Needlestick Injuries: Incidence and Cost in the United States, United

Kingdom, Germany, France, Italy, and Spain

Mario Saia,
1

Friedrich Hofmann,
2
Joanna Sharman,
3
Dominique Abiteboul,
4
Magda Campins,
5
Joerg Burkowitz,
6
Yoonhee Choe,
7
Shane Kavanagh
8


1
Padua Local Health Unit, Italy
2
Bergische Universitt Wuppertal, Wuppertal, Germany
3
Birmingham New Hospitals Project, Birmingham, United Kingdom
4
GERES - Groupe Hospitalier Bichat, Paris, France
5
Hospital Universitario Vall dHebron, Barcelona, Spain
6
Alpha Care GmbH, Celle, Germany
7
Health Economics, Johnson & Johnson Pharmaceutical Services, L.L.C., Raritan, New Jersey, United States
8
Health Economics, Johnson & Johnson Pharmaceutical Services, Beerse, Belgium
ABSTRACT
The objective of this study is to evaluate the incidence and cost of needlestick injuries (NIs) in the United States, United Kingdom, Germany, France, Italy,
and Spain. Comprehensive search of peer-reviewed literature to gather information on the incidence and costs associated with NIs and a Web-based
search to identify pertinent gray literature, trade associa-tions, and key stakeholders for the prevention of NIs. The estimated annual incidence of NIs is
384,000 in the United States, 100,000 in the United Kingdom, 700,000 in Germany, 29,719 in France, 28,200 in Italy, and 21,815 in Spain. The economic
burden of NIs varies from country to country; for instance, annual costs are estimated at 7 million in Italy and $118 million to $591 million in the United
States. An accurate assessment of the incidence and economic burden of NIs is difficult to obtain because of widespread under-reporting. Furthermore,
the projected costs do not account for long-term treatment costs resulting from possible infection with a blood-borne pathogen, absenteeism, workers
compensation, or emotional repercussions. A significant proportion of NIs stem from injections and intravenous-related tasks, account-ing for roughly
one to two thirds of NIs in all countries examined. The US General Accounting Office estimates that 29% of NIs that occur in hospitals could be prevented
through the adoption of safety-engineered needles or needle-free de-vices. In conclusion, findings on the incidence and economic burden of NIs indicate
the need for safety-engineered nee-dles or needle-free technology, along with increased education regarding safer practices in the work environment.
Biomed. Int. 2010; 1: 41-49. 2010 Biomedicine International, Inc. Needlestick and sharps
injuries: practice update
NS643 Adams D (2012) Needlestick and sharps injuries: implications for practice.
Nursing Standard. 26, 37, 49-57. Date of acceptance: March 21 2012.
Abstract
Member states of the European Union have until May 11 2013 to
implement the Council Directive 2010/32/EU Implementing the
Framework Agreement on Prevention from Sharps Injuries in the Hospital
and Healthcare Sector. The aim of this legislation is to achieve a safe
working environment and prevent injuries to healthcare professionals
caused by all medical sharps, including needlesticks. This article examines
the issues surrounding needlestick and sharps injuries, including risk
assessment and prevention, information provision, raising awareness,
use of safety devices, training and reporting procedures.

Preventing Needlestick Injuries among
Healthcare Workers:
A WHOICN Collaboration
SUSAN Q. WILBURN, BSN, MPH, GERRY EIJKEMANS, MD
Effective measures to prevent infections from occupational
exposure of healthcare workers to blood include
immunization against HBV, eliminating unnecessary
injections, implementing Universal Precautions, eliminating
needle recapping and disposing of the sharp
into a sharps container immediately after use, use of
safer devices such as needles that sheath or retract after
use, provision and use of personal protective equipment,
and training workers in the risks and prevention
of transmission. Post-exposure prophylaxis with antiretroviral
medications can reduce the risk of HIV transmission
by 80%. In 2003, the World Health Organization
and the International Council of Nurses launched
a pilot project in three countries to protect healthcare
workers from needlestick injuries. The results of the
pilot will be disseminated worldwide, along with best
policies and practices for prevention. Key words: needlestick;
prevention.

