All About Needlestick Injuries

What are Needlestick Injuries?

A needlestick injury, also called a sharps injury, is an injury that occurs when a sharp instrument penetrates the skin. Although the name suggests needlestick injuries are caused by needles, they can actually occur if the skin is penetrated by a variety of sharp instruments, such as:

• Used needles
• Syringes
• Scalpel blades
• Lancets
• Insulin pens
• IV catheter needles or tips
• Tattoo needles
• Piercing needles or guns
• Razor blades

Needlestick injuries are a serious occupational hazard for healthcare workers, laboratory personnel and anyone handling needles or sharp medical equipment. In 2021-2022, the NHS received 2,600 claims for needlestick injuries, with a cost to the NHS of £10.8 million.

If a needlestick injury occurs, there is a possibility that harmful exposure has occurred. For example, the sharp instrument may have been contaminated with human blood, other body fluids or human tissue. This could expose the injured person to a blood-borne pathogen or virus, such as human immunodeficiency virus (HIV), Hepatitis B or Hepatitis C. Other infections and contaminants can also be transmitted if the needle has been used on a patient.

Needlestick injuries can occur for many reasons, including

• Improper disposal of needles.
• Recapping needles manually.
• Accidental needle slips during procedures.
• Handling needles during cleanup.
• Lack of proper safety training.

Preventing Needlestick Injuries

Needlestick injuries are largely preventable with proper precautions. For example:

Use safety-engineered devices

To reduce the risk of needlestick injuries, safety-engineered devices should be used. For example, healthcare workers should use needles with safety features, such as retractable or shielded needles. Where possible, healthcare settings should opt for needle-free systems.

Proper handling and disposal

Needles should never be recapped. Once the needle has been used, it should immediately be disposed of in a designated puncture-resistant sharps bin. Sharps bins should never be overfilled and should be replaced when they are approximately three-quarters full.

Follow safe work practices

Safe practices are essential when handling sharps. This includes always using both hands when using a sharp, such as a needle, and handling the sharp carefully. The work area should be kept clean and uncluttered and the worker should always plan ahead, for example, by knowing exactly where the sharps bin is, the route to get to it (which should be as short as possible) and how the sharp needs to be disposed of.

Wear personal protective equipment (PPE)

Gloves should always be used when handling needles and other sharps as this provides a barrier between the sharp and the skin. If there is a risk of splashes, for example, from blood or other bodily fluid, wear goggles and a face shield.

Undergo proper training

Anyone working with sharps should undergo needlestick injury prevention training. Training should teach correct needle handling and disposal techniques and the risks of incorrect handling and needlestick injuries. Training should be refreshed every two years so workers can stay up to date with new safety devices and protocols.

Report and address needlestick hazards

Any unsafe sharps handling practices or unsafe sharps storage or disposal practices should be reported to supervisors as soon as possible. Any issues or concerns should be addressed immediately. Once reported, the management or the organisation should participate in safety evaluations, suggest improvements and implement any changes.

Get vaccinated

All individuals who work with sharps, including healthcare workers, should get vaccinated against Hepatitis B to reduce the risk of infection.

Follow post-exposure protocols

If a needlestick injury occurs, report it immediately and follow medical guidelines and the safety protocols of the organisation.

The Risks of Needlestick Injuries

A needlestick injury can pose serious health risks, primarily due to potential exposure to bloodborne pathogens. The severity of the risk depends on factors like the type of sharp, the depth of injury and the presence of infectious material.

The most significant injuries associated with needlestick injuries are:

Infection with bloodborne pathogens

Needlestick injuries can transmit infections from contaminated blood. The three most serious infections include:

Hepatitis B

Hepatitis B is a liver infection that is spread through blood, semen and vaginal fluids. Hepatitis B can cause liver damage, cirrhosis or liver cancer. The best ways to protect yourself from Hepatitis B is through vaccination and to follow best practices when handling sharps.

Hepatitis C

Hepatitis C is another type of virus that infects the liver. It spreads through contact with infected blood. Infection can lead to chronic liver disease and cirrhosis and if it is not treated, Hepatitis C can cause serious life-threatening damage to the liver. Hepatitis C can be particularly dangerous as symptoms often do not become apparent until significant liver damage has occurred. Although there is no vaccine to prevent Hepatitis C, it can be prevented through safe practices and effective treatments are available.

HIV

Human immunodeficiency virus, commonly known as HIV, is a virus that can damage the cells in the immune system and significantly weaken the body’s ability to fight common infections and diseases. If left untreated, HIV can severely damage the immune system and lead to acquired immune deficiency syndrome (AIDS). HIV is spread through the bodily fluids of an infected person, including blood, semen, vaginal fluid and breast milk.

Other infections

Although less common than Hepatitis B, Hepatitis C and HIV, needlestick injuries can also transmit other infections, including syphilis, tuberculosis (TB), malaria and herpes. Bacterial infections can also occur at the puncture site.

Psychological and Emotional Impact

A needlestick injury can also have a significant psychological and emotional impact. This can include anxiety and stress about potential infection. Waiting for test results following the injury to see if you have been exposed to HIV or another infection, can also cause significant emotional distress. Some people may also worry whether the injury could negatively impact their career, for example, if they are judged to have been negligent or at fault or if they fear other people will not want to work with them because of fear of exposure.

