care workers (doctors, nurses, medical students) in a public teaching hospital in Negeri Sembilan, Malaysia. Results  The prevalence of needlestick injuries among the respondents was 24.6% involving 71 cases i.e. 48.0% among doctors, 22.4% among medical students, and 18.7% among nurses and the difference was statistically significant (p<0.001). There were a total of 174 episodes of needlestick injury. Prevalence of episode of needlestick injuries was highest among doctors (146%), followed by nurses (50.7%) and medical students (29.4%). Cases of needlestick injuries attained lower scores on practice of universal precautions compared to non-cases (p<0.001). About 59% of cases of needlestick injury did not report their injuries. Conclusions  The study showed that needlestick injuries pose a high risk to health care workers and it is underreported most of the time. Many needlestick injuries can be prevented by strictly following the practice of universal precautions.     

Needlestick injuries during medical training

Medical students are at risk of acquiring infections caused by needlestick injuries, although it is unknown when needlestick injuries are most likely to occur during medical training. The aim of this study was to define high-risk periods over the course of medical training. A cross-sectional study was conducted among medical students in the first, third, fourth and fifth years of training at two medical schools in Munich. Overall, 1317 (85%) students returned a questionnaire on demographic data, vaccination status against hepatitis B, lifetime prevalence of needlestick injuries, level of knowledge about measures after such accidents, and transmission risks. Lifetime prevalence of needlestick injuries was 23%, ranging from 12% in first year students to 41% in fourth year students. These accidents happened most commonly during medical internships, especially during blood-taking practices; an activity that usually starts during the third year of training. The frequency of respondents not vaccinated against hepatitis B also varied between first (21%) and fourth (6.6%) year students. Needlestick injuries occur frequently and early on in medical training. In order to decrease the risk of preventable infections, complete coverage of vaccination against hepatitis B should be achieved early in medical training.     

Sharps injuries among medical students in the faculty of medicine, Colombo, Sri Lanka

Introduction

Medical students undertake clinical procedures which carry a risk of sharps injuries exposing them to bloodborne infections.

Objectives

To study the prevalence and correlates of sharps injuries among 4th-year medical students in the Faculty of Medicine, University of Colombo, Sri Lanka.

Materials and Methods

The survey was conducted among 4th-year medical students to find out the incidence of injuries during high-risk procedures, associated factors and practice and perceptions regarding standard precautions. A self-administered questionnaire was administered to a batch of 197 4th-year medical students.

Results

A total of 168 medical students responded. One or more injury was experienced by 95% (N = 159) of the students. The majority (89%) occurred during suturing; 23% during venipuncture and 14% while assisting in deliveries. Most of the incidents (49%) occurred during Obstetrics and Gynecology attachments. Recapping needles led to 8.6% of the injuries. Thirty-five percent of students believed they were inadequately protected. In this group, adequate protection was not available in 21% of the incidences and 24% thought protection was not needed. Following the injury, 47% completely ignored the event and only 5.7% followed the accepted post-exposure management. Only 34% of the students knew about post-exposure management at the time of the incident. Only 15% stated that their knowledge regarding prevention and management was adequate. The majority (97%) believed that curriculum should put more emphasis on improving the knowledge and practice regarding sharps injuries.

Conclusions

The incidence of sharps injuries was high in this setting. Safer methods of suturing should be taught and practiced. The practice of standard precautions and post-injury management should be taught.     

Needlestick and sharps injuries among health-care workers in Taiwan.

Sharps injuries are a major cause of transmission of hepatitis B and C viruses and human immunodeficiency virus in health-care workers. To determine the yearly incidence and causes of sharps injuries in health-care workers in Taiwan, we conducted a questionnaire survey in a total of 8645 health care workers, including physicians, nurses, laboratory technicians, and cleaners, from teaching hospitals of various sizes. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 per person in the past 12 months, respectively. Of most recent episodes of needlestick/sharps injury, 52.0% were caused by ordinary syringe needles, usually in the patient units. The most frequently reported circumstances of needlestick were recapping of needles, and those of sharps injuries were opening of ampoules/vials. Of needles which stuck the health-care workers, 54.8% had been used in patients, 8.2% of whom were known to have hepatitis B or C, syphilis, or human immunodeficiency virus infection. Sharps injuries in health-care workers in Taiwan occur more frequently than generally thought and risks of contracting blood-borne infectious diseases as a result are very high.     

