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A needlestick injury is the penetration of the skin by a
hypodermic needle A hypodermic needle (from Greek ὑπο- (''hypo-'' = under), and δέρμα (''derma'' = skin)), one of a category of medical tools which enter the skin, called sharps, is a very thin, hollow tube with one sharp tip. It is commonly used w ...
or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick injury are generally negligible, these injuries can lead to transmission of
blood-borne disease A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious ...
s, placing those exposed at increased risk of infection from disease-causing pathogens, such as the
hepatitis B virus ''Hepatitis B virus'' (HBV) is a partially double-stranded DNA virus, a species of the genus ''Orthohepadnavirus'' and a member of the ''Hepadnaviridae'' family of viruses. This virus causes the disease hepatitis B. Disease Despite there bein ...
(HBV),
hepatitis C virus The hepatitis C virus (HCV) is a small (55–65 nm in size), enveloped, positive-sense single-stranded RNA virus of the family ''Flaviviridae''. The hepatitis C virus is the cause of hepatitis C and some cancers such as liver cancer ( hepato ...
(HCV), and
human immunodeficiency virus The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause AIDS, acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the ...
(HIV). Among healthcare workers and laboratory personnel worldwide, more than 25 blood-borne virus infections have been reported to have been caused by needlestick injuries. In addition to needlestick injuries, transmission of these viruses can also occur as a result of contamination of the
mucous membranes A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...
, such as those of the eyes, with blood or body fluids, but needlestick injuries make up more than 80% of all percutaneous exposure incidents in the United States. Various other occupations are also at increased risk of needlestick injury, including law enforcement, laborers, tattoo artists, food preparers, and agricultural workers. Increasing recognition of the unique occupational hazard posed by needlestick injuries, as well as the development of efficacious interventions to minimize the largely preventable occupational risk, encouraged legislative regulation in the US, causing a decline in needlestick injuries among healthcare workers.


Health effects

While needlestick injuries have the potential to transmit bacteria,
protozoa Protozoa (singular: protozoan or protozoon; alternative plural: protozoans) are a group of single-celled eukaryotes, either free-living or parasitic, that feed on organic matter such as other microorganisms or organic tissues and debris. Histo ...
, viruses and
prions Prions are misfolded proteins that have the ability to transmit their misfolded shape onto normal variants of the same protein. They characterize several fatal and transmissible neurodegenerative diseases in humans and many other animals. It i ...
, the risk of contracting
hepatitis B Hepatitis B is an infectious disease caused by the ''Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no symptoms during an initial infection. Fo ...
,
hepatitis C Hepatitis C is an infectious disease caused by the hepatitis C virus (HCV) that primarily affects the liver; it is a type of viral hepatitis. During the initial infection people often have mild or no symptoms. Occasionally a fever, dark urine, a ...
, and
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
is the highest. The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
estimated that in 2000, 66,000 hepatitis B, 16,000 hepatitis C, and 1,000 HIV infections were caused by needlestick injuries. In places with higher rates of blood-borne diseases in the general population, healthcare workers are more susceptible to contracting these diseases from a needlestick injury. Hepatitis B carries the greatest risk of transmission, with 10% of exposed workers eventually showing
seroconversion In immunology, seroconversion is the development of specific antibodies in the blood serum as a result of infection or immunization, including vaccination. During infection or immunization, antigens enter the blood, and the adaptive immune system ...
and 10% having symptoms. Higher rates of hepatitis B vaccination among the general public and healthcare workers have reduced the risk of transmission; non-healthcare workers still have a lower HBV vaccination rate and therefore a higher risk. The transmission rate of hepatitis C has been reported at 1.8%, but newer, larger surveys have shown only a 0.5% transmission rate. The overall risk of HIV infection after percutaneous exposure to HIV-infected material in the health care setting is 0.3%. Individualized risk of blood-borne infection from a used biomedical sharp is further dependent upon additional factors. Injuries with a hollow-bore needle, deep penetration, visible blood on the needle, a needle located in a deep artery or vein, or a biomedical device contaminated with blood from a terminally ill patient increase the risk for contracting a blood-borne infection.


