Human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) are blood-borne pathogens that pose occupational hazards to healthcare workers (HCWs) exposed to the blood or body fluids of infected patients.(1)
Each year, around 66,000 HBV, 16,000 HCV and 1000 HIV infections were estimated to occur worldwide among HCWs – mostly in developing countries – due to their occupational exposure to percutaneous injuries. Work-related infections are responsible for approximately 37% of the HBV infections of HCWs, 39% of the HCV infections and 4.4% of the HIV infections of HCWs worldwide.(2)
Although the risks of needlestick injuries (NSI) have been well recognised for many years, significant numbers of exposure continue to occur.(3–5)
Change is afoot: European Directive6 has to be implemented by 11th May 2013. Appropriate strategies reduce the probability of transmitting blood-borne pathogens. For this reason, the purpose of the Council Directive 2010/32/EU is to achieve “the safest possible working environment” in healthcare by preventing HCWs’ injuries caused by all medical sharps.
In achieving the safest possible workplace, a combination of planning, awareness-raising, information, training, prevention and monitoring is essential. Continuous reporting mechanisms are required, which should include local, national and Europe-wide systems.(6)
The measures specified in the Directive (training, safer working procedures and the use of safety engineered devices) might prevent the majority of injuries, if implemented together and implemented effectively. However, if one element is missed, the impact will be disappointing and the HCWs will not be well protected against occupational-acquired infections.
The issue of needlestick injuries
The majority of NSI occur when HCWs dispose of needles, administer injections, draw blood, recap needles or handle trash or dirty laundry. Before the introduction of safety devices, the Frankfurt Needlestick Study was conducted to describe the epidemiology of NSI at our hospital. Data were obtained between April and June 2006 (anaesthesia, dermatology, gynaecology, paediatrics, surgery) and between February and April 2007 (ear, nose and throat medicine, internal medicine, neurology/psychiatry, ophthalmology, pathology/forensic medicine, radiology) by an anonymous survey administered to 2085 HCWs. The data of our study clearly point out that there is a high rate of NSI in the daily life of a hospital. The rate of such injuries depends on the medical discipline and the occupational group. In our study, 31.4% of the HCWs had sustained at least one NSI within one year (Fig. 1). The number of NSI per person and year varied significantly from 1 to 55. The highest numbers were reported by surgeons.(7)
Current economic constraints in the healthcare system mean that HCWs are becoming more and more under stress with increasingly heavy workloads. Lapses in concentration and fatigue are nowadays the most common reasons for NSI.(7)
The emotional impact of a NSI should not be underestimated.(8,9) Several cases of post-traumatic stress disorder had been described after NSI involving high-risk patients.(10,11)
HCWs are concerned when they suffer a NSI. They want to take action, and the employers need to make sure that all HCWs know what to do when a NSI happens. Regular training and information are the crucial points in creating a safe working environment.
The rate of NSI is often widely underestimated, as most HCWs do not report the incidents. In our studies among HCWs and medical students, fewer than 30% of injured persons reported all of their NSI and had seen a physician after the incident.(7,12) Consistent reporting of NSI is, however, an essential prerequisite for providing appropriate treatment and taking post-exposure prophylactic measures in a timely fashion.
Council Directive 2010/32/EU makes demands on local, national and European-wide systems and assumes that a complete recording of all NSI is crucial to minimise the occupational hazards. The management of NSI ought to be given high priority and all healthcare institutions should have processes for reporting and managing NSI 24 hours a day and 365 days a year.(8)
Why is the Directive important?
Due to the severe occupational hazards of NSI, preventing NSI should be in everybody’s interest. Despite the wide introduction of safety devices at the University Hospital Frankfurt, Germany almost every day at least one NSI is reported by our HCWs (for example 519 needlestick injuries occurred between October 2010 and April 2012).
During the study period, testing for blood-borne pathogens among the index patients of the University Hospital Frankfurt was performed in 86.5% (449/519) of patients; overall, 20.5% of the index patients were infected with a blood-borne pathogen (Fig. 2). One case of HCV transmission occurred in a physician,(13) two initial diagnoses (active hepatitis B and hepatitis C infection) among index patients were made during the observation period.(14) These results clearly point out a serious risk for occupational infections.
It is our hope that the new EU Directive will minimise the severe health risks caused by NSI. The legislator, the employers and the occupational health physicians should make every effort to implement and support the new legislation.