Risk of needlestick injuries by injection pens

Injection pens are used by patients when auto-administering medication (insulin, interferon, apokinon etc.) by the subcutaneous route. The objective of this study was to evaluate the rate of injection pen use by healthcare workers (HCWs) and the associated risk of needlestick injuries to document and compare injury rates between injection pens and subcutaneous syringes. A one-year retrospective study was conducted in 24 sentinel French public hospitals. All needlestick injuries linked to subcutaneous injection procedures, which were voluntarily reported to occupational medicine departments by HCWs between October 1999 and September 2000, were documented using a standardized questionnaire. Additional data (total number of needlestick injuries reported, number of subcutaneous injection devices purchased) were collected over the same period. A total of 144 needlestick injuries associated with subcutaneous injection were reported. The needlestick injury rate for injection pens was six times the rate for disposable syringes. Needlestick injuries with injection pens accounted for 39% of needlestick injuries linked with subcutaneous injection. In all, 60% of needlestick injuries with injection pens were related to disassembly. Injection pens are associated with needlestick injuries six times more often than syringes. Nevertheless, injection pens have been shown to improve the quality of treatment for patients and may improve treatment observance. This study points to the need for safety-engineered injection pens.     

应用信息化技术调查护生针刺伤现状

目的 了解护生针刺伤发生现状，探讨有效的职业暴露应对策略。方法 回顾性调查某院2016—2018年临床实习护生针刺伤发生情况。护生在进入临床实习前，统一登记基本资料，并对其进行感染预防及控制相关知识培训，告知护生发生针刺伤后应经蓝蜻蜓医院感染实时监控管理系统上报。通过蓝蜻蜓系统导出护生针刺伤相关数据进行统计、分析。结果 共调查2 099名护生，其中男生256名，女生1 843名；大专生1 117名，本科生921名，国内硕士研究生34名，外籍硕士研究生27名。发生针刺伤232例次，针刺伤发生率为11.05%。不同性别、学历、实习阶段、科室护生针刺伤发生率比较差异有统计学意义（均P<0.05）。在操作环节分布上，分离针头、拔针和回套针帽时针刺伤所占比率分别为28.88%、21.55%和18.10%。在暴露源的分布上，HBV和梅毒分别占21.12%、6.90%。在暴露场所分布上，发生在病房的针刺伤占32.33%。结论 该院护生针刺伤发生率较低，但女性实习生、学历较低者、实习第一阶段、分离针头时、回套针帽时针刺伤发生率较高。应加强安全注射规范化培训，制定个性化培训方案等。     

Effect of educational programs, rigid sharps containers, and universal precautions on reported needlestick injuries in healthcare workers

OBJECTIVE: To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital. DESIGN: Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially. SETTING: A 700-bed general hospital that serves as the main teaching hospital of the University of Cincinnati. PARTICIPANTS: All employees of University Hospital who reported to personnel health for management of needlestick injuries. INTERVENTIONS: In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice. RESULTS: Surveillance identified 1,602 needlestick injuries (320/year) or 104/1,000/year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers. CONCLUSIONS: The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.     