Physical injuries and complications

Multiple physical complications can occur from a needlestick injury, including symptoms of local infection, such as redness, swelling and pus and soft tissue damage from deep punctures.

Although all needlestick injuries pose a risk to the injured person, the risk can be higher for certain injuries. For example:

• Deep puncture wounds.
• Blood-contaminated needles.
• Hollow-bore needles (as these have higher blood volume).
• Needles used on high-risk patients (e.g., known HIV or Hepatitis cases).

First Aid for Needlestick Injuries

If you suffer a needlestick injury, taking immediate action can help reduce the risk of infection. First aid is the immediate assistance given to someone experiencing a medical event. First aid is designed to protect life, prevent the needlestick injury from worsening and promote recovery from the injury.

The first aid steps to follow in the event of a needlestick injury are listed below:

Wash the wound

Immediately following the injury, it is recommended to allow mild bleeding to help flush out contaminants. The affected area should then be washed with soap and water, although it should not be excessively scrubbed and bleach or harsh chemicals should not be used on the wound. It is essential to NOT suck the wound, as this can increase the risk of infection from contaminants. If exposure involves mucous membranes (e.g. the eyes or mouth), rinse with water or saline for at least 10–15 seconds.

Apply an antiseptic

Once the wound has been washed, use an antiseptic solution, such as an alcohol-based disinfectant or povidone-iodine solution to reduce the number of microorganisms in the wound and reduce the chance of infection. If necessary, cover the wound with a clean, dry dressing such as a bandage or plaster.

Report the incident

As soon as possible, ideally within minutes of the injury, the supervisor or occupational health department should be notified. You will need to provide details of the exposure, including the type of sharp instrument that caused the injury (e.g. a needle, insulin pen or scalpel), whether the instrument was used on a high-risk patient (e.g. a patient that is known to have HIV, Hepatitis B or Hepatitis C), the depth of the injury and whether it caused any bleeding and, if a needle caused the injury, whether it was hollow-bore or solid (as hollow-bore needles carry higher risks). An incident report should be completed, in line with the workplace or organisation’s policy.

Seek medical evaluation

Although needlestick injuries are not immediately life-threatening and may only look like minor injuries, they should still be taken seriously and the injured person should seek medical evaluation. Medical evaluation should include blood tests to check for infection, specifically for HIV, Hepatitis B and Hepatitis C. If the source patient is known, their blood may also be tested (if possible and consent is given).

The medical evaluation will also require a medical professional to assess the need for Post-Exposure Prophylaxis (PEP), for example, if the patient is HIV-positive or high-risk, the person who received the needlestick injury may be prescribed PEP. PEP is a type of antiretroviral medication and should ideally be started within 2 hours of the injury, although up to 72 hours after is acceptable, and it can significantly reduce the risk of HIV.

If you are unvaccinated for Hepatitis B, you may receive Hepatitis B immunoglobulin (HBIG) and a vaccine. Follow-up testing may also be scheduled over the next six months.

Monitoring for symptoms

Following the injury, it is important to be vigilant for signs of infection, such as fever, rash, redness, swollen lymph nodes, dark urine or jaundice. A healthcare provider will explain infection risks, symptoms to watch for and which follow-up tests need to be attended (e.g., 6 weeks, three months and six months post-exposure).

Needlestick Risk Assessments

A needlestick risk assessment is a systematic process used to evaluate the likelihood and severity of harm caused by needlestick injuries in a healthcare or laboratory setting. It helps identify any potential hazards, evaluate the risks, implement and monitor preventive measures and ensure compliance with safety regulations. The main aim of a needlestick risk assessment is to prevent exposure to sharps injuries or adequately control the risks. Needlestick risk assessments are essential for all employers and organisations where staff may encounter sharps during their duties.

Needlestick risk assessments need to be appropriate to the workplace, the nature of the work and the type of sharp. More high-risk sharps and hazardous workplaces require a more in-depth risk assessment. For example, the risk is higher for procedures such as intravascular cannulation, injections and blood tests. Risk assessments must apply to everyone who is at risk of a needlestick injury, including those who use sharps and those who dispose of them.

The key steps to follow when conducting a needlestick risk assessment are:

Identify needlestick hazards

The first step in the risk assessment should be to determine sharps usage. This involves identifying tasks and procedures where sharps are used, such as injections, blood tests, piercings, tattoos and surgical interventions. The risk assessment should then assess the potential for exposure. This includes identifying situations where employees might inadvertently come into contact with used sharps, including during waste disposal. Any other potential hazards that could cause needlestick injuries should also be identified, for example, if the sharps bin is located on a high shelf, if the room is cluttered or if patients are violent or more likely to move around during the procedure.

