Sharp focus on blood-borne viruses

According to an online survey by the Royal College of Nursing (RCN), 48% of nurses polled had at some point in their career been injured by a needle or sharp that had previously been used on a patient, with 10% sustaining an injury in the last year. Some 4,407 nurses responded to the survey which examined the frequency of needlestick injury and explored nurses’ perceptions of the risk they face. The RCN report, ‘Needlestick Injury in 2008’ highlighted the dangers posed by needlestick injuries to healthcare workers and the subsequent risks of contracting a blood-borne virus (BBV) as a result. Almost all of the nurses polled used needles as part of their jobs and in nine out of ten instances, where a needlestick injury was sustained, the injury drew blood. The survey also revealed a mixed attitude towards reporting needlestick injuries, as well as towards safety training in general to prevent possible BBV transmissions. Reasons for not reporting needlestick injuries to line managers or occupational health colleagues included lack of time, embarrassment, the fear of disciplinary action and a general lack of understanding of reporting procedures. Others would just rather not know if they had been infected or were frightened of what the follow-up post-exposure prophylaxis treatment might involve. Only a third of nurses polled regarded the risk of contracting a BBV from the injury as medium or high. However, in more than a quarter of all cases, nurses did not receive any advice about the risk of contracting a BBV following the injury or their significance within healthcare in general.

BBV contamination routes

BBVs are a group of viruses that may be carried in the blood of certain individuals, often displaying little or no outward signs of their presence. Should these BBVs subsequently be transmitted to or contracted by other persons, however, this can result in either minimal symptoms in some, or severe forms of the disease in others. The two most important BBVs capable of causing severe disease and even death are the hepatitis virus groups consisting mainly of hepatitis B (HBV) and hepatitis C (HBC) which can cause liver disease, plus human immunodeficiency virus (HIV), an immune disorder resulting in acquired immune deficiency syndrome (AIDS). Although BBVs are by their very nature mostly concerned with blood itself, any work involving exposure to other body fluids including semen, urine, faeces, saliva, breast milk, sweat and vomit carries a minimal risk – particularly if contamination by blood is also present, although this may not be immediately obvious. Occupations at possible risk of contracting BBVs include mainly healthcare professionals such as nurses, doctors, midwives and dentists, forensics, laboratory or pathology staff, members of the emergency services, undertakers and mortuary staff – the principal contamination route being via a needlestick or sharps injury. Any piercing wound can be potentially classified as a “needlestick injury”, but the term is most frequently used in relation to healthcare workers who may accidently injure themselves or their colleagues when taking blood, administering intramuscular or intravenous injections, or when engaged in other procedures involving sharps. These injuries also commonly occur during needle recapping and as a result of failure to place used needles in approved sharps disposal containers. According to recent figures released by the NHS Employers Organisation, needlestick and sharps account for 400,000 injuries to NHS staff each year with as many more incidents going unreported. The main risk in all of these incidents is the potential for BBV transmission, particularly HBV, HCV and HIV. In the case of HBV, an effective protective vaccine is available, but no such protection is available for other BBVs. These other infections are often difficult to treat, the prophylaxis treatment is unpleasant, may cause significant side effects and there is no guarantee that treatment will be successful.