Needlestick injuries: mechanisms and control

Consideration of a linear model for venepuncture and patterns that emerge from the literature can help to understand the occurrence of occupational needlestick injuries which are common in healthcare workers. A systematic approach can also help in evaluation of potential control measures and in cost-benefit analysis.     

Needlestick and sharps injuries in hygiene service engineers

An anonymous postal survey was undertaken to assess the frequencyof hygiene service engineers finding sharp objects (includingneedles) in the washrooms in which they worked. Data on thetype of sharps found and their exact location were collectedalong with information on the type and number of accidents whichhad occurred. As a result of the survey it was clear that, althoughthe number of recorded accidents was small, a significant numberof accidents were not being reported and that finding sharpswas a common occurrence for these workers. Recommendations tomanagement on working practises and procedures and on the needfor immunization are outlined.     

Needlestick injuries and unprotected sex in the Netherlands

Needlestick accidents can be divided into occupational and non-occupational accidents. In the Netherlands, occupational accidents are often managed adequately on-site, but the management of non-occupational accidents can be improved. It is questionable whether prophylaxis after unprotected sex (voluntary and involuntary) should be managed using current needle-stick protocols. These accidents require a separate protocol.     

Needlestick injuries among nurses of Fars province, Iran

PURPOSE: A prevalence survey was performed to estimate the magnitude and predictors for needlestick injury (NSI) in nurses of Fars province hospitals. METHODS: Questionnaires were distributed in 52 hospitals to a stratified random sample of 2,118 (46.3%) nurses between April and September 2005 to collect self-reported NSI in the past 12- months. RESULTS: Of the 1,555 nurses who returned a completed questionnaire, 49.6% (95% confidence interval [95 CI] 47.1%-52.1%) recalled at least one sharps injury, of which 52.6% were classified as NSI. Just over one fourth (26.3%; 95 CI 24.1%-28.6%, 409/1,555) of respondents sustained at least one NSI, 75.6% (95 CI 71.1%-79.6%) recalled having sustained between 1 and 4 injuries in the past 12-months, of which 72.2% involved a hollow-bore needle and 95.1% of injuries involved fingers. Predictors of NSI included being a registered nurse (odds ratio [OR] 1.6, 95% CI 1.1-2.3) or midwife (OR 2.4, 95% CI 1.4-3.9) compared with nurse managers, being employed in a hospital located in other cities smaller than Shiraz (OR 1.4, 95% CI 1.1-1.8). Nurses who reported a previous contaminated NSI were less likely to sustain a further injury (OR 0.3, 95% CI 0.2-0.4). CONCLUSION: The prevalence of NSI in Iranian nurses is high, with the majority of injured staff having sustained up to 4 NSIs in a 12-month period. Nearly all NSIs were high-risk injuries involving a hollow-bore needle. Providing nursing staff with safety-engineered devices, including retractable syringes when hollow-bore needles are to be used, will be an important step toward reducing our NSI epidemic.     

Needlestick and Sharps Injuries among Australian medical students

We investigated the prevalence and distribution of Needlestick and Sharps Injuries (NSI) among a group of Australian medical undergraduates from 4 consecutive grades. Data was obtained by means of an anonymous, self-reporting survey. A total of 254 questionnaires were obtained (response rate 97.3%). Among them, 35 students (13.8%) had suffered a total of 41 NSI incidents. By gender, 71.4% of the NSI reporters were female and 28.6% were male. NSI prevalence varied significantly with respect to students' year of study (P for Trend=0.0106), ranging from 7.3% in the 1st year to 26.8% in the 3rd year. Of the 41 NSI incidents, 29.2% were caused by a glass item, 24.4% by a hollow bore needle, 24.4% by another device and 22.0% by a surgical device. The distribution by causative device also varied from year to year. Overall, this study has shown that NSI represent an important hazard for Australian medical students. As such, the importance of intervention strategies to reduce NSI exposures must remain an essential facet of medical education, worldwide. Future preventive measures will also need to consider the unique situation of medical students in Australia, as elsewhere.     

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.     

Needlestick injuries in a tertiary care centre in Mumbai, India

Accidental exposure from blood/body fluid of patients is a risk to healthcare workers (HCWs). Percutaneous injury is the most common method of exposure to blood-borne pathogens. A policy was formulated at our institute, a tertiary care centre in central Mumbai, and we report a six-year (1998--2003) ongoing surveillance of needlestick injuries. Of the 380 HCWs who reported needlestick injuries, 45% were nurses, 33% were attendants, 11% were doctors and 11% were technicians. On source analysis, 23, 15 and 12 were positive for Hepatitis B surface antigen (HBsAg), human immunodeficiency virus (HIV) and hepatitis C virus (HCV), respectively. Immediate action following potential exposure included washing the wound with soap and water, encouraging bleeding and reporting the incident to the emergency room. Analysis of the source of injuries revealed that known sources accounted for 254 injuries, and unknown sources from garbage bags and Operating Theatre instruments accounted for 126 injuries. Most needlestick injuries occurred during intravenous line insertion (N=112), followed by blood collection (N=69), surgical blade injury (N=36) and recapping needles (N=36). Immediate postexposure prophylaxis (PEP) for HCWs who sustained injuries with hepatitis-B-virus-positive patients included booster hepatitis B immunization for those positive for antiHBs. A full course of immunization with hepatitis B immunoglobulin was given to those who were antiHBs negative. All staff who sustained injury with HIV were given immediate antiretroviral therapy (AZT 600 mg/day) for six weeks. Subsequent six-month follow-up showed zero seroconversion.     

