Exposure of healthcare workers to bloodborne viruses

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7305.169 (Published 21 July 2001) Cite this as: BMJ 2001;323:169

Only the tip of the iceberg has been measured

  1. Guy Nash (guy.nash{at}ic.ac.uk), research fellow
  1. Hammersmith Hospital, London W12 0NN
  2. St George's Hospital, London SW17 OQT

    EDITOR—Evans et al try to measure the exposure of healthcare workers to bloodborne viruses by including incidents that are required to be reported under the 1995 regulations for reporting injuries, diseases, and dangerous occurrences.1 We do not, however, know the denominator—namely, the total number of needlestick injuries received by healthcare workers.

    This denominator is an iceberg, the tip of which has been described by Evans et al. From the up to date surveillance data, which include additional information and extend to December 2000, hepatitis C is more common than HIV and hepatitis B combined in infected patients. A large London study showed, however, that most patients found to be infected with hepatitis C have not been previously identified by epidemiological risk factors.2 Therefore, by reporting on the injuries of patients known to be infected, the comparatively huge number of needlestick injuries in which hepatitis C positive patients are not known to be infected may be forgotten.

    We have previously shown that surgeons report only one in 20 known needlestick injuries they receive.3 This is reflected in the paper's reported number of nurses' needlestick injuries—which is higher than that of doctors—and in the fact that over three times as many injuries are reported in wards as operating theatres. We should recognise that these reported figures do not scratch the surface of the actual number of occupational sharps injuries to healthcare workers.


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    Eye and face protection should be used

    1. Nita Mitchell-Heggs (nita.mitchell-heggs{at}ccmail.stgh-tr.sthames.nhs.uk), consultant occupational physician
    1. Hammersmith Hospital, London W12 0NN
    2. St George's Hospital, London SW17 OQT

      EDITOR—Evans and et al, in the preliminary report of their ongoing epidemiological survey of risks to healthcare workers from bloodborne viruses, took the opportunity to reinforce the need for hepatitis B vaccination.1

      Given that almost a third of their reported exposures were mucocutaneous or splash exposures, they could also have taken the opportunity to raise awareness of the need for more general use of eye and face protection. It is still commonplace for this to be unavailable for use by staff, who may be exposed on a day to day basis to the risks of splash of high risk body fluids. Healthcare workers in the United Kingdom should follow the excellent example of those on the American television soap ER, where wearing of protective eyewear and masks is routine.


      • Competing interests None declared.


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