Improving reporting of sharp injuries

Needle-Stick Injuries in the National Health Service: A Culture of Silence

Injury by contaminated sharp instruments and needles constitutes a major occupational hazard for healthcare workers. In a confidential survey at a district general hospital, 300 healthcare professionals were asked about their personal experience of needle-stick injury and their attitudes to reporting. 279 individuals responded, of whom 38% had experienced at least one needle-stick (mean 1.8) in the past year and 74% had sustained such an injury during their careers (mean 3.0). Although 80% of respondents were aware that such incidents should be notified, only 51% of those affected had reported all needle-stick injuries. Doctors were less likely to report than nurses, despite a higher liability to injury. This survey adds to evidence of a culture of silence pertaining to needle-stick injuries. The consequent risks to health, and the ethical and financial implications, remain uncertain.

Incidence of ambulatory care visits after needlestick and sharps injuries among healthcare workers in Taiwan: a nationwide population-based study

Healthcare professionals have a high risk of needlestick and sharps injuries (NSIs), which have a high potential for disease transmission. Ambulatory care follow up is essential, but is usually overlooked. This study aimed to investigate the annual and cumulative (age-, sex-, and subtype-specific) incidences of ambulatory care visits after NSIs. This study was also designed to evaluate the incidences of blood-borne diseases associated with NSIs among Taiwanese health professionals in Taiwan between 2004 and 2010. Data were obtained from the National Health Insurance Research Database, which contains anonymized records representing approximately 99% of the Taiwan population. A total of 4443 nurse healthcare workers (NHCWs) and 3138 non-nurse healthcare workers (NNHCWs), including physicians, medical technologists, and other health professionals were included in this longitudinal study. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The Mantel-Haenszel method was used to adjust for sex, age, and type of affiliation. Results showed that the annual incidence of ambulatory care visits of NHCWs increased from 0.7% in 2004 to 1.9% in 2010; this incidence was significantly higher than that of NNHCWs (from 0.3% in 2004 to 0.5% in 2010) in any yearly comparison (p < 0.05). The sex-adjusted 7-year cumulative incidence rate was 3.23 (95% CI = 1.23-8.45) in males and 3.92 (95% CI = 2.70-5.69) in females (p < 0.05). The age-adjusted 7-year cumulative incidence rate was 2.74 (95% CI = 1.99-3.77) and 2.14 (95% CI = 1.49-3.07) in subjects ≤ 30 and ≥31 years old, respectively (p < 0.0005). The affiliation-adjusted 7-year cumulative incidence rate was 1.89 (95% CI = 1.21-2.94) in medical centers and 3.33 (95% CI = 2.51-4.41) in nonmedical centers (p < 0.01). In conclusion, NSIs increased steadily from 2004 to 2010 in Taiwan with NHCWs having higher NSIs incidences than NNHCWs. A routine ambulatory care visit after NSIs can prevent blood-borne transmission, especially for NHCWs. Educational programs may be helpful for reducing the incidence of NSIs and increasing ambulatory care visit ratios after NSIs.

Frequency and barriers of underreported needlestick injuries amongst Iranian nurses, a questionnaire survey

AIMS AND OBJECTIVES

To determine the frequency of needlestick injuries and barriers of reporting such injuries amongst Iranian nurses.

BACKGROUND

Exposure to blood-borne pathogens because of needlestick injuries in particular is a potential risk for healthcare workers, including clinical nurses. The burden of sharp injuries sustained by healthcare workers is still unclear, primarily because of underreporting.

DESIGN

A cross-sectional study was undertaken amongst 111 clinical nurses working in five major teaching hospitals in Tehran/Iran during 2007-2008 who were randomly selected.

METHODS

A validated self-reported questionnaire containing demographic characteristics and history of experiences with contaminated needlesticks as well as probably reason/s for underreporting such injuries was used.

RESULTS

More than half of the enrolled nurses (54.1%, n = 60) had no experience of contaminated injuries, while the rest of 45.9% (n = 51) had experienced at least one contaminated needlestick injuries during their clinical performance. More than one-third (34.0%, n = 38) had experienced a mean of 58 contaminated needlestick injuries during the past 12 months (crude incidence: 0.52 NSI/nurse/year). Only 14 nurses (36.8%) with needlestick injuries experiences had officially reported their experiences. The major reasons for not reporting needlestick injuries were dissatisfaction with follow-up investigations by officials after reporting the events (33.3%) and safe/low risk considering of source patients (29.2%).

CONCLUSIONS

Increased frequency and underreporting of needlestick injuries amongst Iranian nurses is going to be a major concern. As a preventive strategy, further interventions such as constant staff training, life-long learning and standardising postexposure procedures are recommended.

RELEVANCE TO CLINICAL PRACTICE

Determining the prevalence, burden and reasons for underreporting needlestick injuries by clinical nurses are required for establishing a preventive strategy to decrease hospital infections.

The incidence and reporting rates of needle-stick injury amongst UK surgeons

INTRODUCTION

Needle-stick injuries are common. Such accidents are associated with a small, but significant, risk to our career, health, families and not least our patients. National guidelines steer institution-specific strategies to provide a consistent and safe method of dealing with such incidents. Surgeon-specific guidelines are not currently available. We have observed that hospital sharps policy is often considered cumbersome to the surgeon, resulting in on-the-spot decision making with potential long-term implications. By their essence, these decisions are inconsistent, not reproducible and, thus, we believe them to be unsafe. The under-reporting to occupational health departments is well documented. Current surgical practice has the potential to expose the surgeon to unnecessary risk. The aims of this study were to establish the true incidence of contaminations caused by needle-stick injury in our hospital and to assess how well current protocols are really implemented.