Needlestick injuries and hepatitis B virus vaccination in health care workers

An analysis of 2646 needlestick injuries in hospitals in the Greater Manchester area between April 1992 and April 1999 was carried out. Ten per cent of members of staff injured in these incidents had never been vaccinated against hepatitis B virus (HBV) and 27% of those who had been vaccinated had no anti-HBs (< 10 IU/L). Although few health care workers were at risk of transmission of HBV through needlestick incidents in this study (0.6% (12/2084) of all source patients were HBsAg positive; 9 HBeAg positive, 7 anti-HBe positive), the large number of members of staff who were not protected from HBV infection indicates a need for occupational health departments to reinforce HBV vaccination policies.     

Needlestick and sharps injuries among a cross-section of physicians in Mainland China

BACKGROUND: Although needlestick and sharps injuries (NSI) represent a significant occupational hazard for physicians worldwide, their epidemiology has not been previously examined in Mainland China. This study describes the prevalence, distribution, and risk factors for NSI among a cross-section of Chinese physicians. METHODS: Data was obtained by an anonymous, self-reporting survey administered to all 361 physicians at a university teaching hospital, during 2004. RESULTS: Seventy-nine percent of the physicians responded. Among them, 64% had experienced an NSI in the previous 12 months, 50.3% of which involved contaminated devices. By device, 22.8% were caused by hollow-bore syringe needles, 19.1% by suture needles, and 12.1% by scalpel blades. Surgical procedures accounted for 27.9% of all injuries. Only 15.3% of physicians had officially reported their NSI to management, of which 10% went unreported because the individual felt they were not unlucky enough to get a disease. A statistically significant correlation was demonstrated between NSI and working in the intensive care unit (adjusted odds ratio: 5.3, 95% CI: 1.7-23.4). CONCLUSIONS: Although this study suggests that NSI are an important workplace hazard for Chinese physicians, future measures should consider the unique cultural beliefs of Chinese people and its effect on preventive behaviors. The concept of "luck," and its relationship with NSI reporting in particular, may also need to be addressed.     

体能训练运动损伤原因现况研究

目的 寻找飞行人员体能训练中导致运动损伤的原因,为针对飞行人员体能训练中运动损伤开展有效的预防和治疗工作提供依据.方法 对调查对象进行面对面问卷调查,了解近期发生运动损伤的飞行员与未发生运动损伤的飞行员在一般情况及自我保护意识方面的差异,同时分析发生运动损伤的飞行人员损伤发生的原因.结果 飞行人员运动损伤发生率为39.0％,运动损伤发生的年龄构成差异具有统计学意义(x2=20.342,P＜0.001).技术动作失误(36.8％)、准备活动不充分(33.3％)、注意力不集中(28.2％)是导致运动损伤发生较为主要的原因.损伤组与未损伤组在“运动前准备活动情况”、 “运动时出现疲劳采取的行动”、 “运动中出现不适时采取的行为”3项的差异具有统计学意义.结论 体能训练中运动损伤的原因与准备活动不充分有关,同时也与运动中出现疲劳和不适时未采取恰当的行为有关.     

Needlestick injuries and other occupational exposures to body fluids amongst employees and medical students of a German university: incidence and follow-up

The aim of this study was to obtain data concerning the incidence, reporting and follow-up of occupational exposure to blood or other body fluids (OEB). A questionnaire was distributed to employees and medical students (N=787) and official reports of OEB during the year 2003 (N=203) and their consequent follow-up (N=100) were evaluated. The percentages of needlestick injuries were 29.5% for students and 22.5% for employees. Incidence rates per 1000 employee days were 0.61 for needlestick injuries or sharp object injuries and 0.27 for mucocutaneous exposure to body fluids. The mean rate of underreporting was approximately 45%. Contrary to expectations, only 4.3% of nurses and 3.9% of doctors officially reported an OEB in 2003. The number of persons who did not attend for a serological test increased during the follow-up period. Considering all documented test results, 35 out of 100 affected persons were lost to follow-up due to default of appearance. As a consequence, the employer should provide safety devices and enforce didactical interventions with practical training and incident reporting. Periodical occupational health medicals, including serological testing, should be mandatory for all employees, including medical students and student nurses. To increase compliance after OEB, a short follow-up period using improved laboratory tests requires further discussion.     

Needlestick injuries: how can we teach people better about risk assessment?

At work people run some small risk of death or injury which is directly attributable to their occupation. In biomedical sciences the accidental puncture of the skin by hypodermic needles, other instruments or broken glass has long been regarded as an occupational hazard and there is increasing concern that staff could become infected with a range of micro-organisms, including hepatitis B and the Human Immunodeficiency Virus (HIV). Needlestick injuries should be preventable if staff are trained effectively and take care about disposal of used syringes and needles. Staff at risk must be offered pre-exposure vaccination for hepatitis B and resources must be provided for special training. Fundamental changes may be required in methods and equipment and a number of new ways of targeting groups of health care staff with information are discussed.