Creating a safer working environment

During even the most simple of procedures, clinicians can put themselves at risk of injury from sharp medical instruments. Since the late 1990s, at least 20 healthcare workers have contracted hepatitis C1 and there have been five cases of human immuniodeficiency virus (HIV) transmission as a result of sharps injuries.2 While the level of infection is relatively low – and the increased availability of anti-viral prophylaxis for HIV exposures has further reduced the potential for transmission – healthcare staff exposed to blood-borne infections through sharps injuries can endure months of stress and worry before knowing the outcome. There are existing laws in place, designed to protect healthcare workers, most recently for example, the Control of Substances Hazardous to Health Regulations 2002 – which requires employers to identify any exposure to substances that pose a hazard to health, assess risk and implement subsequent plans to reduce or eliminate this risk. However, the launch of the EU Directive 2010/32/EU this month will introduce some far-reaching and long-awaited changes on a European-wide level. The challenge for NHS Trusts will be to implement the requirements of the new law consistently, cost-effectively and in a timely manner.

Risks and costs

At the recent Reducing HCAI 2013 event, which was held at the Chiswell Street Brewery, in London, Jane Aston, clinical nurse consultant at Mölnlycke Health Care, discussed some of the risks and costs associated with needlestick injuries. “The chances of transmission for hepatitis B, for an unvaccinated healthcare worker exposed to a Hep B e-antigen positive patient, are 1 in 3. This is the most highly transmitted virus,” she said. “However, there are good vaccines and immunoglobulin available to minimise this risk. “The chances of transmission for hepatitis C is 1 in 30 – unfortunately there is currently no vaccine and no postexposure prophylaxis. In 90% of cases, people who are Hep C+ do not have any symptoms for many years – so there is a worry that a healthcare worker may have acquired hepatitis C via a needlestick injury and be unaware of it for some time, if the incident went unreported or they did not attend for follow up testing.” Jane Aston went on to say that there is a 1 in 300 chance of transmission of HIV, if post-exposure prophylaxis is not given. “The last documented case of seroconversion in a healthcare worker was in 1999,” she said. “However, we know there are other healthcare workers who have ‘probably’ contracted HIV from a needlestick injury, but because they did not report it at the time, and no baseline blood sample was taken, they cannot be classed as ‘definite’.” The number of needlestick injuries in Europe is estimated to be at least one million every year. However, studies show that this figure is a huge underestimation. Jane Aston quoted figures from a German study which reported that around 500,000 needlestick injuries occur among healthcare workers every year in Germany alone. (Hoffman et al 2002) “The cost, for a medium sized Trust to manage needlestick injuries is estimated to be £500,000 a year,”3 continued Jane Aston. “So, although there are concerns about the cost of moving to safety devices, in reality there is evidence available to show the huge sums of money that are already being spent just on managing needlestick injuries. “The cost of dealing with a single low-risk needlestick injury is £734. So, assuming we have 100,000 needlestick injuries every year in the UK. If all these injuries were low-risk, this would mean that around £73 million is being spent every year on managing these injuries. However, in an average hospital around 80% of needlestick injures will be low-risk and 20% will be high-risk. This means that closer to £142 m every year is being spent just on managing needlestick injuries.”