Assess the risk

Assessing the risk and the level of risk when using sharps requires the following considerations:

• Work activities: Examine the specific nature of tasks involving sharps to understand how injuries might occur.
• Risk of infection: Does the sharp contain blood or other bodily fluid?
• Who could be at risk: Part of assessing the risk involves identifying who could be at risk. This could be staff members, patients and members of the public.
• Source patient status: Is the patient that the sharp was used on known to have HIV, Hepatitis B, Hepatitis C or another infection that could contaminate the sharp or are they in a high-risk group?
• Potential injury severity: Is the sharp high-risk (e.g., used for taking blood), contaminated or deep?
• Environmental factors: Are safety devices being used, safety protocols in place, appropriate staff training and proper sharps disposal protocols?

The risk assessment should then assess any current controls that are in place and review any existing safety measures to determine their effectiveness in minimising the risk.

Identify appropriate risk controls

Multiple control measures can be outlined in a needlestick risk assessment and effectively implemented, including:

• Where possible, modify work activities or procedures to eliminate unnecessary sharps usage
• Adopt safer sharps devices where possible, for example, sharps with integrated safety features to help reduce the risk of injury.
• Designated sharps containers should be placed at an appropriate height and located close to where activities involving sharps take place.
• Do not overfill sharps containers past the fill line or approximately three-quarters full.
• Do not recap needles or bend or break sharps before disposing of them. When full, sharps bins should be closed and sealed with the locking mechanism engaged.
• Personal protective equipment (PPE) should be available to all staff and should be worn correctly at all times.

Record findings

As part of the recording process, it is important to record what action needs to be taken, who needs to take action and when this action needs to be taken. The record should include a statement that you checked for hazards, who may be affected by the hazards, what actions have been taken to reduce the risk, the effectiveness of any existing precautions and a record of any further action that is planned.

Ongoing monitoring and review

The workplace should be constantly reassessed for new or evolving sharps-related hazards. If any new hazards are identified, the control measures and safety protocols should be updated accordingly to ensure that all risks are addressed effectively.

Safe Use of Needles

Proper needle handling is essential to prevent needlestick injuries, infections and cross-contamination and can protect both healthcare workers and patients. Below is information regarding the best practices to follow to ensure safety in healthcare, laboratories and other settings where needles are used.

Before Using a Needle

Multiple safety protocols can be followed BEFORE the needle is used to ensure the safety of the healthcare worker and the patient. For example:

• Choose the right needle: Choosing the correct type of needle can significantly improve safety. This includes choosing the appropriate needle size and gauge for the procedure and using safety-engineered needles with built-in safety features, where possible, such as retractable or shielded designs.
• Prepare a clean work area: Keep surfaces disinfected and uncluttered and make sure there is nothing in the way of your hands and arms.
• Check needle integrity: Never use a needle without first checking for damage. It is important to ensure the needle is sterile, sealed and undamaged before using it, as this can reduce the risk of injury when removing the needle from the packaging and when using it.
• Wear personal protective equipment (PPE): Always use gloves and, if necessary, wear a gown to reduce exposure risks and create a barrier between the skin and the needle. It can also be beneficial to wear eye protection, such as goggles, to protect the eyes from contamination.
• Plan disposal: Have a sharps container that is puncture-resistant and nonleaking nearby before using the needle. Make sure it is easily accessible, at a safe height and not overfilled. Never place used needles on a surface and make sure to dispose of them immediately.

During Needle Use

While the needle is being used, there is a high risk of injury, particularly if correct protocols are not followed. It is, therefore, important to:

• Handle with care: Avoid sudden movements to prevent accidental puncture. Never hold more than one needle at once and keep both hands clear of anything but the needle. Even small objects, such as plasters or cotton wool should not be picked up until the needle has been disposed of.
• Hold the needle correctly: Use a firm, stable grip as this can prevent the needle from slipping. You should also avoid using excessive force. If resistance occurs, stop and reposition safely, as excessive force can cause the needle to break.
• Never recap a used needle: Needles should never be recapped, even if it wasn’t used as this can increase the risk of self-injury. If necessary, use the one-handed scoop method to reduce the risk of injury.
• Use needles only for intended purposes: Do not use needles for non-medical tasks.

After Using a Needle

Once the needle activity has been completed (e.g., an injection or taking blood), safety protocols are of paramount importance. This includes:

• Dispose of immediately: Place used needles in a puncture-resistant sharps container immediately after use. Never keep a used needle in your hand for longer than is necessary, ask a patient to hold a needle or put it down on any surface. Needles should only be disposed of in designated sharps containers and never put in a regular bin.
• Do not bend or break needles: Bending or breaking the needles or attempting to manually remove the needle from the syringe significantly increases the risk of injury.
• Keep hands away from needle tip: When disposing of the needle, always handle it from the syringe end and avoid any contact with the sharp end. This includes holding it away from your body.
• Ensure sharps containers are not overfilled: Sharp containers should always be replaced when they are three-quarters full or when they reach the full line. If a container is leaking or showing any signs of damage, it should be replaced immediately, even if it is not full.
• Follow local disposal regulations: Always follow the workplace or regional guidelines on disposing of sharps bins. When the sharps bin is full, it should be closed and sealed securely with the locking mechanism engaged. It should then be collected by the appropriate disposal team (e.g., a clinical waste collection team or licensed medical waste company) and never placed with regular rubbish or recycling.