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Preventing Needlestick Injuries
"How can I work in my institution to prevent needlestick injuries?" someone asked
herself this question five years ago after learning that a needlestick injury had
infected her with the human immuno- deficiency virus (HIV). She has since launched
the National Campaign for Healthcare Worker Safety, in order to educate nurses and
facilities on needlestick injuries, and to urge hospitals to implement safer devices.
Like this, you may be among the thousands of health care workers who annually receive
a needlestick contaminated with HIV. According to the a recent report, more than one
million needlestick injuries to health care workers occur every year
What to do if you get stuck
The first Occupational Safety and Health Administration (OSHA) standard specifically
written to protect health care workers was the 1991 Bloodborne Pathogen Standard.
Although tremendous progress has been made as a result, more than 1,000 infections
caused by 20 pathogens are estimated to be transmitted through sharps or needlestick
injuries annually. The greatest threat to nurses are hepatitis B and C viruses
(HBV and HCV)-not HIV, as many believe. In fact, one in six contaminations stems from
HBV, one in 20 from HCV, and one in 300 from HIV.
If you are stuck by a needle, immediately report to employee health services at your
facility for evaluation, counseling, and treatment if appropriate. Timing is critical.
The Centers for Disease Control and Prevention's (CDC) postexposure prophylaxis
guidelines call for treatment with antiviral medications "within a few hours"
following the needlestick. For more information, contact the National Clinician's
Post-Exposure Treatment Hotline at (888) 448-4911.
Formal reporting of the incident is also essential. It's estimated that only 10% of
all needlestick injuries are recorded on OSHA 200 logs, which chronicle and classify
incidents of occupational injuries and illnesses. Without accurate data, OSHA cannot
justify the demand for safer devices. Lack of documentation has also made obtaining
worker's compensation and other benefits more difficult for nurses.
Prevention is possible
According to the CDC, up to 86% of needlestick injuries can be prevented by using
safer needlestick devices. Advances in engineering controls have made it possible
to eliminate sharps from many uses-such as iv piggybacks-and to blunt or retract
the needle so it's no longer a danger. Placing sharps containers within reach and
at eye level in every patient room also reduces the risk of injury.
You can be active on several levels in order to help prevent needlestick injuries.
Work with your state nurses association (SNA) and your colleagues to encourage your
institution to address the issue. Review needlestick injury data in your facility
and ask the following questions: In what areas have needlestick injuries increased,
and where has there been a decrease? Have nurses and other health care workers been
reporting injuries? What happens at your workplace in the event of a needlestick
incident? Can you receive support, including immediate evaluation for postexposure
prophylaxis? What is being done to reduce the injury rate?
Also, remember that several organizations can offer protection. For example,
OSHA will cite hospitals for failure to evaluate and use safer products. Your SNA
can assist you in filing a complaint with OSHA.
Another option is the negotiation of contracts containing firm language.
Several SNAs have successfully negotiated contracts that require hospitals to
involve nurses in reviewing needlestick injury data, as well as in evaluating,
selecting, and implementing safer devices.
FACT SHEET ON NEEDLE STICK INJURY:
Health care workers (HCWs) suffer between 600,000 and one million injuries from
conventional needles and sharps annually. These exposures can lead to hepatitis B,
hepatitis C and Human Immunodeficiency Virus (HIV), the virus that causes AIDS.
At least 1,000 HCWs are estimated to contract serious infections annually from
needlestick and sharps injuries.
Registered nurses working at the bedside sustain an overwhelming majority of
these exposures.
Needlestick injuries are preventable. Over 80% of needlestick injuries could be
prevented with the use of safer needle devices.
Less than 15% of U.S. hospitals use safer needle devices and systems.
In 1992, the Food and Drug Administration issued an alert to all health care
facilities to utilize needleless IV systems wherever possible. This alert is
merely a recommendation, not a mandate. Therefore, health care facilities are
under no legal obligation to comply.
The first safe needle designs were patented in the 1970s, and the FDA has
approved over 250 devices for marketing as safety devices.
More than 20 other infections can be transmitted through needlesticks,
including: tuberculosis, syphilis, malaria and herpes.
Cost Savings from Needlestick Prevention
Hospitals and health care employers in California are expected to save
over $100 million per year after implementing the California Occupational
Safety and Health Administration's requirement for safe needle devices.
According to the American Hospital Association, one case of serious infection
by bloodborne pathogens can soon add up to $1 million or more in expenditures
for testing follow-up, lost time and disability payments.
The cost of follow-up for a high-risk exposure is almost $3,000 per needlestick
injury even when no infection occurs.
Safe needle devices cost only 28 cents more than standard devices.
Hepatitis B
Hepatitis B is now preventable due to the vaccine that must be offered to HCWs
and is given to children at birth.
Regulatory and legislative efforts were largely responsible for the reduction of
deaths from hepatitis B as a result of vaccine programs.
Following these regulatory and legislative efforts, including the Occupational
Safety and Health Administration (OSHA) Bloodborne Pathogens Standard, cases of
hepatitis B in health care workers dropped from 17,000 annually to 400
annually-and continue to drop.
Transmission rate: 2-40%
Hepatitis C
Testing for hepatitis C after needlestick injuries was only recommended in 1998.
It is a silent epidemic. There could be thousands and thousands of nurses with
occupationally acquired hepatitis C who do not know it.
Hepatitis C is the most frequent infection resulting from needlestick and sharps
injuries. Of health care workers who become infected, 85% become chronic carriers.
Chronic carriers have the potential to spread the disease to others, including
their partners.
Drugs that slow the progression of hepatitis C are available, but average $1,700
each month.
Hepatitis C leads to liver failure, liver transplants and liver cancer. A liver
transplant costs $500,000.
At least 4 million Americans are infected with hepatitis C.
Transmission rate: 2.7-10%
HIV
Human Immunodeficiency Virus (HIV) is the virus that causes AIDS, a fatal disease.
Advances in treatment prolong the time before HIV becomes AIDS. The drug treatment
can cost up to $6,000 per month.
16,000 of the 600,000 to one million needlestick injuries each year result in HIV
exposure.
There are over 54 documented cases of HCWs with occupationally acquired HIV and
at least 133 cases of possible transmissions of HIV.
There are 35 new cases each year.
Transmission rate: .2-.4%
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