Psychological effects

The psychological effects of occupational needlestick injuries can include
health anxiety Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. An old concept, the meaning of hypochondria has repeatedly changed. It has been claimed that this debilitating cond ...
, anxiety about disclosure or transmission to a sexual partner, trauma-related emotions, and depression. These effects can cause self-destructive behavior or functional impairment in relationships and daily life. This is not mitigated by knowledge about disease transmission or
post-exposure prophylaxis Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring. COVID-19 In 2021, the FDA has approved bamlanivi ...
. Though some affected people have worsened anxiety during repeated testing, anxiety and other psychological effects typically abate after testing is complete. A minority of people affected by needlestick injuries may have lasting psychological effects, including
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
. In cases where an injury was sustained with a clean needle (i.e. exposure to body fluids had not occurred), the likelihood of infection is generally minimal. Nonetheless, workers are often obligated to report the incident as per the facility's protocol regarding
occupational safety Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wor ...
.


Cause

Needlestick injuries occur in the healthcare environment. When drawing blood, administering an
intramuscular Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle. In medicine, it is one of several methods for parenteral administration of medications. Intramuscular injection may be preferred because muscles have l ...
or
intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
drug, or performing any procedure involving sharps, accidents can occur and facilitate the transmission of
blood-borne disease A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious ...
s. Injuries also commonly occur during needle recapping or via improper disposal of devices into an overfilled or poorly located sharps container. Lack of access to appropriate
personal protective equipment Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, elec ...
, or alternatively, employee failure to use provided equipment, increases the risk of occupational needlestick injuries. Needlestick injuries may also occur when needles are exchanged between personnel, loaded into a needle driver, or when sutures are tied off while still connected to the needle. Needlestick injuries are more common during
night shifts Shift work is an employment practice designed to make use of, or provide service across, all 24 hours of the clock each day of the week (often abbreviated as '' 24/7''). The practice typically sees the day divided into shifts, set periods of ...
and for less experienced people; fatigue, high workload, shift work, high pressure, or high perception of risk can all increase the chances of a needlestick injury. During surgery, a surgical needle or other sharp instrument may inadvertently penetrate the glove and skin of operating room personnel; scalpel injuries tend to be larger than a needlestick. Generally, needlestick injuries cause only minor visible trauma or bleeding; however, even in the absence of bleeding the risk of viral infection remains.


