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 ~  Results
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Year : 2002  |  Volume : 20  |  Issue : 4  |  Page : 206-207
 

Risk of needle stick injuries in health care workers - A report


Department of Microbiology, LTM Medical College and General Hospital, Sion, Mumbai - 400 022, India

Correspondence Address:
Department of Microbiology, LTM Medical College and General Hospital, Sion, Mumbai - 400 022, India

 ~ Abstract 

Health care workers (HCW) are at a risk of occupational acquisition of Human Immunodeficiency Virus (HIV) infection, primarily due to accidental exposure to infected blood and body fluids. In our general public hospital, over a period of one year (June 2000 - 2001) a total number of 38 self reported incidences of needlestick injuries and other exposures to patient's blood and body fluids were reported by HCWs. A greater incidence of occupational exposure was seen in surgery residents as compared to medicine residents. Till date, i.e. in one and a half-year follow up period, no seroconversion was seen in any of the reported accidental injury cases. This data emphasizes, that needle stick injuries present the single greatest risk to medical personnel and the importance of increased awareness and training in universal safety precautions (USP), for prevention of nosocomial infection.

How to cite this article:
Rele M, Mathur M, Turbadkar D. Risk of needle stick injuries in health care workers - A report. Indian J Med Microbiol 2002;20:206-7


How to cite this URL:
Rele M, Mathur M, Turbadkar D. Risk of needle stick injuries in health care workers - A report. Indian J Med Microbiol [serial online] 2002 [cited 2019 Nov 18];20:206-7. Available from: http://www.ijmm.org/text.asp?2002/20/4/206/6957


The first HIV seroconversion in HCW was reported in 1984.[1] A low estimated risk of seroconversion of 0.42% after a single percutaneous exposure has been reported by Centres for Disease Control (Atlanta, GA). The HCWs have become increasingly concerned with the risk of transmission of HIV, hepatitis B and C and other blood borne infections by exposure to infected blood and body fluids. Needle stick injuries present the single greatest risk to medical personnel.[2] In healthcare centres having HIV positive patients, risk of occupational HIV exposure is of special concern. HCWs i.e. residents, interns, nurses, technicians and other staff at these general hospitals are at increased risk of exposure to HIV through accidental needle stick injuries during the course of training.[3],[4]
The purpose of our study was to analyze the self reported cases of needle stick injuries and other exposures to patient's blood or body fluids in HCWs. We explored the nature and circumstances under which these needle stick injuries occurred.

 ~ Materials and Methods Top

In our hospital extensive training programs are conducted on universal safety precautions (USP) for prevention of nosocomial infections. This training program, includes various components of USP namely hand washing, use of protective barriers (gloves, gowns, mask etc.), proper disinfection and sterilization, proper disposal of sharps and other infectious materials and post exposure prophylaxis. This training is given to various categories of HCWs. However, in spite of the intensive training programs a number of needle stick injuries are reported every year.
Over a period of one year, June 2000 - 2001, a total number of 38 cases of accidental exposures were self reported. For these 38 reported cases, pretest and posttest counselling was done and relevant proforma was filled up, including: personal details of HCW, place of work, time, date and type of injury, time of reporting of injury, immediate precautions taken (allowed to bleed, wash with soap and water, application of antiseptic), post exposure prophylaxis (PEP) if started, and prophylactic hepatitis B vaccine, if taken.
For all HCWs, who had reported with needle stick injuries, a baseline status for HIV was done using ELISA and rapid tests as per NACO guidelines. Baseline status for Hepatitis B antigen was done using Hepanostika ELISA kits for detection of HBsAg, as per the manual provided by the Hepanostika ELISA kits. HIV and HBsAg status of source was also done. Therefore, the HCW was instructed to continue follow up for HIV testing after 3 months and if seronegative, after 6 months.