Needlestick Injuries among Nurses
H Ebrahimi, A Khosravi

Abstract

Background: Needlestick injuries (NSIs) are among the most important occupational injuries for health care
workers (HCWs). In Iran, the problem of exposure to contaminated blood among nursing personnels has not well
documented. The aim of this study was to determine the incidence of needlestick injuries in population of nurses in
Shahroud Imam Hossein Hospital, northern Iran.
Methods: A self-administrated questionnaire was completed by 180 nurses in September and October 2005 for their
NSIs experience in the past year. In this study, needlestick injury was defined as percutaneous injury caused by
hollow-borne needles, suturing needles, scalpel blades and lancets.
Results: The case incidence of NSIs was 63.3% (114/180). The total number of episodes of NSIs among
respondents was 220 (range: 1-5 episodes) with incidence rate of episodes i.e. 1.2 per person/year. 12.8% of nurses
had not been vaccinated against hepatitis B virus (HBV). The causal devices in 105 cases (92.1%) were hollow-
borne needles and the main causes of percutaneous injuries with hollow-bore needles were recapping (32.4%) and
manipulating needles in patients (18.1%). The majority (51.8%) of injuries occurred after use and before disposal of
the objects.
Conclusion: Nurses working in Imam Hossein Hospital are frequently exposed to blood-borne infection. NSIs were
highly prevalent in these nurses therefore more intensive education programs should be directed at nurses to increase
their awareness of and compliance with universal precautions (UP). We recommend a surveillance system and a
center for managing injured persons.

Prevalence of Needle-stick and Sharps Injuries among Healthcare
Workers, Najran, Saudi Arabia
Abstract
Introduction: An investigation estimates that needle-stick and sharps injuries affect about 3.5 million individuals on
the global level. In healthcare workers nurses and physicians appear especially at risk.
Objectives: To examine the epidemiology of occupational sharps injuries in Health care workers.
Material and methods: It is retrospective cross-sectional study was carried out among the Health Care Workers of
Maternity and Childrens Hospital, KSA from 1st January to 30th June 2012 with participation of 750 HCWs by Convenient
sampling technique. Data entry and analysis was done on EPINetTM.
Results: A total of 32 cases of sharps injuries occurred during the six months period. Nurses accounted 46.9%,
constituting the largest group of the Health Care Workers. Most frequently site of occurrence was operating/recovery
room 34.4%. 64.5% of injuries occurred during use of device. In 90.6% of cases injuring item was contaminated.
59.4% injuries occurred while wearing single pair of gloves, only 21.9% with double pair of gloves. Most common site
of injury was the right hand.
Conclusion: There can be serious consequences of needle stick injuries in hospitals as large proportion of injuries
involves used needles and sharps if health care workers do not take appropriate measures of protection.

Interventions to reduce needle stick injuries at a tertiary care centre

A Mehta, C Rodrigues, T Singhal, N Lopes, N D'Souza, K Sathe, FD Dastur
Department of Microbiology, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim (West),
Mumbai - 400 016, India

Background: Occupational exposure to blood/body fluids is associated with risk of infection with blood borne pathogens like
human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Materials and Methods: We
carefully document needle stick injuries (NSI) and implement post-exposure prophylaxis (PEP). We report a four-year
continuing surveillance study where 342 healthcare workers (HCWs) sustained NSI. PEP was given to HCWs injured from
seropositive sources. If the source was HbsAg positive, HCWs were given a hepatitis B immunization booster. If the HCW was
antiHBs negative, both hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine were administered. For HCWs who
sustained injuries from HIV positive sources, antiretroviral therapy was started. Follow-up was done after three and six months
of exposure. Recent interventions by the infection control committee at our hospital reduced NSI considerably during
intravenous line administration and glucose monitoring. Results and Discussion: Of 342 injuries, 254 were from known
sources and 88 from unknown sources. From known sources, 37 were seropositive; 13 for HIV, 15 for HCV, nine for HBV. Sixty
six sharp injuries were sustained through garbage bags, 43 during IV line administration, 41 during injection administration, 35
during needle recapping, 32 during blood collection, 27 during blood glucose monitoring, 24 from OT instruments, 17 during
needle disposal, 16 while using surgical blade, 7 during suturing and 34 from miscellaneous sources. Conclusion: No case of
seroconversion has taken place, so far, as a result of needle stick injuries at our centre.