Prevention

The prevention of needlestick injuries should focus on those health care workers that are most at risk. The group most at risk are surgeons and surgical staff in the operating room who sustain injuries from suture needles and other sharps used in operations. There are basically three complementary approaches to prevention of these sharps injuries. The first one is the use of tools that have been changed so that they are less likely to lead to a sharps injury such as blunt or taper-point surgery needles and safety engineered scalpels. Needleless connectors (NCs) were introduced in the 1990s to reduce the risk of health care worker needlestick injuries. The second is to start using safe working practices such as the hands-free technique. The third line of prevention is increased personal protective equipment such as the use of two pairs of gloves. In addition to these preventive approaches implementation measures are necessary because the measures are not universally taken up. To achieve better implementation, legislation, education and training are necessary among all health care workers at risk. Another large group at risk are nurses but their frequency of exposure is much less than in surgeons. Their main risk comes from the use and disposal of injection syringes. The same prevention approaches can be implemented here. There are many so-called safety engineered devices such as retractable needles, needle shields/sheaths, needle-less IV kits, and blunt or valved ends on IV connectors. The use of extra gloves is less common among nurses. Some studies have found that safer needles attached to syringes reduce injuries, but others have shown mixed results or no benefit. The adherence to "no-touch" protocols that eliminate direct contact with needles during use and disposal greatly reduces the risk of needlestick injuries. In the surgical setting, especially in abdominal operations, blunt-tip suture needles were found to reduce needle stick injuries by 69%. Blunt-tip or tapered-tip suture needles can be used to sew muscle and fascia. Though they are more expensive than sharp-tipped needles, this cost is balanced by the reduction in injuries, which are expensive to treat. Sharp-tipped needles cause 51–77% of surgical needlestick injuries. The
American College of Surgeons The American College of Surgeons is an educational association of surgeons created in 1913.American College of Surgeons Online "What is the American College of Surgeons?"/ref> See also *American College of Physicians The American College o ...
(ACS) and the
Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) have endorsed the adoption of blunt-tip suture needles for suturing fascia and muscle. Hollow-bore needles pose a greater risk of injury than solid needles, but hollow-bore needle injuries are highly preventable: 25% of hollow-bore needle injuries to healthcare professionals can be prevented by using safer needles . Gloves can also provide better protection against injuries from tapered-tip as opposed to sharp-tipped needles. In addition, a Cochrane review showed that the use of two pairs of gloves (double gloving) can significantly reduce the risk of needle stick injury in surgical staff. Triple gloving may be more effective than double gloving, but using thicker gloves does not make a difference. A Cochrane review found low quality evidence showing that safety devices on IV start kits and venipuncture equipment reduce the frequency of needlestick injuries. However, these safety systems can increase the risk of exposure to splashed blood. Education with training for at-risk healthcare workers can reduce their risk of needlestick injuries. The
National Institute for Occupational Safety and Health The National Institute for Occupational Safety and Health (NIOSH, ) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the C ...
(NIOSH) has a campaign (Stop Sticks) to educate at-risk healthcare workers.


Treatment

After a needlestick injury, certain procedures can minimize the risk of infection. Lab tests of the recipient should be obtained for baseline studies, including HIV, acute hepatitis panel (HAV IgM, HBsAg, HB core IgM, HCV) and for immunized individuals, HB surface antibody. Unless already known, the infectious status of the source needs to be determined. Unless the source is known to be negative for HBV, HCV, and HIV,
post-exposure prophylaxis Post-exposure prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring. COVID-19 In 2021, the FDA has approved bamlanivi ...
(PEP) should be initiated, ideally within one hour of the injury.


Hepatitis B

The risk of hepatitis B (e antigen positive) seroconversion is estimated at 37–62%, significantly more than other blood borne pathogens. After exposure to the hepatitis B virus (HBV), appropriate and timely prophylaxis can prevent infection and subsequent development of chronic infection or
liver disease Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common. Signs and symptoms Some of the sig ...
. The mainstay of PEP is the
hepatitis B vaccine Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and th ...
; in certain circumstances,
hepatitis B immunoglobulin Hepatitis B immunoglobulin (HBIG) is a human immunoglobulin that is used to prevent the development of hepatitis B and is used for the treatment of acute exposure to HBsAg. Medical uses HBIG is indicated as a postexposure prophylaxis for people a ...
is recommended for added protection.


Hepatitis C

The risk of hepatitis C seroconversion is estimated at 0.3–0.74%. Immunoglobulin and antivirals are not recommended for hepatitis C PEP. There is no vaccine for the hepatitis C virus (HCV); therefore, post-exposure treatment consists of monitoring for seroconversion. There is limited evidence for the use of antivirals in acute hepatitis C infection.