 ~ Results Top

Out of the 38 self reported accidental injuries by HCWs; the breakup of categories was as follows, residents-29, interns-2, nurses-4, technician-1 and house keeping staff-2. Of the 29 residents, 22 were from surgical specialties and 7 were from medical specialties [Table].
Of the 38 reported cases; 34 were needle stick injuries, two were scalpel cuts, and one was exposure to body fluids (vitreous humor) by splashing and one was a human bite, from a schizophrenic patient admitted in psychiatric ward. Majority of the 34 needle stick injuries were by hollow bore needles. Of these, 20 were during blood collection procedure by hollow bore needle, five during angioplasty procedure, four during central venous puncture line cut down procedures, two during suturing of contused lacerated wound and three while recapping the needle. The 38 source cases were also tested for HIV 1 and 2 antibodies and HBsAg. Ten were HIV seropositive and 28 were HIV seronegative and four were HBsAg positive and 34 were HBsAg seronegative. However, all the HCWs were HIV and HBsAg seronegative till date after one and half years and had received recombinant Hepatitis B vaccine prophylactically.

 ~ Discussion Top

With the HIV epidemic, occupational exposures to HIV infection is a cause of concern to all HCWs, especially those, in hospitals. Among the HCWs, resident doctors have the highest incidence of occupational exposure as compared to nurses, interns, technicians and house keeping staff. Among the residents, surgery residents have a six-fold higher incidence of occupational exposure as compared to medicine residents. In surgery residents, the type of exposure is mainly due to needle stick injuries and cuts, during operative procedures. Medicine residents have higher rate of hollow-bore needle puncture incidents.[1]
In our study, it was observed that the incidence of occupational exposure due to infected blood and body fluids were highest among residents 76%, followed by nurses 11%, interns and house keeping staff 5% each and technicians 3%. Our study found that the accidental injuries among surgery residents (58%) was three times as compared to medicine residents (18%). The risk of HIV infection after single percutaneous exposure, has been quoted to be 0.42% by CDC study and 0.3% by Ippolito et al study.[5]
Conjunctiva contamination by infected blood carries a slightly higher risk whereas contamination of mucous membrane and intact skin carries an even lower risk. Worldwide, 296 cases have been reported of HCWs who had HIV seroconversion after occupational exposure, of which 56 cases are documented HIV transmission and 138 cases are possible occupationally acquired AIDS / HIV infection reported in United States.[6]
Among the accidental needle stick injuries reported in our study, three were due to recapping of needles. Hence to avoid needle stick injuries, newer devices should be designed so that the HCWs hand remains behind the needle during the procedure and the needle remains covered before disassembly of the device and remains covered after disposal.[7] Present study emphasises that in HCWs needle stick injuries are the most common source of occupational exposure to infected blood and body fluids. 

 ~ References Top

1.O'Neill TM, Allan V, Radeeski A. Risk of needle sticks and occupational exposures among residents and medical students. Arch Intern Med 1992;152:1451-1456.  Back to cited text no. 1    
2.Kelen GD, Fritz SF, Qaqish B, et al. Unrecognized HIV infection in emergency Department patients. N Engl J Med 1998;38:1645-1650.  Back to cited text no. 2    
3.MMWR. Update AIDS - United States, 1989. 1990;39:81-86.  Back to cited text no. 3    
4.Henderson DK, Fahley BJ, Willy M. Risk for occupational transmission of HIV type 1 (HIV - 1) associated with clinical exposures. Am Intern Med 1990;113:740-746.  Back to cited text no. 4    
5.Philippa E, Guiseppe I. Prophylaxis after occupational exposure to HIV. BMJ 1997;315(9):557-558.  Back to cited text no. 5    
6.CDC, Survey Report. June 2000, Vol. 12(1).  Back to cited text no. 6    
7.Jagger J, Hunt EH, Brend - Elnagger J, Pearson RD. Rates of needle stick injury caused by various devices in a university hospital. N Engl J Med 1988;319:284-288.  Back to cited text no. 7    
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