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Needlesticks in the Workplace:
Information for HealthCare Workers

A significant occupational hazard for healthcare workers continues to be exposure to blood borne pathogens in the workplace. In 1980’s this risk became a critical issue with the emergence of HIV/AIDS and increase in cases of Hepatitis C. The first documented case of HIV infection in a healthcare worker as a result of a workplace exposure occurred in 1984. Because of the potentially serious, even fatal outcome of such incidents, Universal Precautions used in the health care field evolved.

These workplace safeguards indeed had a significant impact on the number of exposures to contaminated blood or body fluid. Several studies into the outcome of workplace exposure to HIV/AIDS through needlesticks confirm a low rate of sero-conversion, just 2%. Yet, all needlestick exposures, theoretically, are preventable.

While the highest number of needlestick incidents occur in nurses, all healthcare personal are vulnerable to these accidental exposures. Physicians, emergency medical technicians, phlebotomists, nurse’s aids, maintenance workers, housekeepers, lab technicians, pathology/autopsy personnel and other hospital or health facility workers should all be apprised of Universal Precautions and incident reporting protocols.

Numerous studies now show that two factors have a strong impact on the chance of contracting a blood borne illness from a needlestick. One important factor is the health status of the source patient. Patients with more severe disease, higher blood levels of virus, lower levels of immune components and drug resistance represent the highest risk. If exposure occurs, it’s important to get as much information as possible about the source patient’s health status, especially the drug regimen they are on, and any resistance to mediations that has been recorded.

Another component of disease transmission is the method of exposure. Different modes of exposure, whether through a fluid splash to mucous membranes, exposure of contaminated material with open skin, or a percutaneous inoculation have varying rates of disease transmission. Research shows that hollow bore needles, and exposure to medical instruments that have contacted an artery or vein, or deep tissues carry are higher risk of transmitting blood borne viruses than other types of exposure. For these reasons, practices like recapping used needles are strongly discouraged.

What to do if you’re exposed
In the event of an exposure, it is critical to closely evaluate the situation to decide on the appropriate course of action to ensure an exposed workers health.

According to the most recent recommendations from National Institute for Occupational Safety and Health (NIOSH), immediate action following a needlestick or exposure to potential contaminated blood or body fluids should include:

  • Through cleansing of the area with soap and water
  • Copious flushing of exposed skin or mucous membranes with water
  • Eyes should be flushed with sterile saline or water
  • Report the incident to your Infection Control Manager or supervisor
  • Obtain medical evaluation and treatment

Health agencies making recommendations on exposure management agree that the source patient status is critical to determining the most appropriate treatment following exposure to potentially contaminated materials. If possible, the incident report should include the health status of the source patient from whom the sharp instrument was used. If the patient has any blood borne infections such as HIV or Hepatitis, the clinical and laboratory degree of severity should be determined. In some cases, such an injury from a sharps container or waste, the source of the contaminated sharp is unknown.

Guidelines released September 30, 2005 by the US Public Health Service update the protocol for prophylaxis in health care workers exposed to HIV.

Post Exposure Prophylaxis Protocol Recommendations (PEP)
Source Minor Exposure Major Exposure
No HIV None None
Asymptomatic, HIV+ 2 drug PEP 3 drug PEP
Symptomatic, HIV+ 3 or > drug PEP 3 or > drug PEP
HIV status unknown Case by case basis, consider likelihood of source HIVstatus
Unknown Source 2 drug PEP 2 drug PEP

If, after testing a source patient is found to be HIV negative, the PEP can be safely discontinued.

Antiretroviral drugs are divided into five classes: nucleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs), non-nucleotide reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs) and one fusion inhibitor. The most common drug combination used for occupational exposures is zidovudine + lamivudine. These drugs are available as single agents and as a combination tablet. The combination form should be taken once daily, or the individual agents are taken on a twice daily or tree times daily regimen, depending on the dosage required. This combination is used most often because of it’s efficacy and tolerability in exposed healthcare workers. Several alternate drug protocols are also used and described in detail in the September 30, 2005 report by the US Public Health Service.

The specific choice of drugs for PEP depends on the circumstances of each incident and the health status of the exposed worker. Special circumstance such as pregnancy, other complicating medical conditions or medications, and poor tolerance of anti-retrovirals should guide the choice of medications in each individual case.

Post-exposure treatment should be started as soon as possible following the incident. In cases where the HIV/Hepatitis status of the source is unknown, treatment for the most severe possibility should be initiated while testing is pursued. Since records have been kept on needlestick incidents worldwide, only six workers exposed to HIV in the workplace who have started a PEP have gone on to develop HIV.

Prevention
Awareness of the risks of workplace exposure is crucial to reducing needlestick incidents. All workers who handle sharp medical devices should be trained in Universal Precautions and provided with the appropriate protective gear. Caution when working with blood and body fluids and contaminated medical devices is the best way to reduce occupational exposure. Sharps containers should be well marked and located close to the area where sharps are used.

According to the The Health Protection Agency (HPA,) following precautions whenever providing patients care, and common sense can drastically reduce the number of needle stick incidents. Established in 2003, the agency is responsible for providing an integrated approach to protecting UK public health through the provision of support and advice to the NHS, local authorities, emergency services, the Department of Health and other related agencies. http://www.hpa.org.uk/infections/topics_az/bbv/good_bad.htm

Health Protection Agency Recommendations for Workplace Safety

DO:
Dispose of contaminated sharps immediately after use
Always discard in designated sharp container
Dispose of sharp waste containers immediately when they are full
Use universal precautions when handling blood/body fluids


NEVER:
Recap needles
Handle contaminated sharp with out gloves
Overload or over fill sharps disposal
Discard sharps in unmarked or undesignated container- ever if it seems safe

This article is provided as a source of information, in case of any such incidence that may cause concern or if you have any other health concerns , whatsoever , please consult your doctor.


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