Needlestick injury

A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick injury are generally negligible, these injuries can lead to transmission of blood-borne diseases, placing those exposed at increased risk of infection from disease-causing pathogens, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). In healthcare and laboratory settings globally, there are over 25 distinct types of blood-borne diseases that can potentially be transmitted through needlestick injuries to workers. In addition to needlestick injuries, transmission of these viruses can also occur as a result of contamination of the mucous membranes, such as those of the eyes, with blood or body fluids, but needlestick injuries make up more than 80% of all percutaneous exposure incidents in the United States. Various other occupations are also at increased risk of needlestick injury, including law enforcement, laborers, tattoo artists, food preparers, and agricultural workers. Increasing recognition of the unique occupational hazard posed by needlestick injuries, as well as the development of efficacious interventions to minimize the largely preventable occupational risk, encouraged legislative regulation in the US, causing a decline in needlestick injuries among healthcare workers.

Health effects While needlestick injuries have the potential to transmit bacteria, protozoa, viruses and prions, the risk of contracting hepatitis B, hepatitis C, and HIV is the highest. The World Health Organization estimated that in 2000, 66,000 hepatitis B, 16,000 hepatitis C, and 1,000 HIV infections were caused by needlestick injuries. In places with higher rates of blood-borne diseases in the general population, healthcare workers are more susceptible to contracting these diseases from a needlestick injury. Hepatitis B carries the greatest risk of transmission, with 10% of exposed workers eventually showing seroconversion and 10% having symptoms. Higher rates of hepatitis B vaccination among the general public and healthcare workers have reduced the risk of transmission; non-healthcare workers still have a lower HBV vaccination rate and therefore a higher risk. The transmission rate of hepatitis C has been reported at 1.8%, but newer, larger surveys have shown only a 0.5% transmission rate. The overall risk of HIV infection after percutaneous exposure to HIV-infected material in the health care setting is 0.3%. Individualized risk of blood-borne infection from a used biomedical sharp is further dependent upon additional factors. Injuries with a hollow-bore needle, deep penetration, visible blood on the needle, a needle located in a deep artery or vein, or a biomedical device contaminated with blood from a terminally ill patient increase the risk for contracting a blood-borne infection.

Psychological effects The psychological effects of occupational needlestick injuries can include health anxiety, anxiety about disclosure or transmission to a sexual partner, trauma-related emotions, and depression. These effects can cause self-destructive behavior or functional impairment in relationships and daily life. This is not mitigated by knowledge about disease transmission or post-exposure prophylaxis. Though some affected people have worsened anxiety during repeated testing, anxiety and other psychological effects typically abate after testing is complete. A minority of people affected by needlestick injuries may have lasting psychological effects, including post-traumatic stress disorder. In cases where an injury was sustained with a clean needle (i.e. exposure to body fluids had not occurred), the likelihood of infection is generally minimal. Nonetheless, workers are often obligated to report the incident as per the facility's protocol regarding occupational safety.

Cause Needlestick injuries occur in the healthcare environment. When drawing blood, administering an intramuscular or intravenous drug, or performing any procedure involving sharps, accidents can occur and facilitate the transmission of blood-borne diseases. Injuries also commonly occur during needle recapping or via improper disposal of devices into an overfilled or poorly located sharps container. Lack of access to appropriate personal protective equipment, or alternatively, employee failure to use provided equipment, increases the risk of occupational needlestick injuries. Needlestick injuries may also occur when needles are exchanged between personnel, loaded into a needle driver, or when sutures are tied off while still connected to the needle. Needlestick injuries are more common during night shifts and for less experienced people; fatigue, high workload, shift work, high pressure, or high perception of risk can all increase the chances of a needlestick injury. During surgery, a surgical needle or other sharp instrument may inadvertently penetrate the glove and skin of operating room personnel; scalpel injuries tend to be larger than a needlestick. Generally, needlestick injuries cause only minor visible trauma or bleeding; however, even in the absence of bleeding the risk of viral infection remains.

Prevention

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