Needlestick Injuries Among Health Care Workers


Introduction

Magnitude of Problem

Potential Outcomes of Injuries

Risk Factors

Strategies for Prevention

Barriers to Prevention

Conclusion

References


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Magnitude of the Needlestick Injury Problem;
Epidemiology and Economic Burden

Where do the data come from?
How many needlestick injuries occur in the U.S. every year?
Costs associated with needlestick injuries

Where do the data come from?

Perusing the scientific literature or Internet for information regarding needlestick injuries leaves one with many different ideas of just how large this occupational injury problem really is. Due to this fact, one must consider carefully where estimates come from and how they were computed. Several surveillance systems have been established in the United States in an attempt to more accurately quantify the magnitude of the needlestick injury problem.

The National Surveillance System for Healthcare Workers (NaSH) was established in 1995 by the Centers for Disease Control and Prevention (CDC) in collaboration with hospitals nationwide to collect data on the circumstances surrounding needlestick injuries, the severity of those injuries, the device(s) involved, whether the source patient was known to be infected with Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) or Human Immunodeficiency Virus (HIV), and to monitor the incidence of transmission of tuberculosis and vaccine-preventable diseases (CDC, 2004; Panlilio et al., 2004). The Exposure Prevention Information Network (EPINet), established in 1991 by Dr. Janine Jagger at the University of Virginia, provides healthcare facilities (both hospital and non-hospital) with an easy to use, standardized form with which they can track rates of needlestick injuries (International Health Care Worker Safety Center (IHCWSC), 2005; Panlilio et al., 2004). While over 1500 healthcare facilities now use the standardized tracking system, just 70 are part of the “EPINet network,” sending information to the IHCWSC where data are compiled and annual needlestick injury rates are published (IHCWSC, 2005).

These sentinel surveillance systems are an invaluable source of epidemiologic information with which public health organizations, occupational safety organizations, and healthcare facilities can monitor trends in rates of needlestick injuries. Still, it is important to note that the needlestick injury estimates produced from these systems are naturally limited by the degree of reporting that takes place among healthcare workers.

How many needlestick injuries occur in the U.S. every year?

CDC (2004) estimates that approximately 385,000 needlestick and sharps-related injuries occur every year to healthcare workers in hospital settings, and this estimate is probably one of the most current available today. Panlilio et al. (2004) set out to establish a single estimate with greater reliability and validity than previous descriptive studies were able to obtain. After using data from both NaSH and EPINet, adjusting for underreporting, and applying weights to adjust for the correlation between hospital size and number of needlestick injuries, they arrived at the estimate used by the CDC: that is, a total of 384,325 needlestick or sharps-related injuries annually among healthcare workers. The authors concede that this number likely underestimates the truth despite their adjustment for underreporting (Panlilio et al., 2004).

Other estimates of the magnitude of the needlestick injury problem are considerably higher. For example, the National Institute of Occupational Safety and Health (NIOSH, 2000) estimates that up to 800,000 needlestick injuries occurred in the United States in 2004. However, one should note that this estimate includes both hospital and non-hospital healthcare workers, while Panlilio et al. (2004) included just hospital employees.

Based on data from EPINet, NIOSH (2000) also estimated that, on average, 30 needlestick injury events occurred in U.S. hospitals per 100 beds in 1999. Finally, a study conducted in Washington used numbers of filed workers' compensation forms as its primary source of data and found that, from 1996 to 2000, 3303 claims were filed. This is equivalent to 158.6 needlestick injuries per 10,000 full-time healthcare workers in a hospital setting during the study period (Shah, Bunauto, Silverstein, & Foley, 2005).

Despite whatever questions may surround the accuracy of these numbers, the magnitude of this occupational injury problem is clearly large enough to warrant considerable attention from those with an interest in injury control and prevention.

Costs associated with needlestick injuries
Because the number of needlestick injuries that go unreported is known to be high, estimating the costs - both financial and emotional - associated with these injuries is a difficult task. In order to arrive at such estimates, investigators are forced to make many assumptions and generalizations along the way; thus whatever costs are calculated are truly estimates and should be treated and interpreted as such.

  • Quantifiable costs
    CDC (2004) estimates that the direct costs associated with initial follow-up and treatment of healthcare workers who sustain a needlestick injury range from $500 to $3,000 depending upon the type of treatments provided. Jagger, Bentley, and Juillet (1998) based their estimates of direct costs to the hospital for follow-up of needlestick injuries on financial data provided by two randomly selected hospitals (labeled hospitals A and B) reporting to EPINet between 1995 and 1997. These hospitals reported costs including lab charges for blood testing, costs associated with treatments for HBV, HCV, and HIV, service charges for ER visits, and costs falling into any other category. From June of 1995 to May of 1997, Jagger et al. (2000) found that total costs ranged from $197 to $1094 between the two hospitals, with an average cost of $672 per injury at hospital A and an average of $539 at hospital B.

    Another more recent study investigated the short-term economic impact of needlestick injuries among nurses caring for patients with diabetes. Lee et al. (2005) based their estimates on direct healthcare costs, or those accumulated by post-exposure lab tests, hospital visits, and post-exposure prophylaxis for viral infections, as well as indirect costs, calculated by considering the number of missed workdays among injured nurses and subsequent lost productivity, in the first year following needlestick injury. Lee et al. (2005) estimated that the total mean annual cost of needlestick injuries for the 110 nurses (out of 400) who experienced at least one needlestick injury within 12 months of participating in the study was $28,492, or approximately $259 spent annually per injured nurse. 56% of this total was attributed to indirect costs, 15% to post-exposure tests, 20% to physician visits, and 9% to use of drugs.

    Altogether, assuming 700,000 needlestick injuries occur each year and that 58% of those who sustain a needlestick injury are nurses, the national economic burden of needlestick injuries is estimated to be $65 million. Lee et al. (2005) believe these numbers underestimate the true cost for several reasons: the nurses they studied were at a lower risk of obtaining infections from their patients than other nurse populations, they only examined short-term costs, they used self-reported data, and they did not include costs associated with treating side-effects of HIV drugs.

  • Un-quantifiable costs.

    There is little question that exposure to bloodborne pathogens via needlestick injuries exacts a significant emotional and psychological toll on the victims, the cost of which is difficult, if not impossible, to quantify. Healthcare workers who are injured by needlesticks face the uncertainty of their infection status in the immediate period following the injury, and, once the news is known, face whatever life-changing, long-term consequences are associated with the disease they may have contracted.

    In their study of the economic impact of needlestick injuries, Lee et al. (2005) found that 29 out of 110 nurses who sustained a sharps-related injury sought emotional counseling in the year following the injury. In a more detailed case study, Worthington, Ross, and Bergeron (2006) described two nurses who received needlestick injuries from an HIV-infected patient. Despite testing negative for HIV antibodies more than 22 months after their injuries, both nurses displayed symptoms consistent with posttraumatic stress disorder (PTSD): insomnia, ongoing depression and anxiety, nightmares, and panic attacks upon returning to the work environment where the injuries were received. Although these may be extreme examples, Worthington et al. (2006) maintain that the long-term emotional consequences of needlestick injuries are likely unappreciated.

Next (Potential Outcomes of Needlestick Injuries)