Context

Needlestick injuries and exposure incidents are an occupational hazard for healthcare workers. Reported incidence rates vary from country to country.

• Public Health England received report of 8,765 significant exposures in healthcare workers between 1997 and 2018 (1).
• In the UK they are most common among nursing staff, with up to 48% reporting having incurred one in their career (2).

The emergency department (ED) should provide initial assessment and treatment for HCWs incurring a needlestick injury who cannot access occupational health services directly. This usually means those presenting out of hours (3). Members of the public who incur a needlestick injury will often present to the ED. All patients should have immediate access to PEP 24 hours a day. It is common practice in hours for HCW to be sent directly to the local occupational health service.

Significant infective consequences of needlestick injuries are rare. The 2020 Public Health England ‘Eye of the Needle report’, considers 8,765 reported significant occupational exposures in healthcare workers in England, Wales, and Northern Ireland between 1997 and 2018 (1).

• It identifies 23 cases of seroconversion to active infection of hepatitis C, all following hollow bore needle injury.
• The only reported case of HIV seroconversion as a result of an occupational needlestick injury in a healthcare worker in the UK dates back to 1999.
• There are no reported cases of hepatitis B seroconversion.

There is no such consistently recorded data on the consequences of needlestick injuries among the general public.

The risk of BBV transmission from needlestick injury is frequently quoted as (4):

Learning bite

HCWs and members of the public who incur a needlestick injury present directly to the ED. Emergency department clinicians should be familiar with how to risk assess, investigate, and manage them.

References

1. Public Health England. Eye of the Needle Report. 2020. [accessed May 2020]

2. Royal College of Nursing. Needlestick injury in 2008: results from a survey of RCN members. 2008.

3. Royal College of Emergency Medicine Clinical Effectiveness Committee. Emergency department care of patients who have been potentially exposed to blood borne viruses by needlesticks a position statement. 2013 [accessed May 2020]

4. Health and Safety Executive. Risk to Healthcare workers. [accessed May 2020].