https://internationalscholarjournal.org Vol.

2 (1):2024 Research article

INTERNATIONAL SCHOLAR JOURNAL

Needle Stick Injuries in Healthcare Settings: A Persistent Occupational Hazard
Subramanian Chandrodyam*1&2, Adise Nega2, Chalachew Tadess2,
Esayiyas Derbe2, Getachew Zenebe2, Tayo Tadess2, Tewodros Ferede2 Tseharnew Sleshi2
[email protected] *
1. School of Life and Allied Sciences, Baba Farid Institute of Technology, Dehradun, India.
2. Department of Biology, College of Natural and Computational Sciences, University of Gondar, Ethiopia

ABSTRACT

Needle-stick injuries (NSIs) remain a significant occupational hazard for healthcare workers (HCWs), posing a substantial risk of
exposure to bloodborne pathogens, including hepatitis B, hepatitis C, and HIV. This review examines the prevalence, risk factors, and
consequences of NSIs in healthcare settings, highlighting the persistent challenges despite advancements in safety devices and the
implementation of universal precautions.

The review will explore the factors contributing to the occurrence of NSIs, including procedural errors, inadequate training, and the
use of unsafe medical devices. It will delve into the potential consequences of NSIs for HCWs, encompassing the risk of infection
transmission, the psychological impact of exposure, and the potential for long-term health complications.

Furthermore, this review will discuss the importance of effective strategies for preventing NSIs. These strategies include the
implementation and consistent use of safer medical devices, such as needleless systems and safety syringes; adherence to strict
infection control protocols, including proper hand hygiene, safe disposal of sharps, and the use of personal protective equipment; and
comprehensive training programs for all HCWs on safe work practices, including proper needle handling and disposal techniques.

Finally, the review will emphasize the crucial role of incident reporting and post-exposure prophylaxis (PEP) in mitigating the risks
associated with NSIs. Prompt reporting of incidents allows for timely investigation and appropriate medical interventions, while PEP
can significantly reduce the risk of infection transmission following exposure.

By addressing these critical issues and implementing effective prevention strategies, healthcare institutions can significantly reduce
the incidence of NSIs and improve the safety and well-being of their healthcare workforce.

INTRODUCTION
Needle stick injuries (NSIs) represent a significant
The Impact of NSIs:
occupational hazard for healthcare workers (HCWs)
worldwide. These injuries occur when a sharp object, such as a The primary concern with NSIs is the potential for transmission
needle, scalpel, or broken glass, punctures the skin, potentially of blood-borne pathogens. These include:
exposing the worker to blood-borne pathogens. While
advancements in medical technology and safety protocols have  Hepatitis B Virus (HBV): A highly infectious
been made, NSIs remain a persistent concern, impacting the virus that can cause serious liver disease.
health and well-being of healthcare professionals and  Hepatitis C Virus (HCV): A chronic liver
contributing to healthcare costs. infection that can lead to cirrhosis and liver cancer.
 Human Immunodeficiency Virus (HIV):
Understanding the Scope of the Problem: The virus that causes AIDS, a condition that severely
weakens the immune system.
NSIs are not uncommon occurrences in healthcare settings.
Studies have shown that a substantial proportion of HCWs While the risk of transmission for each of these pathogens
experience at least one NSI during their careers. The varies, the potential consequences for an infected HCW can be
prevalence varies depending on factors such as the type of severe.
healthcare facility (hospitals, clinics, long-term care facilities),
the specific department (emergency departments, operating
rooms), and the type of procedures performed.

Subramanian et al. Page 1

 https://internationalscholarjournal.org Vol.2 (1):2024 Research article
such as needleless systems, retractable needles, and
self-sheathing syringes, significantly reduce the risk of
Beyond the Risk of Infection: injury during procedures.
 Proper Disposal of Sharps: Dedicated sharps
The impact of NSIs extends beyond the risk of disease containers should be readily available and properly
transmission. used for the disposal of all sharps. These containers
should be puncture-resistant and clearly labeled.
 Education and Training: Comprehensive
 Psychological Distress: NSIs can cause training programs on safe injection techniques, the use
significant anxiety and fear among HCWs. The fear of of safety devices, and the importance of adhering to
contracting a serious illness can lead to psychological universal precautions should be provided to all HCWs,
distress, including anxiety, depression, and post- including nurses, physicians, technicians, and other
traumatic stress disorder. healthcare personnel.
 Lost Work Time: Following an NSI, HCWs may  Adherence to Standard Precautions:
require medical evaluation, testing, and post-exposure Consistent adherence to standard precautions,
prophylaxis (PEP), which can involve medications including the use of PPE, hand hygiene, and safe work
and ongoing monitoring. This can result in time away practices, is essential to prevent the spread of
from work, impacting both the individual and the infections and reduce the risk of NSIs.
healthcare system.
 Needleless Systems: Whenever possible,
 Increased Healthcare Costs: The costs needleless systems should be used to reduce the risk of
associated with NSIs include medical evaluations, injury.
testing, PEP medications, and lost productivity. These
costs can be substantial for both individual HCWs and
 Incident Reporting and Surveillance:
Thorough reporting and surveillance of NSIs are
healthcare institutions.
crucial to identify trends, evaluate the effectiveness of
prevention strategies, and implement necessary
Factors Contributing to NSIs: improvements.

