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Occupational Exposure

What to do if you sustain a needlestick injury: Steps to follow

  1. Encourage bleeding
  2. Wash area thoroughly with warm water, but without scrubbing
  3. Cover area with plaster
  4. Report injury IMMEDIATELY to your manager AND to you local Occupational Health Department

Occurrence and prevention of reported occupational needlestick injuries within NHSScotland, with particular reference to the role of safety devices

Background

In 1984, following the publication of the first documented case of HIV transmission from patient to health care worker (HCW)1, a passive surveillance system was set up in Scotland to monitor the occupational exposure of HCWs to HIV and other blood borne viruses. A more active system replaced this in July 1997 on the release of the Department of Health and Scottish Office guidelines for the use of post exposure prophylaxis (PEP) in HCWs occupationally exposed to HIV 2. This active system enabled 'high-risk' exposures and the use of PEP to be monitored. The guidance was replaced by the HIV Post-Exposure Prophylaxis Guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS 3 (Sept 2008)

A Short Life Working Group was convened in March 2000 to investigate the prevalence, cause and prevention of occupational needlestick injuries within NHSScotland. However, the Group's ability to make informed recommendations concerning needlestick injury prevention was hampered by the absence of national surveillance data. Subsequently, the Group's report Needlestick Injuries: Sharpen your Awareness4 highlighted the need for both rigorous epidemiological data (e.g. incidence, type of injuries, circumstances surrounding injuries) and for information relating to safety device use, education and training of staff, and staff adherence to guidelines.

To address these issues, a Chief Scientist Office (Scottish Executive) funded study was undertaken by Health Protection Scotland (HPS) and Occupational Health (OH) departments throughout Scotland (reference CZH/4/26).

Map of Scotland

Study AimsDefinitions

  1. To describe the epidemiology of occupational needlestick injuries reported to OH via the health and safety management system within NHSScotland.
  2. To estimate the proportion of incidents preventable through a) safety device use, b) policy adherence, c) policy revision.

 

Methods

Study Design

This six-month prospective survey, undertaken during June to December 2002, employed several methodologies, including administration of a questionnaire to all consenting HCWs reporting an injury to their OH department, a follow-up telephone interview with a sample of eligible HCWs, and an expert panel assessment to determine the proportion of preventable incidents.

Study Algorithm

Study Questionnaire Questionnaires

The reporting systems for needlestick injuries vary significantly throughout Divisions/Trusts in Scotland, making comparison of data difficult. Consequently, a 'study report form' was designed for use during the study period to collect details of the HCWs' occupational group, circumstances surrounding the incident, device involved, contributory factors, training history, clinical management, etc.

Telephone Interview

To supplement the questionnaire data, short, semi structured telephone interviews were conducted, allowing information on reporting history, infection control practices, perceived risk of transmission and training history to be gathered.

Expert Panel Assessment

Following data collection, each incident reported was considered by members of an expert panel to assess whether safety device use or policy adherence/revision could have prevented the injury. The panel consisted of thirty infection control nurses and advisors and was randomly divided to form six subgroups so that five experts would review each incident independently.

Safety Device Review

A review was carried out in tandem with the study to identify devices currently available on the UK market and to collate the results of safety device trials to date, in an attempt to overcome current duplication of efforts.

Sample

Of 1497 exposures reported to OH departments during the six months, 1091 questionnaires (73%) were forwarded to HPS.

Individual telephone interviews were conducted with a sub-sample of the 1091 HCWs. Only individuals reporting injuries during months 1-4 were eligible for inclusion (n=503). A total of 348 interviews were completed, achieving a response rate to interview of just under 70%.

Analysis

Analyses were performed using Microsoft® Access, Excel and SPSS®. Demographic characteristics of injured HCWs (i.e. age, gender and post) and their injuries (i.e. procedure undertaken, stage of procedure when incident occurred) were described. The experts' assessment of the preventability of reported injuries was examined. Each injury was allocated to one of the 5 levels of preventability (definitely not preventable, probably not preventable, unsure, probably preventable, definitely preventable) based on the median value of experts' scores for each of the three interventions (i.e. safety device use, policy adherence, policy revision). Multi-factorial analyses were conducted to ascertain the determinants of those reported injuries considered probably/definitely preventable through the use of safety devices and adherence to guidelines.

Results

At this time, work is continuing on papers to be submitted for peer-review publication and, as a consequence, dissemination of the study results has had to be restricted for the moment to those individuals/departments who contributed to the study. It is hoped that the final report will appear on these web pages in the near future when this process has been completed.

Confidentiality/Data Protection

Data gathered via questionnaire were anonymised prior to forwarding to HPS for analysis. Furthermore, contact details of those who participated in follow-up telephone interviews were treated as highly confidential and stored securely. These were then destroyed on completion of the interviews. In line with data protection policy, all electronic information has been stored securely under password protection.

References

  1. Anon. (1984), Needlestick Transmission of HTLV-III from a patient infected in Africa, Lancet, ii:1376-7
  2. Department of Health and Scottish Office (1997), Guidelines on Post Exposure Prophylaxis (PEP) for Health Care workers Occupationally Exposed to HIV, London, UK
  3. Department of Health (2008), HIV Post-Exposure Prophylaxis Guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS, London, UK
  4. Scottish Executive Health Department (2001), Needlestick Injuries: Sharpen your Awareness, Report of the Short Life Working Group in the NHSScotland, St. Andrew's House, Edinburgh, UK.

Acknowledgements

We would like to extend thanks to all OH staff throughout NHSScotland who were involved in the collection of data for the study. We are most grateful for their help and support without which the study would not have been possible. We would also like to thank the members of the Expert Panel for their willingness to be involved.

Contact details

If you would like further information regarding the study, please contact Beth Cullen, Project Researcher, at HPS on 0141 300 1404 or by email at beth.cullen@nhs.net

Steering Group Members

Professor Jeremy Bagg

Head of Dental School, Glasgow University Dental Hospital and School

Beth Cullen

Project Researcher, HPS

Fiona Genasi

Nurse Epidemiologist, HPS

Professor David Goldberg

Consultant Epidemiologist, HPS

Professor Mary Henry

Consultant Nurse Epidemiologist, HPS & Director of Nursing, National Services Scotland

May McCreaddie

Senior Lecturer (Research), School of Health, Nursing & Midwifery, University of Paisley

Thelma McGuire

Director, Lothian NHS Occupational Health Service

Dr Ian Symington

Director, North Glasgow NHS Occupational Health Service

Professor Avril Taylor

Associate Dean (Research & Commercialisation), School of Social Sciences, University of Paisley