应用信息化技术调查护生针刺伤现状

目的了解护生针刺伤发生现状,探讨有效的职业暴露应对策略。方法回顾性调查某院2016—2018年临床实习护生针刺伤发生情况。护生在进入临床实习前,统一登记基本资料,并对其进行感染预防及控制相关知识培训,告知护生发生针刺伤后应经蓝蜻蜓医院感染实时监控管理系统上报。通过蓝蜻蜓系统导出护生针刺伤相关数据进行统计、分析。结果共调查2 099名护生,其中男生256名,女生1 843名;大专生1 117名,本科生921名,国内硕士研究生34名,外籍硕士研究生27名。发生针刺伤232例次,针刺伤发生率为11.05%。不同性别、学历、实习阶段、科室护生针刺伤发生率比较差异有统计学意义(均P0.05)。在操作环节分布上,分离针头、拔针和回套针帽时针刺伤所占比率分别为28.88%、21.55%和18.10%。在暴露源的分布上,HBV和梅毒分别占21.12%、6.90%。在暴露场所分布上,发生在病房的针刺伤占32.33%。结论该院护生针刺伤发生率较低,但女性实习生、学历较低者、实习第一阶段、分离针头时、回套针帽时针刺伤发生率较高。应加强安全注射规范化培训,制定个性化培训方案等。     

Lack of risk-awareness and reporting behavior towards HIV infection through needlestick injury among European medical students

Medical students are at risk for occupational needlestick injuries (NSIs) which can result in substantial health consequences and psychological stress. Therefore, an open online survey among final year medical students from Austria, Germany, and the United Kingdom (UK) was conducted. The aim of the study was to evaluate risk-awareness and reporting behavior regarding needlestick injury (NSI), post-exposure prophylaxis, and level of education regarding the transmission of HIV through NSIs. Of 674 medical students, 226 (34%) reported at least one NSI during medical school. Respondents from Austria and Germany experienced a significantly higher number of NSIs in comparison to respondents from the UK. Seventy-six respondents (34%) did not report their most recent injury to an employee health office. Almost one third were not familiar with reporting procedures in case of a NSI and 45% of the study population feared that reporting an injury might have an adverse effect on their study success. 176 respondents (78%) who had suffered a NSI were not aware of the patient's HIV status. Education regarding NSIs and HIV transmission reduced the actual risk of experiencing a NSI significantly. These data indicate that medical students are at high risk of suffering NSIs during medical school. The rate of nonreporting of such injuries to an employee health service is alarmingly high. Improved medical curricula including precise recommendations may contribute to a more efficient prevention of occupational HIV infection in medical students.     

Needlestick injuries among German medical students: time to take a different approach?

Context  Medical students are at risk of occupational exposure to blood-borne viruses following needlestick injuries (NSIs) during medical school. The reporting of NSIs is an important step in the prevention of further injuries and in the initiation of early prophylaxis or treatment. The objective of this study was to describe the mechanisms whereby medical students experience occupational percutaneous blood exposure through NSIs and to discuss rational strategies for prevention.
Methods  Incidents of exposure to blood-borne pathogens among medical students at a large German university were analysed. Year 6 medical students completed a written survey immediately before the clinical part of their training began, describing incidents that had occurred during the previous 5 years.
Results  In our study, 58.8% (183/311) of participating medical students recalled at least one NSI that had occurred during their studies. Overall, 284 NSIs were reported via an anonymous questionnaire.
Discussion  Occupational exposure to blood is a common problem among medical students. Efforts are required to ensure greater awareness of the risks associated with blood-borne pathogens among German medical students. Proper training in percutaneous procedures and how to act in the event of injury should be given in order to reduce the number of injuries.     

Impact of introduction of sharps containers and of education programmes on the pattern of needle stick injuries in a tertiary care centre in India

Documentation of needlestick injuries was started in the Christian Medical College Hospital, Vellore in 1993. In 1995 large sharps containers were introduced, accompanied by an intensive education programme. Details of documented injuries from 1993 to 1999 were analysed using the Epi-Info software. A total of 347 injuries occurred, mainly due to improper disposal of needles, re-capping and carelessness during use. The percentage of injuries attributed to disposal fell from 69.2% in 1995 to 38.5% in 1996 (after the education programme). A further decrease was noted after the additional introduction of small sharps containers. In 1995, 73% of injuries involved housekeeping staff, this fell to 12% in 1998. Relatively simple interventions decreased the numbers of injuries, and we recommend that all healthcare institutions should have a system of documenting needlestick injuries, and take measures to decrease their incidence.