EXECUTIVE SUMMARY

Needlestick injuries are increasing. Healthcare workers and safety leaders have become complacent about needlestick injuries and the potential for infection.

  • Needlestick injury episodes declined for several years but are now rising.
  • Many needlesticks occur in the operating room.
  • Flu vaccines — and a potential COVID-19 vaccine — will increase the risk.

Needlestick injuries are on the rise after a long period of decline. Healthcare organizations may not be taking the risk of infection as seriously as they once did. A national expert on needlestick injuries is urging risk managers to reassess prevention programs and respond more aggressively when staff and physicians are injured.

The incidence of needlestick injuries fell sharply after national legislation passed in 2000 mandated risk reduction and response programs, says Karen Daley, PhD, RN, FAAN, former president of the American Nurses Association, who was herself a victim of an accidental needlestick that infected her with HIV. She is now a consultant in Cotuit, MA, serving on the board of several safety organizations and a company that has developed syringe technology addressing needlesticks.

Daley was one of the architects of the 2000 Needlestick Safety and Prevention Act (NSPA), the Occupational Health and Safety Administration bloodborne pathogens standard that requires the institution of safety measures in workplaces where there is occupational exposure to blood or other potentially infectious materials.

Data from the Exposure Prevention Information Network surveillance system (EPINet) shows that after a sharp drop in accidental needlesticks after NSPA was enacted, needlesticks are on the rise again, almost at pre-2000 levels. From 1997 to 2000, the rate of needlestick injuries per 100 hospital beds per day, on average, was 34.825. That figured dropped to as low as 21.860 for 2010-2014, but it rose sharply in 2015-2019 to 31.040.

“We saw a couple of years where the immediate impact was significant, with about a 32% reduction in injuries, largely because the requirement to use safety devices was implicit within the law,” Daley says. “Hospitals started adopting safer devices and making them accessible to the workers. Then, we saw a steady decline in injuries from year to year, until about 2010.”

Injuries Taken Less Seriously

The rate of injuries plateaued for several years, then began rising in 2015. Daley says the increase is worrisome, and it is compounded by healthcare safety leaders taking the effects of needlesticks less seriously than in the past.

When the risk of needlesticks became a prominent issue in the healthcare community in the 1980s, the primary concern was the transmission of HIV. Now, the major concern after a needlestick injury is hepatitis B or hepatitis C. Healthcare organizations can follow guidelines from the Centers for Disease Control and Prevention to manage needlestick injuries, which may include post-exposure HIV prophylaxis.

Rates of seroconversion after a needlestick are low. But Daley says the potential effect of seroconversion can be quite high in terms of the personal costs to the worker and the costs to the employer.

Daley says that while it is good that there is less panic about the potential consequences of a needlestick than in years past, the normalization of needlesticks is leading to more injuries and less comprehensive treatment.

“There’s a bit of complacency around the injures,” she says. “We’ve had better drugs come out for things like HIV and hepatitis C, so workers are under the impression that it’s not happening as much and it’s not as serious when it does. I think hospital administrators are in the same space.”

The reality is these injuries are increasing, especially in the operating room (OR). Needlestick injuries occur more in the OR because surgery involves a lot of sharps, but there is not as much needlestick prevention technology, she says.

Vaccine Administration Increases Risk

Most needlesticks involve suture needles and injection devices such as hollow-bore needles, Daley says. More than half of needlesticks currently involve devices without needlestick prevention technology.

“That’s a significant concern, given how frequently injections are given in this country and how we are getting ready to administer a COVID-19 vaccine when that is available,” she notes. “Flu season also is coming, and we’re going to be challenged to provide more access points to get these vaccines. You need about 70% of the population to get the vaccine in order to have herd immunity, and that means about 230 million people in the United States.”

That surge in injections increases the likelihood of more needlestick injuries, Daley says.

The approach to needlestick prevention and treatment has changed dramatically in the past 20 years, at least among some healthcare leaders and safety professionals. It is not uncommon to hear administrators and managers downplay the potential risk of a needlestick with comments about the low likelihood of disease transmission and the ability to treat any infection that does occur, she says.

But Daley speaks from experience when she says the person suffering the needlestick takes it very seriously. Or they should, if their organization has not downplayed the risks.

“It’s a horrible experience because you’re waiting potentially hours or days for the blood work on the source patient to come back. You don’t know what you’ve been exposed to,” Daley laments. “For administrators and C-suite leadership, there are places that are very diligent about responding to needlesticks. But in too many others, the complacency comes from thinking it is not as a big a problem as it used to be and doesn’t need their attention and resources.”

Daley was an emergency room nurse when she suffered a needlestick injury on the job in 1998. She had drawn blood from a patient and was discarding the needle when she was stuck by a second needle that was wedged in the sharps disposal container. Daley tested positive for HIV and hepatitis C a few months later.

The emotional stress on the healthcare worker is worse if managers, administrators, and the organization downplay the incident, Daley says. They mean well by trying to reassure the worker the outcome is unlikely to be catastrophic, but that message should be balanced with an acknowledgment of how worrisome the incident is for the worker.

Some employers reassure the worker that drugs are available after exposure to pathogens, but Daley cautions this can turn into an insensitive dismissal of the worker’s legitimate fears. Some post-exposure drugs are difficult to take, she says, and exposed workers will need support and follow-up by occupational health staff to help them cope with potential side effects.

Review Data, Seek Improvements

Risk managers also should engage workers after needlesticks to learn more about the incident and the aftermath. Seek insight about how the needlestick might have been prevented, but also how the hospital’s response and follow-up care could improve, Daley suggests.

Hospitals and health systems should regularly review needlestick injuries, at least on an annual basis, to determine how, when, and where they are occurring. That review should be used to identify improved processes and devices that might reduce the incidence of needlesticks.

Daley says the attitude of immediate supervisors and the organization’s overall culture can influence needlestick reporting.

“It’s always a worry when a healthcare worker is giving an injection because we don’t test every patient to know what they have. When you’re stuck, your mind suddenly goes to wondering what is in that patient’s blood,” she explains. “Unfortunately, we know underreporting of needlesticks is still a big issue in healthcare, so all the complacency about how we have better drugs to treat HIV and these other diseases doesn’t mean much if people don’t report their injuries and get treatment.”

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