SUBJECTS AND METHODS

We identified all surgeons of consultant, non-career staff grade (NCSG) and registrar grade working in a large 687-bed district general hospital serving a population of 550,000, in the UK. We designed a retrospective, anonymous 30-second survey. Surgeons' awareness and opinion of local policy was sought in a free-text section.

RESULTS

Of the 98 surgeons in the hospital, 77% responded to the questionnaire and 44% anonymously admitted to having a needle-stick injury. Only 3 of the 33 (9%) who sustained an needle-stick injury said that they followed the agreed local policy. Twenty-three surgeons (70%) performed first aid type procedures such as informing scrub nurse, changing needle and gloves. Seven surgeons (21%) simply ignored the incident and continued. Forty-three surgeons commented on the policy's nature with only 9 who regarded it as 'user friendly'.

CONCLUSIONS

Needle-stick injury is still a common problem, particularly in the surgical cohort and remains significantly under-reported. The disparity between hospital sharps policy and actual surgical practice is considered and an explanation for the difference sought. Without this awareness of 'real-life' surgical practice, the occupational health figures for sharps injury will always tell a rosy story under-estimating a real problem. We strongly advocate universal precautions in the operating theatre. However, we acknowledge that sharps injuries will occur. We should remain vigilant and act upon contaminations without surgical bravado but with mater-of-fact professionalism. This includes regular review of policy and, particularly, promotion of surgical awareness.

The national study to prevent blood exposure in paramedics: exposure reporting

BACKGROUND

This survey was conducted to provide national incidence rates and risk factors for exposure to blood among paramedics. The present analysis assesses reporting of exposures to employers.

METHODS

A questionnaire was mailed in 2002-2003 to a national sample of paramedics selected using a two-stage design. Information on exposure reporting was obtained on the two most recent exposures for each of five routes of exposure.

RESULTS

Forty-nine percent of all exposures to blood and 72% of needlesticks were reported to employers. The main reason for under-reporting was not considering the exposure a "significant risk." Females reported significantly more total exposures than males. Reporting of needlesticks was significantly less common among respondents who believed most needlesticks were due to circumstances under the worker's control. Reporting was non-significantly more common among workers who believed reporting exposures helps management prevent future exposures. Reporting may have been positively associated with workplace safety culture.

CONCLUSIONS

This survey indicates there is need to improve the reporting of blood exposures by paramedics to their employers, and more work is needed to understand the reasons for under-reporting. Gender, safety culture, perception of risk, and other personal attitudes may all affect reporting behavior.

Needlestick injuries, management and education: a role for emergency medicine?

INTRODUCTION

The objectives of the study were to study the pattern of needlestick injuries presenting to an inner city emergency department, and to highlight areas where greater training is required. The emergency department is involved in the management of injuries both in the hospital setting and in the community. The setting was an inner city area with a high incidence of intravenous drug abuse, HIV, hepatitis B and C.

METHODS

A retrospective review of all emergency notes triaged as needlestick injury for a 12-month period from July 2001 to July 2002. Information studied included times from incident, arrival at department, to be seen by doctor and to get post-exposure prophylaxis (PEP) if indicated; also the number of tetanus toxoid, hepatitis B immunoglobulin/vaccine, HIV PEP given as well the number indicated. The risk of injury and exposure were assessed and follow-up was checked.

RESULTS

There were 73 needlestick injuries, 35 (48%) presented during normal working hours (09.00-17.00 h) and 38 (52%) presented outside these hours. Twenty-six (34%) were in healthcare workers, 51 (66%) were in non-healthcare workers. The average time from the incident to arrival was 1.4 h for healthcare workers and 22.6 h for non-healthcare workers. The median time from arrival in the department to be seen by a doctor was 90 min. Ten injuries (13.7%) were high risk. Antiretroviral agents were given to 15 patients (20.1%) and the median time from door to HIV PEP was 90 min (average 141 min).

CONCLUSIONS

There is a delay and lack of urgency in the presentation of needlestick injuries for assessment and treatment. Education of emergency staff, other healthcare workers and the general public is needed to reduce the needle-to-door and needle-to-PEP time for the effective management of needlestick injuries and prevention of hepatitis and HIV seroconversion.

Needle-stick injuries in the National Health Service: a culture of silence

Injury by contaminated sharp instruments and needles constitutes a major occupational hazard for healthcare workers. In a confidential survey at a district general hospital, 300 healthcare professionals were asked about their personal experience of needle-stick injury and their attitudes to reporting. 279 individuals responded, of whom 38% had experienced at least one needle-stick (mean 1.8) in the past year and 74% had sustained such an injury during their careers (mean 3.0). Although 80% of respondents were aware that such incidents should be notified, only 51% of those affected had reported all needle-stick injuries. Doctors were less likely to report than nurses, despite a higher liability to injury. This survey adds to evidence of a culture of silence pertaining to needle-stick injuries. The consequent risks to health, and the ethical and financial implications, remain uncertain.