HIV

The risk of HIV transmission with a skin puncture is estimated at 0.3%. If the status of the source patient is unknown, their blood should be tested for HIV as soon as possible following exposure. The injured person can start
antiretroviral drugs The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multipl ...
for PEP as soon as possible, preferably within three days of exposure. There is no vaccine for HIV. When the source of blood is known to be HIV positive, a 3-drug regimen is recommended by the CDC; those exposed to blood with a low viral load or otherwise low risk can use a 2-drug protocol. The antivirals are taken for 4 weeks and can include
nucleoside reverse transcriptase inhibitors Reverse-transcriptase inhibitors (RTIs) are a class of antiretroviral drugs used to treat HIV infection or AIDS, and in some cases hepatitis B. RTIs inhibit activity of reverse transcriptase, a viral DNA polymerase that is required for replicatio ...
(NRTIs),
nucleotide reverse transcriptase inhibitor Reverse-transcriptase inhibitors (RTIs) are a class of antiretroviral drugs used to treat HIV infection or AIDS, and in some cases hepatitis B. RTIs inhibit activity of reverse transcriptase, a viral DNA polymerase that is required for replicati ...
s (NtRTIs), Non-nucleoside reverse transcriptase inhibitors (NNRTIs),
protease inhibitors Protease inhibitors (PIs) are medications that act by interfering with enzymes that cleave proteins. Some of the most well known are antiviral drugs widely used to treat HIV/AIDS and hepatitis C. These protease inhibitors prevent viral replicat ...
(PIs), or fusion inhibitors. All of these drugs can have severe side effects. PEP may be discontinued if the source of blood tests HIV-negative. Follow-up of all exposed individuals includes counseling and
HIV testing HIV tests are used to detect the presence of the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), in serum, saliva, or urine. Such tests may detect antibodies, antigens, or RNA. AIDS diagn ...
for at least six months after exposure. Such tests are done at baseline, 6 weeks, 12 weeks, and 6 months and longer in specific circumstances, such as co-infection with HCV.


Epidemiology

In 2007, the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
estimated annual global needlestick injuries at 2 million per year, and another investigation estimated 3.5 million injuries yearly. The European Biosafety Network estimated 1 million needlestick injuries annually in Europe. The US
Occupational Safety and Health Administration The Occupational Safety and Health Administration'' (OSHA ) is a large regulatory agency of the United States Department of Labor that originally had federal visitorial powers to inspect and examine workplaces. Congress established the agenc ...
(OSHA) estimates 5.6 million workers in the healthcare industry are at risk of occupational exposure to blood-borne diseases via percutaneous injury. The US
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC) estimates more than 600,000 needlestick injuries occur among healthcare workers in the US annually. It is difficult to establish correct figures for the risk of exposure or the incidence of needlestick injuries. First of all it is difficult to observe a needlestick injury, either in oneself or in other persons. Glove perforations in surgeons are considered a reasonable proxy that can be measured objectively. Even though glove perforations can be objectively measured, it is still unclear what the relation is between glove perforations and needlestick injuries. Another problem is underreporting of needlestick injuries. It is estimated that half of all occupational needlestick injuries are not reported. Additionally, an unknown number of occupational needlestick injuries are reported by the affected employee, yet due to organizational failure, institutional record of the injury does not exist. This makes it difficult to determine what the exact risk of exposure is for various medical occupations. Most studies use databases of reported needlestick injuries to determine preventable causes. However this is different from establishing an exposure risk. Among healthcare workers, nurses and physicians appear especially at risk; those who work in an operating room environment are at the highest risk. An investigation among American surgeons indicates that almost every surgeon experienced at least one such injury during their training. More than half of needlestick injuries that occur during surgery happen while surgeons are sewing the
muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...
or
fascia A fascia (; plural fasciae or fascias; adjective fascial; from Latin: "band") is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches to, stabilizes, encloses, and separates muscles and other internal organs. ...
. Within the medical field, specialties differ in regard to the risk of needlestick injury: surgery,
anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...
,
otorhinolaryngology Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical a ...
(ENT), internal medicine, and
dermatology Dermatology is the branch of medicine dealing with the skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical ...
have high risk, whereas
radiology Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiat ...
and
pediatrics Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until th ...
have relatively low rates of injury. A systematic review of 45 studies of sharps injuries in surgical staff found that sharps injuries occur once in 10 operations per staff member. Per 100 person-years, the injury rate in surgical staff was 88.2 (95% CI, 61.3-126.9; 21 studies) for self-reported injuries, 40.0 for perforations (95% CI, 19.2-83.5; 15 studies), and 5.8 for administrative injuries (95% CI, 2.7-12.2; 5 studies). Self-report probably overestimates the real risk and administrative data underestimate the risk considerably. Perforation data are probably the most valid indicators. Considering that the perforation rates provided here are much lower than the self-reported injuries used to calculate the burden of disease due to sharps injuries by the WHO, these calculations should be revised. In the United States, approximately half of all needlestick injuries affecting health care workers are not reported, citing the long reporting process and its interference with work as their reason for not reporting an incident. The availability of hotlines, witnesses, and response teams can increase the percentage of reports. Physicians are particularly likely to leave a needlestick unreported, citing worries about loss of respect or a low risk perception. Low risk perception can be caused by poor knowledge about risk, or an incorrect estimate of a particular patient's risk. Surveillance systems to track needlestick injuries include the National Surveillance System for Healthcare Workers (NaSH), a voluntary system in the northeastern United States, and the Exposure Prevention Information Network (EPINet), a recording and tracking system that also gathers data.


