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Needlestick and sharps injuries in Saudi Arabia

 

Clinical bottom line

After nurses and doctors, housekeeping staff recorded the third largest number of workers injured by sharps, though the most at risk were phlebotomists, respiratory therapists and paramedics. There was one hepatitis C seroconversion among about 2,800 workers over four years.


Reference

ZA Memish et al. Epidemiology of needlestick and sharps injuries in a tertiary care center in Saudi Arabia. American Journal of Infection Control 2002 30: 234-241.

Study

This was a prospective study began in 1997 to 2000 (and ongoing) in a 600-bed tertiary care hospital in Riyadh. It used the Exposure Prevention Information Network (EPINET) data collection tool. On employment all employees are screened for HBV, HCV and HIV. hepatitis B vaccination is advised for all employees with documented non-immunity. The average number of employees per year was 2,773.

Results

Over four years there were 364 reported needlestick and sharps injuries, declining from 38/1000 workers in 1997 to 29/1000 in 2000. The overall rate was 33/1000 workers over the four years.

Who was injured

Though most injuries were caused to nurses, the professions with the highest rates were phlebotomists, respiratory therapists and paramedics (Table 1). The source patient was known in most cases, but not with injuries to housekeepers, where it was only known in 13% of cases.

Table 1: Rate of needlestick or sharps injury per 1000 workers by type of worker

Type of worker Sharps injury per 1000 workers
Staff physician 24
Resident/intern 33
Nurses 38
Respiratory therapist 49
Phlebotomist 66
Clinical laboratory worker 18
Non laboratory technologist 11
Housekeeper 34
Paramedic 46

Place of accidents

The majority of injuries occurred in wards, the emergency department, intensive care unit and operating theatres. A high proportion of injuries occurred in direct patient care activities, but 12% of cases were caused by devices inadvertently left in inappropriate places after use, and 6% were a result of inappropriate disposal (protruding from sharps containers or trash bags, for instance). Recapping contaminated needles accounted for a further 6% of injuries, while a further 6% were caused by attempts to manually disassemble devices.

What caused the accident

Hollow bore devices were involved with 65% of injuries, with disposable syringes alone accounting for 28%. Solid devices (lancets, suture needles, scalpels) accounted for 25% of injuries while all other items accounted for the remaining 10%. Most (87%) were known to be contaminated by blood or body fluids at the time of the accident.

Half the workers were wearing a single pair of gloves at the time of injury, and 5% were double-gloved.

None of the sharps items was of a safety design (shielded, recessed, retractable, or blunted).

Blood tests

The results of blood tests on source patients and staff members is shown in Table 2. A minority of patients and staff were not tested for a range of reasons. There was one seroconversion of a staff member to hepatitis C on completion of follow up.

Table 2: Test results on source patients and staff affected

  Percentage
Test result HBV HCV HIV
Source patients
Positive 8 10 0
Negative 70 69 76
Not tested 22 22 24
Healthcare workers
Positive 0.3 0.3 0
Negative 94 94 90
Not tested 6 6 10

Comment

This is a well conducted and well reported study, with much detail, and demonstrates just how much detail is needed to get a handle on needlestick and sharps injuries and their prevention. It is well worth a read.