Never Fail to Report a Needlestick Injury
Vidya K. Rao MD
Shawn T. Beaman MD
According to the World Health Organization (WHO), an estimated 3 million people worldwide suffer from accidental needlestick injuries each year. The Centers for Disease Control (CDC) and the National Institute for Occupational Safety and Health (NIOSH) report that an estimated 600,000 to 800,000 needlestick injuries occur annually among health care workers in the United States. There are limited data regarding specific occupational hazards to anesthesia personnel. However, Greene et al., in a multicenter study, reported 1.35 contaminated needlestick injuries per 1,000 anesthetics administered, or 0.54 per 1,000 hours of anesthesia.
Accidental needlestick injuries in the health care setting have been associated with the transmission of up to 20 blood-borne pathogens, most commonly human immunodeficiency virus (HIV), hepatitis C virus, and hepatitis B virus. Although significant data exist regarding transmission rates based on documented needlestick injuries in the health care setting, exact information is unavailable because of the underreporting of needlestick injuries by health care workers.
Despite well-publicized institutional protocols for reporting needlestick injuries and the ready availability of postexposure prophylaxis and medical follow-up for health care workers, recent research demonstrates that underreporting continues to be a significant problem. In fact, in one report a surprising 60% to 95% of house staff failed to report needlestick injuries! In the United States, only 45% of anesthesia personnel who suffered a needlestick injury sought treatment! Surveys of anesthesiology residents and attending physicians revealed significant underreporting as well. Residents and attending physicians reported only 29% and 19% of needlestick and percutaneous injuries, respectively. Although needlestick injuries may be individually detrimental and potentially life-threatening, the underreporting of these injuries has the secondary effect of preventing precise calculations of disease transmission rates.
COMMON SCENARIOS ASSOCIATED WITH NEEDLESTICK INJURIES
Needlestick injuries may occur any time a needle is exposed. Engineering and technology have dramatically increased the safety of needle use, but
these advances represent only one component of accidental needlestick prevention. Examples of safety features include built-in safety devices, such as needle shields, retractable needles, safety catheter encasement devices, and needleless intravenous (IV) delivery systems.
these advances represent only one component of accidental needlestick prevention. Examples of safety features include built-in safety devices, such as needle shields, retractable needles, safety catheter encasement devices, and needleless intravenous (IV) delivery systems.
However, accidental needlestick injuries continue to occur despite these advances in technology. These injuries most commonly occur during certain situations:
During clean-up after use (such as starting an IV, phlebotomy)
When sharps are disposed of improperly
When a needle is being recapped
While manipulating the needle in the patient
While handling a device or passing a device to another health care worker during or after use
While handling or transferring specimens
During collision with a sharp or with a health care worker handling the sharp
Between steps of a multistep process
Some needlestick injuries are considered to be “high risk.” These include injuries from hollow-bore needles, needles that are contaminated with blood, and needles that are blood-filled. Anesthesiology personnel are especially susceptible to the above high-risk situations. Prevention of needlestick injuries involves vigilance on the part of personnel handling sharps. Most injuries have been shown to arise from the use of needles attached to syringes, suture needles, hollow-bore needles, IV catheter-needle stylets, and epidural needles. The majority of contaminated needlestick injuries in anesthesia personnel are preventable. One multicenter study reported that 59% of all injuries, 68% of injuries from the use of hollow-bore needles, and 78% of highrisk contaminated percutaneous injuries were preventable.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
The risk of HIV transmission to health care workers after percutaneous exposure to HIV-infected blood has been estimated at approximately 0.3% percent, and among anesthesia personnel, an estimated 0.56 HIV infections will occur per year to anesthesia personnel in the United States. The transmission rate varies based on the seroprevalence of the patient population. Projections by Greene et al. cite the 1-year risk of an anesthesia provider contracting HIV from occupational exposure at 0.00013% to 0.3%, and the 30-year risk to be from 0.0038% to 0.94%.
Several factors have been associated with an increased risk of HIV transmission from a patient to a health care worker as a result of a needlestick injury. These factors include an increased quantity of blood transferred during the exposure, use of a larger-bore needle (gauge smaller than 18), deep injury,
a device visibly contaminated with the patient’s blood, exposure during a procedure that involved placing a needle into a source patient’s vasculature, or exposure to a source patient in the terminal stage of acquired immunodeficiency syndrome (AIDS). It is likely that the immunologic status of the injured health care worker also plays a role in determining risk.
a device visibly contaminated with the patient’s blood, exposure during a procedure that involved placing a needle into a source patient’s vasculature, or exposure to a source patient in the terminal stage of acquired immunodeficiency syndrome (AIDS). It is likely that the immunologic status of the injured health care worker also plays a role in determining risk.
Symptoms of primary or acute HIV infection are generally nonspecific, resemble flu-like symptoms, and can occur within days or weeks of the initial exposure. They typically include fever, rash, malaise, pharyngitis, lymphadenopathy, and headache. Some people experience severe symptoms after contracting HIV, whereas others experience no symptoms whatsoever. Given the non-specificity of symptoms, the only reliable method of diagnosing HIV infection is antibody testing, with subsequent confirmation by Western blot. Historically, antibody testing was effective after the “window period,” which ranges from 2 weeks to 6 months following exposure. Current enzyme immunoassays, however, are able to detect the HIV antibody within several days.
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