Needlestick

Excerpt

Needlestick injuries are known to occur frequently in healthcare settings and can be serious. In North America, millions of healthcare workers use needles in their daily work, and hence, the risk of needlestick injuries is always a concern. While the introduction of universal precautions and safety conscious needle designs has led to a decline in needlestick injuries, they continue to be reported, albeit on a much smaller scale than in the past. Awareness of needlestick injuries started to develop soon after the identification of HIV in the early 1980s. However, today the major concern after a needlestick injury is not HIV but hepatitis B or hepatitis C. Guidelines have been established to help healthcare institutions manage needlestick injuries and when to initiate post-exposure HIV prophylaxis. The Centers for Disease Control and Prevention (CDC) has developed a model which helps healthcare professionals know when to start antiretroviral therapy.

Needlestick injuries are an occupational hazard for millions of healthcare workers. Even though universal guidelines have decreased the risks of needlestick injuries over the past 30 years, these injuries continue to occur, albeit at a much lower rate. Healthcare professionals at the highest risk for needlestick injuries are surgeons, emergency room workers, laboratory room professionals, and nurses. The use of needles is unavoidable in healthcare, and even though every hospital has guidelines on proper handling and disposal of needles and the newest design of safety conscious needles, needlestick injuries continue to occur more often in et al. healthcare professionals like surgeons and emergency room personnel. In most cases, needlestick injuries occur chiefly because of unsafe practices and gross negligence on the part of the healthcare workers. The reality is that most needlestick injuries are preventable by following established procedures.

Needlestick injuries came to the forefront of healthcare after the discovery of the HV in the early 1980s. Since the adoption of universal precautions, the number of needlestick injuries has greatly decreased but continues to occur, but the numbers are low. Today the major threat after a needlestick injury is not HIV but acquiring hepatitis B or hepatitis C.

In the past, the majority of needlestick injuries occurred during resheathing of the needle after the withdrawal of blood from a patient. Even though this practice is now no longer recommended, there are experts in infectious disease who indicate that not resheathing the needle greatly increases the risk of needlestick injuries in house cleaners and porters who are in charge of collecting and disposing of the sharps containers. Over the years, many cases of cleaners and porters being injured by unsheathed needles have been reported. Further, this is more of a concern when healthcare workers ignore policies and discard needles directly into the plastic bags instead of the sharps containers. To prevent these injuries, many healthcare institutions have now adopted unique ways of resheathing needles. For example, in the operating room, there are now established protocols on how the nurse will pass sharp instruments and needles to the surgeon and vice versa. Another method of avoiding needlestick injuries is double gloving.

Factors that increase the risk of exposure to body fluids:

1. Failure to adopt universal precautions

2. Not following established a protocol of safety

3. Performing high-risk procedures that increase the risk of blood exposure such as withdrawing blood, working in the dialysis unit, administering blood

4. Using needles and other sharp devices that lack safety features

What Organisms are Involved in Needlestick Injuries?

In reality, almost any microorganism can be transmitted following a needlestick injury, but practically only a handful of organisms are of clinical concern. The most important organisms that can be acquired after a needlestick injury include HIV, hepatitis B, and hepatitis C. All these three viruses can be acquired by a percutaneous needlestick or splashing of blood on the mucosal surfaces of the body. While HIV primarily affects the immune system, both hepatitis B and C have a predilection for the liver. Tetanus should always be considered when a needlestick injury has occurred, and the patient's vaccination history must be obtained.