What to do if you sustain a needlestick injury: Steps to follow
- Encourage bleeding
- Wash area thoroughly with warm water, but without scrubbing
- Cover area with plaster
- 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 recently replaced by the HIV Post-Exposure Prophylaxis Guidance
from the UK Chief Medical Officers' Expert Advisory Group on AIDS 3
(February 2004) (http://www.advisorybodies.doh.gov.uk/eaga/prophylaxisguidancefeb04.pdf).
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 Awareness' 4 (http://www.show.scot.nhs.uk/sehd/publications/nisa/nisa.pdf)
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).
Study Aims
- To describe the epidemiology of occupational needlestick injuries
reported to OH via the health and safety management system within
NHSScotland.
- 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 Questionnaire 
The reporting systems for needlstick 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
- Anon. (1984), Needlestick Transmission of HTLV-III from a patient infected
in Africa, Lancet, ii:1376-7
- Department of Health and Scottish Office (1997), Guidelines on Post
Exposure Prophylaxis (PEP) for Health Care workers Occupationally Exposed
to HIV, London, UK
- Department of Health (2004), HIV
Post-Exposure Prophylaxis Guidance from the UK Chief Medical Officers'
Expert Advisory Group on AIDS, London, UK
- 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
Professor Jeremy Bagg
Head of Dental School, Glasgow University Dental Hospital and School
Beth Cullen
Project Researcher, Health Protection Scotland
Fiona Genasi
Nurse Epidemiologist, Health Protection Scotland
Professor David Goldberg
Consultant Epidemiologist, Health Protection Scotland
Professor Mary Henry
Consultant Nurse Epidemiologist, Health Protection Scotland &
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
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