Managing injuries from sharp instruments in health care workers in MerseyBMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6960.989 (Published 15 October 1994) Cite this as: BMJ 1994;309:989
- R R White,
- E J Ridgway
- Correspondence to: Dr White.
- Accepted 20 May 1994
Exposure of health care workers to bloodborne viruses due to injuries from sharp instruments is of increasing concern. Guidelines exist on the action to be taken if a needlestick accident occurs.1,2 We carried out a postal questionnaire survey to investigate the management of such accidents in Mersey Regional Health Authority.
Methods and results
We sent questionnaires to all the consultant microbiologists (17), senior sisters or managers of occupational health departments (14), genitourinary physicians (nine), infectious disease physicians (two), and heads of accident and emergency departments (15) in the Mersey region. We also sent questionnaires to eight of all 12 infection control nurses.
Forty seven (72%) of the 65 questionnaires were returned. The response rate from the occupational groups ranged from 55% to 100%. In answer to the first question, nine of the respondents said that they always referred people injured by sharp instruments to another department so these respondents did not complete the rest of the questionnaire. Not all of the remaining 38 respondents answered all the questions.
Of the 23 hospitals from which replies were received, 21 had a written policy on injuries from sharp instruments. Three hospitals did not keep records of such incidents. The responses from eight hospitals allowed us to compare the action taken by different respondents in the same hospital. In five of these hospitals the recommended action varied among respondents while in the remaining three hospitals similar management was recommended by all the respondents.
Testing of the donor (patient whose blood or other fluid is on the sharp instrument causing the injury) varied among respondents (table). Most respondents (28 out of 36) recommended long term storage of the serum of the recipient (person injured by the sharp instrument); 11 of these would test for hepatitis B surface antigen before storage. Thirty two respondents reported that they would advise recipients who were not immune to hepatitis B virus to be given hepatitis B specific immunoglobulin if (a) the donor was hepatitis B positive (26), (b) was regarded as high risk (16), or (c) was unknown (four). Thirty two respondents would offer hepatitis B vaccine to (a) all non-immune recipients (24) or (b) staff in certain occupational groups only (six) or only if the donor was hepatitis B positive (two). Twenty nine out of 32 respondents would seek advice about zidovudine if a donor was known to be HIV positive. None of the hospitals' policies outlined procedures for dealing with a risk of transmission of hepatitis C virus.
Responses to survey in Mersey Regional Health Authority about testing donor for hepatitis B surface antigen and HIV antibody after injury to member of staff from sharp instrument. Values are numbers of respondents (n=34)
Hepatitis B HIV surface antigen antibody
Always test 19 6 Test only high risk donor 13 19 Never test 2 9
As the overall response rate was only 72% we could not assess how well the results reflect procedures throughout the Mersey region. Some important points, however, came out of the survey.
We found that the screening of donors varied depending on the person handling the incident. Storage of serum from the recipient was usually recommended, however, and over a third of respondents who recommended storage also tested the samples for hepatitis B surface antigen. The result of such testing only provides information about previous exposure; it does not show infection as a result of the current injury.
It is of concern that immunisation against hepatitis B virus may be advised only for staff who are in occupations that are regarded as high risk, as surveys have shown that staff in a wide range of occupations are vulnerable to injury.3 We also found that the criteria for using hepatitis B immunoglobulin varied among respondents.
None of the hospitals' policies on injuries from sharp instruments addressed the issues that would arise if transmission of hepatitis C virus was a risk. Seroconversion occurs in 2.7% of cases of exposure to blood from people who are positive for hepatitis C antibodies, and up to 50% of those who seroconvert may develop irreversible liver disease.4,5
In conclusion, we have shown that the management of injuries from sharp instruments varied both among hospitals and among members of staff in the same hospital. It is important to reduce the number of needlestick accidents, but as preventive measures do not always succeed health care workers who are injured by a sharp instrument must be able to obtain clear advice and counselling immediately, with appropriate intervention and follow up.