Several factors contribute to the occurrence of NSIs in

healthcare settings:

 Unsafe Injection Practices: Improper needle

recapping, needle reuse, and inadequate disposal of
sharps are significant contributors to NSIs.
 Inadequate Training: Insufficient education and
training on safe injection techniques, the use of safety
devices, and the importance of adhering to universal
precautions can increase the risk of injury.
 Lack of Personal Protective Equipment
(PPE): Insufficient or inappropriate use of gloves,
gowns, and other protective gear can expose HCWs to
potential hazards.
 Overcrowding and Workload: Increased
workload and overcrowding in healthcare settings can
lead to rushed procedures and increased risk of
accidental punctures.
 Patient Factors: Patients with aggressive or
unpredictable behavior may pose a greater risk to
HCWs.

Prevention Strategies:

Sharps Safety Devices: Implementing effective

prevention strategies is crucial to minimize the risk of NSIs:

 The use of safety devices on needles and other sharps

is a cornerstone of NSI prevention. These devices,
Subramanian et al. Page 1
 https://internationalscholarjournal.org Vol.2 (1):2024 Research article
Methods 4. Other Factors:

Needle stick injuries (NSIs) can occur in various ways within

 Lack of Awareness: Insufficient knowledge
healthcare settings. Understanding these mechanisms is crucial among healthcare workers regarding safe handling and
for effective prevention strategies. Here are some of the disposal of sharps.
primary methods:  Distractions and Rushing: Rushing through
procedures or distractions can lead to errors and
increase the risk of injury.
1. During Use:
 Inadequate Training: Insufficient training on
safe injection techniques, the use of safety devices, and
 Accidental Puncture: This is the most common the importance of adhering to universal precautions.
scenario. It can happen during:  Overcrowding and Workload: Increased
o Needle Insertion and Withdrawal: workload and overcrowding in healthcare settings can
When inserting or withdrawing needles contribute to stress and increase the likelihood of
during procedures like injections, blood errors.
draws, or intravenous (IV) therapy.
o Manipulating Needles: While handling Preventing NSIs Requires a Multifaceted
needles for procedures, such as preparing Approach:
injections or transferring fluids.
o Recapping Needles: A common and Addressing these various methods of NSI occurrence requires a
dangerous practice, recapping needles multi-pronged approach, including:
increases the risk of accidental punctures.
o Passing Sharps: Insecurely passing  Enhanced Training and Education:
needles or other sharps between healthcare Comprehensive training programs for all healthcare
workers. workers on safe injection techniques, the use of safety
o Collisions: Accidental contact with a devices, and the importance of adhering to universal
needle or other sharp object during patient precautions.
care or while moving around the healthcare  Implementation of Safety Devices:
setting. Widespread use of safety-engineered devices on
needles and other sharps, such as retractable needles,
2. During or After Disposal: self-sheathing syringes, and needleless systems.
 Improved Work Practices: Promoting safe
work practices, such as avoiding unnecessary needle
 Improper Disposal: recapping, using two-handed techniques for handling
o Direct Contact: Touching or handling sharps, and ensuring proper disposal of all sharps in
used needles or other sharps before proper designated containers.
disposal.  Creating a Culture of Safety: Fostering a
o Incorrect Placement: Not placing used culture of safety within healthcare settings, where all
sharps in designated sharps containers. workers are actively involved in identifying and
o Overfilling Sharps Containers: addressing safety concerns.
Overfilling sharps containers can increase
the risk of punctures when removing or By understanding the various mechanisms of NSI occurrence
replacing them. and implementing effective prevention strategies, healthcare
facilities can significantly reduce the risk of these injuries and
3. Due to Equipment Design and Failure: protect the health and well-being of their workforce.

 Faulty Equipment: Malfunctioning or defective

equipment, such as syringes with loose or broken
parts, can increase the risk of injury.
 Lack of Safety Features: The absence of safety
features on needles and other sharps devices, such as
retractable needles or self-sheathing syringes.