Needlestick and Sharps Injury Prevention Susan Q. Wilburn, MPH, RN
Abstract
Every day while caring for patients, nurses are at risk to exposure to bloodborne pathogens potentially resulting in infections such
as HIV or hepatitis B and C. These exposures, while preventable, are often accepted as being a part of the job. In the United
States, needlestick injuries have begun to decrease from an estimated one million exposures per year in 1996 to 385,000 per year
in 2000. This decline has resulted from the protections afforded by the Occupational Safety and Health Administrations (OSHA)
Bloodborne Pathogens Standard. Reasons for the success in decreasing needlestick and sharps injuries may be attributed to the
elimination of needle recapping and the use of safer needle devices, sharps collection boxes, gloves and personal protective gear,
and universal precautions.
The prevention of needlestick injuries has made slow progress over the past 20 years since the HIV epidemic drew attention to the
deadly nature of health care work and to protection of health care worker health and safety. In Africa, where the AIDS virus
originated and where the prevalence of the human immunodeficiency virus (HIV) among hospitalized patients is highest in the
world, attention has been directed only recently at protecting health care workers. Nurses, especially those infected from a
preventable exposure, have been at the forefront of advocacy for prevention.
This article includes a review about the hazard of exposure to bloodborne pathogens and epidemiology of occupational infection.
The author discusses how to apply standard methods of occupational health and industry hygiene using the hierarchy of controls
framework to prevent exposure to blood, and discusses evidence-based prevention and efficacy of particular control measures.
Legislative progress and implementation of enforceable policy to protect health care workers is outlined
Incidence Of Needle Stick Injury Among
Proficiency Certificate Level Nursing Students In
Kathmandu, Nepal
Binita Kumari Paudel, Kanchan Karki, Leena Dangol, Arjun Mani Guragain
Abstract: An academic institution based cross- sectional survey was done to identify the incidence density of needle stick
injury among PCL level
nursing students. Multi stage sampling method was used to select 407 samples from nursing students studying inside
Kathmandu valley. Self
administered questionnaire and review the records guideline were used as research tool. Incidence density was calculated by
using R software. Out of
total participated students, 46.9 % had have needle stick injuries in the past and 44.7% experienced it more than one time.
The overall incidence
density was found 5.82/person 1000 days exposure. The incidence density in night shift (6.86) and in second year practicum
period (6.91) was found
higher than day shift (5.41) and first year (4.21) respectively. Out of total 298 injuries, 67.8 % were happened during
medication, 41% while drawing
medicine, 20% while recapping the needle and 45.1 % at medical ward. Only 46.6% injuries were reported and prophylaxis
was used only in five
injuries. However, almost all the students (98.3%) stated that they follow universal precaution but only 28% practicing no-
recapping. Although the
curriculum focuses on no recapping, there is a common practice of reusing syringes for the same patient in Nepal. Therefore,
students must have to
recap the needle. So, it is recommended that content in the curriculum and universal precaution training should be revised in
the context of Nepal. Thirty
one percent students also stated that needle should recap properly by using one hand technique for the prevention

Occupational Health and Safety Issues Among Nurses in the Philippines
A. B. de Castro, PhD, MSN/MPH, RN, Suzanne L. Cabrera, MN, RN, Gilbert C. Gee, PhD, Kaori Fujishiro, PhD, andEularito A.
Tagalog, RN, COHN
Abstract
Nursing is a hazardous occupation in the United States, but little is known about workplace health and safety issues facing the
nursing work force in the Philippines. In this article, work-related problems among a sample of nurses in the Philippines are
described. Cross-sectional data were collected through a self-administered survey during the Philippine Nurses Association
2007 convention. Measures included four categories: work-related demographics, occupational injury/illness, reporting
behavior, and safety concerns. Approximately 40% of nurses had experienced at least one injury or illness in the past year,
and 80% had experienced back pain. Most who had an injury did not report it. The top ranking concerns were stress and
overwork. Filipino nurses encounter considerable health and safety concerns that are similar to those encountered by nurses
in other countries. Future research should examine the work organization factors that contribute to these concerns and
strengthen policies to promote health and safety.

Sharps Injuries among Nurses in a
Thai Regional Hospital: Prevalence
and Risk Factors
M Honda1, J Chompikul1, C Rattanapan1, G Wood2, S Klungboonkrong3
Abstract
Background: Sharps injuries (SIs) are one of the most serious occupational accidents among nurses due to the possible
severe consequences, such as the transmission of infectious diseases and inducing of mental impairment.
Objective: To discover the prevalence of SIs among nurses in a regional hospital in Thailand and to identify factors
associated with SIs.
Methods: A cross-sectional study was conducted in 2011. Stratified random sampling was used to select the respondents,
with wards as the strata and the number of nurses selected proportional to the size of the ward nurse population. 261 self-
administered questionnaires were distributed to nurses who used needles, syringes or other sharp medical equipment in
their work. Data were analyzed using chi-square tests, correlation analysis and multiple logistic regression analysis.
Results: The prevalence of SIs for the previous 12 months was 55.5% among the 250 nurses who returned a completed
questionnaire. Of these, 91.1% were with blood. Needles (52.8%) were the main cause of SIs. The reporting rate of SIs to
the hospital was 23.8%. SIs had a significant association with each of marital status, work duration, work department,
attitude regarding SI prevention, and preventive management. Using multiple logistic regression analysis, attitude was
found to be the strongest predictor of SIs when adjusted for other factors. Nurses who had negative attitudes towards
prevention of SIs were nearly two times more likely to have SIs than those with positive attitudes (adjusted odds
ratio=1.86; 95% CI: 1.033.38).
Conclusion: The study showed a high prevalence of SIs, but a low reporting rate. This suggests the reporting system
requires simplification and also should include a quick response management component. Promoting positive attitudes to SI
prevention, and improving the reporting system would reduce SIs.

