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What is a needle stick injury?
Needle stick injury is not just the pricking pain or the wound caused by a needle. There’s more to it than that.
By definition, needle stick injuries are wounds caused by hypodermic needles or sharp medical devices accidentally puncturing the skin. Passage of infectious fluids are the biggest concern in a needle stick injury, though there is potential for passage of hazardous drugs also.
After the discovery of HIV in the early 1980s, needle stick injuries became a contentious issue in medicine. The CDC says, approximately 385,000 needle sticks and other sharps-related injuries are reported in hospital-based healthcare workers every year. When it comes to workers outside healthcare, it is 1 in 10,000 workers who are likely to get needle stick injuries in a year.
The risk of transmission to a healthcare worker following a needle stick or sharps injury is
- Hepatitis B Virus- 6% – 30% (in unvaccinated workers)
- Hepatitis C Virus – 2% to 4%
- HIV – 0.3%
Procedures such as surgery, blood sampling, dialysis, and blood transfusion are some of the high- risk medical procedures involving a chance of needle stick injuries.
Let me now take you through the statistical data of International Safety Center Exposure Prevention Information Network (EPINet). This is in connection with the common devices that caused needle stick injuries in 2019.
Disposable syringes – 19.5%
Suture needles – 23.5%
Disposable scalpel blades – 3.3%
Intravenous catheter stylets – 3.3%
Winged steel needles – 2.8%
Needle stick injuries can occur during use, after use- before disposal and during or after disposal. However, with advances in safer technology, injuries from disposable syringes and winged steel needles have been ordered.
The risk of needle stick injuries remains a concern for health care workers who use needles in their day-to-day work. The health professionals most at risk for needle stick injuries include surgeons, nurses, emergency room workers, veterinarian staff and laboratory room professionals. Nonhealth care sectors at risk include waste management, hospitality etc.
Needle stick injuries were very common in the past when resheathing of the used needles were carried out by medical professionals after usage. Nowadays resheathing is not recommended. This in turn elevates the risk of needle stick injuries in cleaners and porters who are responsible for picking up and disposing of sharps containers.
Factors Causing Needle Stick Injuries
- Lack of staff training
- Bending, snapping, or recapping used needles
- Inadequate safety precautions
- Incorrect needle disposing protocols
- Performing high-risk procedures without safety measures
- Using unsafe needles and sharp medical devices
Hazards of Needle Stick Injuries
Needle stick injury hazards are most prominent in health care sectors where the used needles and devices would be contaminated with body fluids of infected patients. During needle stick injuries, the body fluids from the devices may pass to the medical professionals through the punctures. The risk of transmission may or may not be high depending upon the body fluid and the age and health condition of the injured.
The following are the commonly reported acquired infections related to needle stick injuries. Needle stick injury symptoms may differ in individuals according to the type of infection they encounter.
- Rocky Mountain spotted fever
- Cutaneous gonorrhea
Needle Stick Injury Treatment
Needle stick injury medication and treatment depends upon the circumstances of the injury. Post-exposure prophylaxis or PEP for needle stick injury can be followed for accidental exposure to body fluids containing HIV, Hepatitis B Virus and Hepatitis C Virus. In general, the following steps could be followed as a part of needle stick injury management.
- Wash the puncture or cut site with soap and water
- Hold it under running water and encourage bleeding
- Dry it and cover it with a waterproof plaster
- Report the incident to the work supervisor
- Immediately seek medical care
- Perform tests suggested by the physician
- Ensure follow-ups as suggested by the physician
Needle Stick Injury Regulation Act in the US
As per the Occupational Safety and Health Administration (OSHA), proper documentation of the needle stick injury is mandatory in all workplaces. The report should be presented to the victim’s attending physician to obtain a clear picture of the injury. The report should accommodate the following details.
- Date and time of the injury
- Details about the personnel including his health and vaccination details
- Details of the device or the needle that caused the injury
- Details of the procedure during which the injury occurred
- Details regarding the severity and risk of exposure
- Details about the exposure source (if in a healthcare sector)
- Details of post-exposure management and follow-up
The Needlestick Safety and Prevention Act was amended in the year 2000 to address the growing needle stick and sharp injury accidents in the US. The act demands an employer to provide a safe work environment to the employees along with adequate employee training.
As per the Needle stick Safety and Prevention Act, OSHA revised its Bloodborne Pathogens Standards in the year 2001. 24 states and two territories that follow OSHA-approved state programs follow the revised standard. This includes both non-healthcare and healthcare activities. But it is not applicable to public sector employees.
Some states in the US follow the law of the State Needle Safety Legislation. This law covers provisions that are not included in the federal OSHA Bloodborne Pathogen standard. The state law also covers public employees not regulated by OSHA.
Needle stick injury protocols in the state law emphasize the following requirements:
- Listing of safety devices as engineering controls
- Development of a list of available safety devices by the state for use by employers
- Development of a written exposure plan by employers and periodic review and updates
- Development of protocols for safety device identification and selection by employers and involvement by frontline workers in the process
- Development of a sharps injury log and reporting log information
- Development of methods to increase the use of vaccines and personal protective equipment
- Waivers or exemptions from safety device use under certain circumstances (including patient and/or worker safety issues, use of alternative effective strategies, market unavailability, etc.)
- Placement of sharps containers in accessible positions
- Training for workers regarding safety device use
Worker’s Compensation for Needle Stick Injuries
It is important to note that the victim of a needle stick injury can pursue a worker’s compensation claim as per the law in the US. The victim should immediately seek medical attention without fail. Suing for needle stick injury requires the support of a workers’ compensation lawyer who has a proven record of handling needle stick injuries. The injury report maintained by the employer may help the victim in a needle stick injury claim.
The compensation for needle stick injuries of the employee would be paid by the employer’s insurance provider. The employer would be liable for not complying with the federal or the state law of needle stick injury depending upon the state.
Needle stick injury compensation could cover the following damages depending upon the severity of infection acquired.
- Medical expenses
- Weekly lost wage benefits
- Future medical care expenses
- Lump-sum settlements
- Lost wage differential
- Permanent total disability (If applicable)
- Monetary compensation
- Vocational rehabilitation
- Death benefits (If applicable)
Needle Stick Injury Prevention
Needle stick injury prevention could be effectively done by proper education to the personnel who are routinely exposed to needles and other sharp devices. Proper monitoring systems should also be ensured by the management.
Below are some effective safety measures to avoid needle stick injuries.
- Systematic employee training
- Use of Personal Protective Equipment (PPE)
- Following recommended safety maneuvers
- Implication of safety-engineered devices
- Effective needle disposal systems with proper labels.
- Active surveillance programs
- Reporting unsafe practices
Although there have been significant advancements in the usage of safer needles and sheathing systems, these devices are not always fail-safe. We cannot underestimate the chance of blood-borne infections through needle stick injuries. Ignoring these minor punctures can even turn out life-threatening. It’s the responsibility of the employer to implement effective surveillance programs and a safe work environment for the employees. Negligence in these aspects can make him liable for the needle stick injuries sustained by his employees.
The employee should also be responsible for ensuring safe handling practices of these devices. In case of a needle stick injury, the victim should seek medical attention and get the assistance of a dirty needle stick attorney to know his legal rights and the workers’ compensation benefits.