Society and culture


Cost

There are indirect and direct costs associated with needlestick injuries. The US
Government Accountability Office The U.S. Government Accountability Office (GAO) is a legislative branch government agency that provides auditing, evaluative, and investigative services for the United States Congress. It is the supreme audit institution of the federal govern ...
(GAO) determined that requiring hospitals to use safety-engineered needles would result in substantial savings due to the reduction in needlestick injuries requiring treatment. Costs of needlestick injuries include prophylaxis, wages and time lost by workers, quality of life, emotional distress, costs associated with drug toxicity, organizational liability, mortality, quality of patient care, and workforce reduction. Testing and follow-up treatment for healthcare workers who experienced a needlestick injury was estimated at $5,000 in the year 2000, depending upon the medical treatment provided. The American Hospital Association found that a case of infection by blood-borne pathogens could cost $1 million for testing, follow-up, and disability payments. An estimated $1 billion annually is saved by preventing needlestick injuries among healthcare workers in the US, including fees associated with testing, laboratory work, counseling, and follow-up costs.


Legislation

In the United States, the Needlestick Safety and Prevention Act of 2000 and the subsequent Bloodborne Pathogens Standard of 2001 require safer needle devices, employee input, and records of all sharps injuries in healthcare settings. In the US, nonsurgical needlestick injuries decreased by 31.6% in the five years following the passage of the Needlestick Safety and Prevention Act. However, this legislation did not affect surgical settings, where injuries increased 6.5% in the same period.


