Needlesticks: Causes and Consequences

Why needlesticks and other sharps injuries occur

Needlesticks occur because dangerous equipment is used in fast-paced, stressful and often understaffed facilities. The focus of the work has always been on the safety and well being of patients. Too little attention has been given to preventing the injuries and illnesses that health care workers develop as a result of taking care of patients.

Hollow-bore needles accounted for 62 percent of the injuries between June 1995 and July 1999.

* Centers for Disease Control National Surveillance System for Hospital Health Care (International Health Care Worker Safety Center, 1997; EPINet, 1999; CDC unpublished data, 1999)

Equipment design

A closer look at equipment design explains why particular devices are more likely to cause injuries. There are certain features that make some devices more dangerous, such as:

• Syringes that have an exposed needle after they are used. 
  
  
• Needle devices that must be taken apart or manipulated (e.g., blood drawing devices with needles that must be detached after use). 
  
  
• Needles attached to a length of flexible tubing (e.g., butterflies) that are difficult to place in sharps containers. 
  
  

Equipment use

In addition to identifying unsafe equipment, it is also important to determine the tasks that health care workers are performing when injuries occur. According to the Centers for Disease Control and Prevention (CDC), almost all injuries resulted during the activities listed in Figure 2.

Recapping needles

The OSHA Bloodborne Pathogens Standard prohibits recapping needles unless the employer can demonstrate that no alternative is feasible, or that such action is required by a specific medical or dental procedure. The percentage of needlesticks due to recapping has dropped from 10-25 percent to 5 percent according to the National Institute for Occupational Safety and Health (NIOSH).

The risks from needlesticks and other sharps injuries

A needlestick or other injury that punctures, cuts or penetrates the skin (percutaneous) with a non-sterile sharp carries the risk of infection from diseases that are passed through contact with blood. The most serious diseases that are transmitted by needlesticks include HIV/AIDS, hepatitis B and hepatitis C.

HIV/AIDS

The Human Immune-deficiency Virus (HIV) attacks the immune system, which is the body’s natural defense against infections. HIV causes Acquired Immune Deficiency Syndrome, or AIDS. People with AIDS become ill when their immune system is too weak (immunocompromised) to fight off other infections. The estimated number of people infected with HIV in the United States is between 750,000 and 1 million.

There are generally no symptoms of HIV infection. Once the immune system becomes damaged, the individual is likely to experience weight loss, persistent low-grade fever, night sweats and flu-like symptoms. As the individual’s immune/defense system becomes less able to ward off diseases, the infected person is more vulnerable to pneumonias, intestinal disorders and fungal infections. An HIV-positive person is given a diagnosis of "AIDS" after developing one of these "opportunistic infections." There is no vaccine to prevent HIV infections. There is medication to slow the progress of damage to the immune system and to treat the opportunistic diseases, but there is still no cure.

The estimated risk of HIV infection from a needlestick is about 3 percent. The CDC has reported 55 documented cases and 136 possible cases of HIV transmission to U.S. health care workers between 1985 and June 1999. Most of these cases involved nurses and lab technicians. Other researchers estimate that the number of cases of occupationally acquired infections is much higher.

Hepatitis C

Hepatitis C is a virus that causes serious damage to the liver, and can be fatal. Infection can occur without symptoms or only mild ones. Chronic hepatitis develops in 75-80 percent of infected patients, and 70 percent of these individuals get active liver disease. Of those with active liver disease, 10-20 percent develop cirrhosis and 1-5 percent develop liver cancer.

The risk of acquiring hepatitis C infection from a needlestick is about 4 percent. There is no vaccine to prevent hepatitis C infection and there is no cure. The estimated number of people infected with hepatitis C in the United States is 4 million.

Hepatitis B

Hepatitis B is another virus that can cause serious liver damage and death. Symptoms include jaundice, fever, nausea and abdominal pain. Approximately 5 to 10 percent of patients develop chronic infection with hepatitis B, which carries an estimated 20 percent lifetime risk of dying from cirrhosis and 6 percent risk of dying from liver cancer. The chance of becoming infected with hepatitis B from a needlestick is estimated to be between 6 and 30 percent.

Fortunately, there is an effective vaccine to prevent infection with hepatitis B. Since the vaccine became widely available in the 1980s, the rate of infection among health care workers has decreased by 95 percent. It has been estimated that the vaccine has prevented as many as 300 deaths among health care workers each year.