Needlestick injuries among health care workers of
University of Alexandria hospitals
M.I. Hanafi,1
A.M. Mohamed,1
M.S. Kassem2
and M. Shawki1
ABSTRACT The aims of this cross-sectional study were to investigate the prevalence and circumstances of
needlestick injury (NSI) among heath care workers at University of Alexandria teaching hospitals and to assess
the effectiveness of the existing control measures and standard precautions. Data were obtained by anonymous,
self-reporting questionnaire from 645 nurses, physicians and ancillary staff in 2007. Around two-thirds of workers
(67.9%) had suffered at least 1 NSI in the last 12 months. High-risk patients (with history of HIV, hepatitis B virus or ,
hepatitis C virus infection or injecting drug use) were involved in 8.2% of injuries. On evaluating the effectiveness
of existing control measures, significant protective factors against NSI were: using devices with safety features
(OR 0.41), adherence to infection control guidelines (OR 0.42), training in injection safety (OR 0.14), comfortable
room temperature (OR 0.32) and availability of a written protocol for prompt reporting (OR 0.37).

Prevalence and Factors Associated with Needle Stick Injuries among Registered Nurses
in Public Sector Tertiary Care Hospitals of Pakistan
AUTHORBackground: Needle stick injuries remain the main cause of Hep B, Hep C and HIV which lead to mortality and morbidity in heal th
care providers especially in nurses all over the world. Although needle stick injuries have been well studied in developed countries, data from
developing countries is limited. Aim & Objectives: To estimate the prevalence of needle stick injuries among nurses and its associated factors
in public sector tertiary care hospitals of Pakistan. Methods: This cross sectional survey was conducted in 3 major tertiary care hospitals of
Rawalpindi, Pakistan. Study duration was from March 2010 to May 2010 (3 months). Two Hundred and Sixteen (216) nurses were selected by
simple random sampling with proportionate sampling. All those registered nurses who were working in allied hospitals of Rawalpindi and
involved in clinical work were included, while all those who were on administrative positions, students, retired or on maternity leave were
excluded from the study. Pre structured questionnaire was used and data was collected by questionnaire having optional choices and few
open ended questions. The questionnaire was piloted among thirty nurses in a tertiary care hospital and their comments were i ncorporated
accordingly to redesign the final questionnaire. The data was analysed using SPSS 16. Results: Sixty Seven (67%) of nurses got needle stick
injury during job. Almost all (99%) nurses said that they didnt report their injury because of no reporting system in their hospital (p value <
0.05). Injection and needles (72%) are the most injury causing instrument and needle stick injuries mostly occurred (81%) at bedside and ward
(p value < 0.05)). Sixty six percent (66%) of nurses said that they didnt attended any educational session, seminar or workshop related to
needle stick injuries during their job. Conclusion: The frequency of needle stick injuries among nurses is quite high in publ ic sector hospitals of
Rawalpindi Pakistan. Non-reporting and less health education are the main factors leading to needle stick injuries.
SafeHandS small grants project report
The Safe @ Work Program:
Safe Handling and Disposal of Needles and Sharps
Background
Davao Regional Hospital, Tagum
City, Philippines, formulated policies
on handling and safe disposal of
needles and sharps in 2003 which
were revised in 2008 to include the
reporting and treatment of
needlestick injuries. There were
identified violations to policies such
as not observing procedures in
proper handling of syringes and
needles when administering
parenteral injection and not reporting
such incidents for fear of sanctions.
In 2009, only three cases of
needlestick injuries were reported.
Since 2003, there have been two
cases of Hepatitis B infection of
healthcare staff probably due to
needlesticks involving Hepatitis B
infected patients, suggesting the
serious nature of underreporting and
the need for improved safe handling
of syringes and needles.