Outside healthcare

The Coalition for Safe Community Needle Disposal estimates there are over 7.5 billion syringes used for home medical care in the United States. This large amount of home medical syringes has added to the problem of non-healthcare related needlestick injuries due to mishandling and improper disposal of the syringes. Blood on any sharp instrument may be infectious, whether or not the blood is fresh. HIV and the hepatitis C virus (HCV) are only viable for hours after blood has dried, but the hepatitis B virus (HBV) is stable even when dried. The risk of hepatitis B transmission in the community is also increased due to the higher prevalence of hepatitis B in the population than HIV and the high concentration of HBV in the blood. Many professions are at risk of needlestick injury including
law enforcement Law enforcement is the activity of some members of government who act in an organized manner to enforce the law by discovering, deterring, rehabilitating, or punishing people who violate the rules and norms governing that society. The term en ...
, waste collectors, laborers, and agricultural workers. There is no standard system for collecting and tracking needlestick injuries in the community, which makes it difficult to measure the full impact of this problem. Law enforcement workers, like healthcare workers, under-report needlestick injuries. In
San Diego San Diego ( , ; ) is a city on the Pacific Ocean coast of Southern California located immediately adjacent to the Mexico–United States border. With a 2020 population of 1,386,932, it is the List of United States cities by population, eigh ...
, 30% of police reported needle sticks. A study of 1,333 police officers in the
Denver Police Department The Denver Police Department (DPD) is the full service police department jointly for the City and County of Denver, Colorado, which provides police services to the entire county, including Denver International Airport, and may provide contractu ...
found that only 43.4% reported a needlestick injury they received; 42% of which occurred during their evening shift. Most of the needlestick injuries experienced by these workers occurred in their first 5 years of employment. In New York City, a study found a rate of 38.7 exposures (needlesticks and human bites) per 10,000 police officers. In Tijuana, Mexico, 15.3% of police officers reported ever having a needlestick injury, with 14.3% reporting a needlestick within the past year. Needlestick injuries are among the top three injuries that occur among material-recovery facility workers who sort through trash to remove recyclable items from the community-collected garbage. Housekeeping and janitorial workers in public sites, including hotels, airports, indoor and outdoor recreational venues, theaters, retails stores, and schools are at daily risk of exposure to contaminated syringes. A small study of
sanitation workers A sanitation worker (or sanitary worker) is a person responsible for cleaning, maintaining, operating, or emptying the equipment or technology at any step of the sanitation chain.World Bank, ILO, WaterAid, and WHO (2019)Health, Safety and Dignity ...
in Mexico City found that 34% reported needlestick injuries while working in the past year. Needlestick injuries that occur in children from discarded needles in community settings, such as parks and playgrounds, are especially concerning. While the exact number of needlestick injuries in children in the US is unknown, even one injury in a child is enough to cause public alarm. Studies in Canada have reported 274 injuries from needlesticks in children with the majority being boys (64.2%) and occurring from needles discarded in streets and/or parks (53.3%). There are a number of ways in which needlestick injuries could be prevented. First and foremost, increased education in the community is vital. It is especially important to educate kids while they are young. Studies of injuries from discarded needles have reported that the average age of children injured is between five and eight years. In one study, 15% of injuries occurred in children pretending to use drugs. Therefore, children should be taught at a young age about the risks of handling needles and the correct actions to take if they find a syringe. More outreach programs for addiction treatment and infection prevention programs for injection drug users would be very beneficial. Public needle disposal and syringe service programs (SSPs) or needle exchange programs (NEPs) have also proven to reduce the number of needles discarded in public areas. According to the CDC, these programs are effective in the prevention of HIV, and they help reduce the risk of infection with HCV.Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C. (30 September 2016). Retrieved 16 March 2017, from https://www.cdc.gov/niosh/topics/bbp/disposal.html Additionally, in 2004, the Environmental Protection Agency came up with a number program options for safe disposal including: *Drop-off collection sites *Syringe exchange programs *Mail-back programs *Home needle destruction devices *Household hazardous waste collection sites *Residential waste special pick-up programs In the event that needlestick prevention programs are not put in place in a given community, a 1994 study suggests an alternative for "high risk" areas. The study proposed the implementation of a vaccination effort to give children a routine prophylaxis against hepatitis B to prevent the development of the illness in the event that a child encounters an improperly disposed needle.


