Aids Guide-NIOSH releases guidelines on preventing needlesticks

HIV transmission rate via needlestick injuries is 0.3%, so risk to health care workers is low

More than 8 million health care workers in the United States run the risk of being infected with HIV or hepatitis through needlestick injuries. Each year, an estimated 600,000 to 800,000 such injuries occur annually. Federal statistics estimate that workers experience needlestick injuries at the rate of about 30 per 100 hospital beds per year.

However, the risk of actually becoming infected with HIV is low. Health care workers who are exposed to HIV-infected blood through a needlestick injury rarely become infected with the virus, according to studies and government statistics.

A recent analysis of 20 studies, involving 6,498 exposures to HIV-infected blood, showed that a total of 21 infections occurred, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. This made an average transmission rate of 0.3% per injury.

Other research has shown that health care workers increase their risk of contracting HIV when they're exposed to a larger quantity of blood from the patient, caused by a bloody device, a procedure of placing a needle in a patient's vein or artery, or a deep injury.

The CDC reports that between 1985 and June 1999, there were a total of 55 documented cases and 136 possible cases of occupational HIV transmission to U.S. health care workers. The documented cases were of health care workers who had documented HIV after occupational exposure. The possible cases were of health care workers who had no identifiable behavioral or transfusion risks, who reported having percutaneous or mucocutaneous occupational exposures to blood or body fluids or laboratory solutions, and who had no documented HIV seroconversion resulting from a specific occupational exposure.

Most of the workers involved in the documented cases were nurses or laboratory technicians, and 89% of the transmissions were caused by percutaneous injuries. Further more, of the 49 needlestick injuries, 44 involved hollow-bore needles used to collect blood or insert an IV catheter.

The CDC statistics also show that about 38% of percutaneous injuries occur during the use of a needle, and 42% occur after use and before disposal. Other risk factors are caused by certain work practices, such as recapping, transferring body fluid between containers, and failing to dispose properly of used needles in puncture-resistant sharps containers.

The National Institute for Occupational Safety and Health (NIOSH) recently released needlestick prevention guidelines for health care workers. According to NIOSH, needlestick injuries, including injuries caused by hypodermic needles, blood collection needles, intravenous stylets, and needles used as part of IV delivery systems can cause a number of serious and potentially fatal infections with HIV, hepatitis B, and hepatitis C.

Here are some of the new NIOSH prevention guidelines:

• Use safer devices. Health care employers should eliminate the use of needles when it's possible to use safe and effective alternatives. Also, they should implement the use of devices with safety features.

• Establish needlestick program. Employers also should implement a needlestick safety program that incorporates these features:

— Analyzes needlestick and other sharps-related injuries within the workplace to identify hazards and injury trends.

— Sets strategies for prevention by examining local and national information about risk factors for needlestick injuries.

— Ensures that health care workers are properly trained in the safe use and disposal of needles.

— Modifies work practices that pose a needlestick injury hazard to make them safer.

— Promotes safety awareness among workers.

— Establishes procedures that encourage the reporting and timely follow-up of all needlestick and sharps-related injuries.

— Evaluates the effectiveness of prevention efforts and provides feedback on performance.

• Promote safety among workers. Health care workers also should take certain steps to protect themselves and their coworkers from injury. These include:

— Avoid the use of needles where safe alternatives are available.

— Help employers select devices with safety features.

— Use devices with safety features.

— Avoid recapping needles.

— Plan for safe handling and disposal before beginning a procedure involving needles.

— Dispose of used needles promptly in appropriate sharps disposal containers.

— Report all needlestick and other sharps-related injuries promptly to ensure they will receive follow-up care.

— Tell their employers about any hazards from needles in the workplace.

— Participate in bloodborne pathogen training and follow recommended infection prevention practices, including hepatitis B vaccination.

• Distribute the NIOSH Alert. NIOSH's new guidelines, called "Preventing Needlestick Injuries in Health Care Settings," provides detailed information about prevention techniques and statistics regarding health care worker needlestick injuries.

The document is available from: NIOSH — Publications Dissemination, 4676 Columbia Parkway, Cincinnati, OH 45226-1998. Telephone: (800) 35-NIOSH. Fax: (513) 533-8573. E-mail: pubstaft@cdc. gov. Web site: www.cdc.gov/ niosh. Request document: DHHS (NIOSH) Publication 2000-108.

• Follow OSHA standards. The U.S. Occupational Safety and Health Administration (OSHA) has standards regarding bloodborne pathogens that require the following:

— A written exposure control plan designed to eliminate or minimize worker exposure to bloodborne pathogens.

— Compliance with universal precautions (an infection control principle that treats all human blood and other potentially infectious materials as infectious).

— Engineering controls and work practices to eliminate or minimize worker exposure.

— Personal protective equipment (if engineering controls and work practices do not eliminate occupational exposures).

— Prohibition of bending, recapping, or removing contaminated needles and other sharps unless such an act is required by a specific procedure or has no feasible alternative.

— Prohibition of shearing or breaking contaminated needles (OSHA defines contaminated as the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface).

— Free hepatitis B vaccinations offered to workers with occupational exposure to bloodborne pathogens.

— Worker training in appropriate engineering controls and work practices.

— Postexposure evaluation and follow-up, including postexposure prophylaxis when appropriate.