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Original article | Published 10 February 2012, doi:10.4414/smw.2012.13523
Cite this as: Swiss Med Wkly. 2012;142:w13523
Underreporting of needlestick and sharps injuries among healthcare workers in a Swiss University Hospital

Cathy Voidea, Katharine Elizabeth A. Darlinga, Alain Kenfak-Foguenaa, Véronique Erarda, Matthias Cavassinia, Catherine Lazor-Blanchetb

a Infectious Diseases Service, University Hospital, Lausanne, Switzerland
b Occupational Health Service, University Hospital, Lausanne, Switzerland

NSSIs needlestick and sharps injuries

OBJECTIVES: To determine 1) rates of needlestick and sharps injuries (NSSIs) not reported to occupational health services, 2) reasons for underreporting and 3) awareness of reporting procedures in a Swiss university hospital.

MATERIALS AND METHODS: We surveyed 6,367 employees having close clinical contact with patients or patient specimens. The questionnaire covered age, sex, occupation, years spent in occupation, history of NSSI during the preceding twelve months, NSSI reporting, barriers to reporting and knowledge of reporting procedures.

RESULTS: 2,778 questionnaires were returned (43.6%) of which 2,691 were suitable for analysis. 260/2,691 employees (9.7%) had sustained at least one NSSI during the preceding twelve months. NSSIs were more frequent among nurses (49.2%) and doctors performing invasive procedures (IPs) (36.9%). NSSI rate by occupation was 8.6% for nurses, 19% for doctors and 1.3% for domestic staff. Of the injured respondents, 73.1% reported all events, 12.3% some and 14.6% none. 42.7% of doctors performing invasive procedures (IPs) underreported NSSIs and represented 58.6% of underreported events. Estimation that transmission risk was low (87.1%) and perceived lack of time (34.3%) were the most common reasons for non-reporting. Regarding reporting procedures, 80.1% of respondents knew to contact occupational health services.

CONCLUSION: Doctors performing IPs have high rates of NSSI and, through self-assessment that infection transmission risk is low or perceived lack of time, high rates of underreporting. If individual risk analyses underestimate the real risk, such underreporting represents a missed opportunity for post-exposure prophylaxis and identification of hazardous procedures. Doctors’ training in NSSI reporting merits re-evaluation.

Key words: healthcare workers; needlestick injuries; blood-borne infections; underreporting

Introduction

Healthcare workers (HCWs) are at risk of occupational blood-borne infections, notably hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV), if percutaneous or mucocutaneous exposure to blood and other body fluids should occur. More than three million HCWs worldwide are exposed to HBV, HCV or HIV each year as a result of needlestick and sharps injuries (NSSIs). In the year 2000, 16,000 HCV, 66,000 HBV and 1,000 HIV infections may have occurred worldwide among HCWs following such events.

In Switzerland, 8,602 occupational injuries with exposure to blood or other body fluids were notified to the national health reference centres between 2001 and 2008 . This report showed an increase in NSSI cases during this period (on average 1,146 cases reported per year) compared to the period between 1997 and 2000 (average of 671 cases reported per year). The authors of this report suggest that the increase observed may be due to a real increase in the rate of NSSIs, improved rates of reporting or greater risk appreciation among HCWs. Of the source patients associated with the 8602 NSSI events reported between 2001 and 2008 who were tested, 2.2% were positive for HBV (HBV serology performed only when the HCW sustaining the NSSI is not immune), 12.3% were positive for HCV, and 6.5% for HIV.

The risk of HBV, HCV and HIV transmission after exposure to blood and body fluids (respectively 6–30%, 0.5% and 0.3%) increases with increasing viral load of the source patient and the amount of blood exposure. Blood exposure may be significant for HCWs performing invasive procedures (IPs), those procedures which involve the use of sharp instruments and/or where there is a risk of contact between a patient’s blood or body fluids and the blood of the HCW.

When NSSIs occur, reporting is important for reasons of treatment and prevention. For the injured individual, NSSI reporting instigates evaluation of the need for post-exposure prophylaxis, allows early detection of seroconversion and helps to decrease anxiety. More generally, injury reporting allows identification of hazardous devices or procedures and so serves to diminish the risk of future injuries. Preventive strategies such as HCW education, increased use of universal precautions and implementation of safety devices have been shown to significantly reduce NSSIs .

In our hospital, a telephone hotline managed by the occupational health service is in place, and all staff are encouraged to report every NSSI involving blood and body fluids. In spite of this, a proportion of NSSIs goes unreported. Indeed, the incidence of NSSIs observed from prospective studies or retrospective questionnaires may be as much as 10-fold higher than that derived from standard reporting systems. The purpose of this study was to determine the rate of NSSI underreporting to our occupational health service, to examine the reasons for underreporting, and to assess awareness of reporting procedures in a Swiss university hospital.

COMMENT: Most Ontario docs not covered by (cheap) but optional WSIB (Workers Safety and Insurance Board) insurance. No free Min.Health death & disability Insurance for Docs. Estate of Toronto GP Nestor YANGA who died from SARS got NOTHING as “self-employed”. Families of Nurses who died got millions. Possible reason why Ontario docs are leaving general GP for “focused practice” with less blood contact: e.g. GP psychotherapy.

Cheers,

Dr. Alex Franklin

alex.franklin@harrovian.net

This entry was posted on Monday, February 27th, 2012 at 11:37 am and is filed under Longwoods Online.