Needle exchange programs

Needle exchange programs A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It ...
were first established in 1981 in
Amsterdam Amsterdam ( , , , lit. ''The Dam on the River Amstel'') is the Capital of the Netherlands, capital and Municipalities of the Netherlands, most populous city of the Netherlands, with The Hague being the seat of government. It has a population ...
as a response from the injecting-drug community to an influx of hepatitis B. Spurred to urgency by the introduction of HIV/AIDS, needle syringe programs quickly became an integral component of public health across the developed world. These programs function by providing facilities in which people who use injecting drugs can receive sterile syringes and injection equipment.. Preventing the transmission of blood-borne disease requires sterile syringes and injection equipment for each unique injection, which is necessarily predicated upon access and availability of these materials at no cost for those using them. Needle exchange programs are an effective way of decreasing the risk associated with needlestick injuries. These programs remove contaminated syringes from the street, reducing the risk of inadvertent transmission of blood-borne infections to the surrounding community and to law enforcement. A study in
Hartford, Connecticut Hartford is the capital city of the U.S. state of Connecticut. It was the seat of Hartford County until Connecticut disbanded county government in 1960. It is the core city in the Greater Hartford metropolitan area. Census estimates since the ...
found that needlestick injury rates among Hartford police officers decreased after the introduction of a needle exchange program: six injuries in 1,007 drug-related arrests for the 6-month period before vs. two in 1,032 arrests for the 6-month period after. Data almost universally confirm the value of needle exchange programs, which substantially decrease the risk of HIV among injectable drug users and do not carry unintended negative consequences. US states that publicly fund exchange programs are associated with reduced rates of HIV transmission, increased availability of sterile syringes among injecting drug users, and increased provision of health and social services to users. States that do not fund needle exchange programs are associated with increased rates of HIV/AIDS. Nevertheless, the US government has explicitly prohibited federal funding for needle exchange programs since 1988, as part of the
zero tolerance A zero tolerance policy is one which imposes a punishment for every infraction of a stated rule.zero tolerance, n.' (under ''zero, n.''). The Oxford English Dictionary, 2nd Ed. 1989. Retrieved 10 November 2009. Italy, Japan, Singapore China, Indi ...
drug policy in that country. Needle exchange programs have therefore been sparsely implemented in the United States.


See also

*
Needle spiking Needle spiking (also called injection spiking) is a phenomenon initially reported in the UK and Ireland where people have reported themselves subjected to surreptitious injection of unidentified sedative drugs, usually in a crowded environment such ...
*
Peggy Ferro Margaret Frances "Peggy" Ferro (March 19, 1949 – November 4, 1998) was an American healthcare activist and nurse's aide. Her efforts led to laws requiring the use safety syringes in hospitals and other medical settings. Early life Ferro wa ...
*
Pin prick attack A pin prick attack is an assault on another person with a Hypodermic needle, needle or syringe tainted with the blood of somebody carrying a blood-borne disease, such as HIV. Although there have been numerous cases of people being attacked with need ...
* *
Sharps waste Sharps waste is a form of biomedical waste composed of used "sharps", which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as biohazardous waste and must be carefully handled. Common medical mate ...


References


External links

* http://www.gao.gov/products/GAO-01-60R GAO
Preventing Needlestick Injuries in Health Care Settings
an alert from the
National Institute for Occupational Safety and Health The National Institute for Occupational Safety and Health (NIOSH, ) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the C ...
(NIOSH)
What Every Worker Should Know: How to Protect Yourself From Needlestick Injuries
from the
National Institute for Occupational Safety and Health The National Institute for Occupational Safety and Health (NIOSH, ) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the C ...

NIOSH Bloodborne Infectious Diseases Topic Page

International Healthcare Worker Safety Center, University of Virginia
* Worker Information https://www.cdc.gov/niosh/topics/bbp/emergnedl.html
OSHA Bloodborne Pathogen Standard (BBPS)Bloodborne Pathogens and Needlestick Prevention
from the
Occupational Safety and Health Administration The Occupational Safety and Health Administration'' (OSHA ) is a large regulatory agency of the United States Department of Labor that originally had federal visitorial powers to inspect and examine workplaces. Congress established the agenc ...
(OSHA)
OSHA Bloodborne Pathogens Workplace Safety Standards and RegulationsNIOSH Bloodborne Infectious Diseases Topic PageOSHA Standard – Bloodborne Pathogens Training for handling BBP
{{DEFAULTSORT:Needlestick Injury Medical hygiene Industrial hygiene Injuries Occupational safety and health