Sustaining a needlestick injury or other type of exposure is scary. According to the CDC, there is an average of 385,000 sharps-related injuries annually among healthcare workers. Healthcare workers are at risk for contracting diseases such as Hepatitis B or C as well as HIV – which can be terrifying. Despite legislation for needlestick prevention and safety measures in place, accidents do happen, and nurses need to know what to do in case of an exposure.
The actions taken after exposure depend on the type of exposure. For sharps/needlestick injuries, nurses should immediately wash the area with soap and water and "milk" the area to encourage bleeding. Viruses begin to multiply rapidly once in the bloodstream, so preventing entry into the bloodstream in the first place is extremely important. For splash exposures, nurses should scrub the area thoroughly with soap and water. For splash exposures involving mucous membranes (eyes, nose, mouth), irrigate the area well with water.
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Nurses should immediately report exposures to a supervisor. This is one of the largest problems; nurses are extremely busy and sometimes choose not to report right away. They may not want to "dump" their work on others and sometimes they are afraid of discipline for reporting a sharps injury. Some are even embarrassed, or are too frightened to face the possibility of contracting a disease or too much in shock to report. However, reporting should not be delayed – treatment should begin immediately to help prevent transmission of bloodborne pathogens.
Once reported to the provider, several things may happen at once. In some cases, the patient is contacted and blood work ordered to check Hepatitis B and C status as well as HIV. This is only if it is known where the exposure came from. Also, the patient must give consent to check blood work. Concurrently, the nurse would also get baseline lab work done. A Hepatitis B vaccine may also be indicated, and the nurse may choose the option of starting post-exposure prophylaxis (PEP) to reduce the transmission of HIV. Subsequent blood work (for at least six months) to monitor conversion status may also be indicated. Learn more about the role of HIV/AIDS RNs.
RELATED: How Do Nurses Protect Themselves from Highly Infectious Patients?
Nurses may also benefit from counseling services. As stated earlier, an exposure can be very stressful and scary, affecting not just the patient and nurse but the nurse's family as well. Some nurses feel like they "failed" by experiencing a needlestick or other type of exposure, playing the scenario back to find out how things could have been done differently.
Unfortunately, needlestick and other types of exposures happen. Nurses can reduce their risk by following safety measures and using needleless systems (when possible) and activating the safety device on sharps. Proper use of personal protective equipment (PPE) when performing a procedure or task that has a high risk of exposure to body fluids is also critical. Nurses should also avoid rushing and "cutting corners" as it could result in an accidental exposure.
RELATED: How Do Psychiatric Nurses / NPs Stay Safe on the Job?
For more information on what to do following an exposure, please visit the CDC website.
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Amanda Bucceri Androus, RN, BSN
Amanda Bucceri Androus is a Registered Nurse from Sacramento, California. She graduated from California State University, Sacramento in 2000 with a bachelor's degree in nursing. She began her career working night shifts on a pediatric/ med-surg unit for six years, later transferring to a telemetry unit where she worked for four more years. She currently works as a charge nurse in a busy outpatient primary care department. In her spare time she likes to read, travel, write, and spend time with her husband and two children.
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What you need to know about needlestick injury prevention to keep your workplace safe
Hundreds of thousands of US healthcare workers – from laboratory and blood banking staff to nurses and physicians – are affected by needlestick or sharps injuries each year.
About 385,000 sharps related injuries are reported each year, but according to The National Institute for Occupational Safety and Health (NIOSH), it’s likely more than half of all needlesticks go unreported.
Devastatingly, dozens of blood-borne pathogens can be transmitted from needlestick injuries including hepatitis B, hepatitis C, and human immunodeficiency virus (HIV).
And, these types of injuries can have a significant financial impact on the healthcare industry, not to mention the psychological impact on the workers involved.
In this article, we’ve looked at what you need to know to help prevent needlestick injuries, and the innovations that can make a huge difference to safety in your workplace.
Causes of needlestick injuries
Needlestick injury is an accidental piercing wound caused by a contaminated sharps instrument, usually a hollow-bore needle.
Whenever a needle is exposed, injuries and infections can happen. It’s one of the most frequent routes of transmission in workplace-acquired blood-borne infections.
However, the circumstances leading to a needlestick injury can depend on the type and design of the device used, and the way it’s handled.
The two most common causes of needlestick injury in the workplace are two-handed recapping, and the unsafe collection and disposal of sharps waste.
Transferring blood between containers (sample transfer) can also be a hazardous practice for needlesticks.
The cost of needlestick injuries
Recognition of needlestick injuries in healthcare came to the fore in the 1980s and 90s after the HIV epidemic drew attention to the potentially deadly nature of healthcare work.
Between 1985 and 1999, there were 55 ‘documented’ cases and 136 ‘possible’ cases of occupational HIV transmission reported to the Centers for Disease Control and Prevention (CDC). Most of these cases involved nurses and laboratory technicians.
Needlestick injury was associated with almost 90% of those documented HIV transmissions. And, exposure to contaminated sharps is responsible for about 40% of cases of hepatitis B and C infections in healthcare workers worldwide.
In addition to the physical effects, healthcare workers can experience serious emotional and mental health issues after a needlestick injury, which can lead to work loss and post-traumatic stress disorder.
It’s estimated that one case of severe infection by bloodborne pathogens can add up to $1 million or more in expenses for testing, follow-up, lost time and disability payments.
Changes to needle safety standards and engineering
Over the years, standards and legislation have been enacted to protect workers from needlestick injury, such as the Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard in 1992.
In 2000, the Needlestick Safety and Prevention Act came into force, which requires the use of safer needle devices.
While OSHA does not endorse specific safety devices, the standards are clear that a healthcare facility’s Exposure Control Plan “must document consideration and implementation of appropriate commercially available and effective engineering controls designed to eliminate or minimize exposure”.
And according to NIOSH, improved engineering controls are often among the most effective approaches to reducing occupational hazards and therefore are an important element of a needlestick prevention program.
Examples of these engineering controls include: needleless systems, shielded needle devices, blunt needles, and plastic capillary tubes.
Needle safety device characteristics
NIOSH has documented the desirable characteristics of needle safety devices. These include:
- The device is needleless
- The safety feature is an integral part of the device
- The device preferably works passively (i.e. it requires no activation by the user)
- The user can easily tell whether the safety feature is activated
- The safety feature cannot be deactivated and remains protective through disposal
- The device performs reliably
- The device is easy to use and practical
- The device is safe and effective for patient care
Needle safety technology is constantly improving, with a now available to minimize risk for the three most common causes of needlesticks: recapping, disposal and culture transfer.
Needle safety technology is constantly improving, with a range of products now available to minimize risk for the three most common causes of needlesticks: recapping, disposal and culture transfer.
According to the American Nurses Association Needlestick Prevention Guide, more than 80% of needlestick injuries can be prevented with the use of safer needle devices, which, in conjunction with worker education and work practice controls, can reduce injuries by over 90%.
Checklist for protecting yourself and your workplace from needlesticks
- Avoid the use of needles where safe and effective alternatives are available.
- Help your employer select and evaluate devices with safety features that reduce the risk of needlestick injury.
- Use devices with safety features provided by your employer.
- Avoid recapping needles.
- Plan for safe handling and disposal of needles before using them.
- Promptly dispose of used needles in appropriate sharps disposal containers.
- Report all needlestick and sharps-related injuries promptly to ensure that you receive appropriate follow up care.
- Tell your employer about any needlestick hazards you observe.
- Participate in training related to infection prevention.
- Get a hepatitis B vaccination.
ITL BioMedical manufactures a range of needle safety devices for blood banks and laboratories. Find out more.