Subramanian et al. Page 1

 https://internationalscholarjournal.org Vol.2 (1):2024 Research article
RESULT
 prophylaxis (PEP), which can involve medications and
Needle stick injuries (NSIs) can have a range of consequences ongoing monitoring. This can lead to time away from
for healthcare workers (HCWs), extending beyond the work, impacting both the individual and the healthcare
immediate physical wound. These impacts can be categorized system.
into:  Increased Healthcare Costs: The costs
associated with NSIs include medical evaluations,
1. Health Risks: testing, PEP medications, and lost productivity. These
costs can be substantial for both individual HCWs and
healthcare institutions.
 Transmission of Blood-borne Pathogens:
o Hepatitis B Virus (HBV): HBV is a
significant concern. While vaccination rates
4. Long-Term Health Consequences:
are high among HCWs, there's still a risk of
infection.  Chronic Infections: Infections with HBV, HCV,
o Hepatitis C Virus (HCV): HCV or HIV can have significant long-term health
infection can lead to chronic liver disease, consequences, including liver disease, cancer, and
cirrhosis, and liver cancer. immune system impairment.
o Human Immunodeficiency Virus  Chronic Pain: In some cases, NSIs can lead to
chronic pain at the injury site.
(HIV): The risk of HIV transmission
through an NSI is relatively low, but it
remains a serious concern. Mitigating the Consequences:
 Other Infections: While less common, NSIs can
potentially transmit other blood-borne pathogens,  Prompt Medical Attention: Seeking immediate
such as bacterial infections. medical attention following an NSI is crucial. This
allows for appropriate evaluation, testing, and initiation
of PEP if necessary.
2. Psychological Impact:
 Psychological Support: Access to counselling
and psychological support services can help HCWs
 Anxiety and Fear: The fear of contracting a cope with the emotional and psychological impact of
serious illness can cause significant anxiety and NSIs.
distress among HCWs following an NSI. This anxiety  Employee Assistance Programs: Many
can persist even when testing negative for blood- healthcare institutions offer employee assistance
borne pathogens. programs (EAPs) that provide confidential counselling
 Psychological Distress: NSIs can trigger a range and support services to employees.
of psychological reactions, including:  Vaccination: Vaccination against HBV is highly
o Anxiety disorders: Generalized anxiety recommended for all HCWs.
disorder, obsessive-compulsive disorder  Post-Exposure Prophylaxis (PEP): PEP
(OCD) related to infection fears. involves the administration of medications to prevent
o Depression: Feelings of sadness, infection after a potential exposure to a blood-borne
pathogen.
hopelessness, and low self-esteem.
o Post-traumatic stress disorder
(PTSD): In some cases, NSIs can trigger
PTSD symptoms, such as flashbacks,
nightmares, and hypervigilance.
 Stigma and Discrimination: Concerns about
disclosure of the NSI and potential stigma within the
workplace can further exacerbate psychological
distress.

3. Occupational and Economic Impacts:

 Lost Work Time: Following an NSI, HCWs may

require medical evaluation, testing, and post-exposure
Subramanian et al. Page 1
 https://internationalscholarjournal.org Vol.2 (1):2024 Research article

results in increased healthcare costs for both

Discussion individuals and healthcare institutions.
 Long-Term Health Consequences: Infection
Needle stick injuries (NSIs) represent a significant occupational with blood-borne pathogens can have serious long-
hazard for healthcare workers (HCWs), posing a substantial risk of term health implications, including chronic liver
blood-borne pathogen transmission. These injuries not only have
immediate health implications but also profound psychological and
disease, cancer, and immune system impairment.
socioeconomic consequences.
Prevention Strategies:
Prevalence and Risk Factors:
Implementing effective prevention strategies is crucial to
While the exact prevalence of NSIs varies across studies and minimize the risk of NSIs:
healthcare settings, it remains a concerning issue. Factors
contributing to the risk of NSIs include:  Sharps Safety Devices: The use of safety devices
on needles and other sharps is paramount. These
 Unsafe Injection Practices: Improper needle devices, such as needleless systems, retractable
recapping, needle reuse, and inadequate disposal of needles, and self-sheathing syringes, significantly
sharps are major contributors. reduce the risk of injury.
 Inadequate Training: Insufficient education and  Proper Disposal of Sharps: Dedicated sharps
training on safe injection techniques, the use of safety containers should be readily available and properly
used for the disposal of all sharps.
devices, and adherence to universal precautions.
 Lack of Personal Protective Equipment  Education and Training: Comprehensive
training programs on safe injection techniques, the use
(PPE): Insufficient or inappropriate use of gloves, of safety devices, and the importance of adhering to
gowns, and other protective gear. universal precautions should be provided to all HCWs.
 Overcrowding and Workload: Increased  Adherence to Standard Precautions:
workload and overcrowding in healthcare settings can Consistent adherence to standard precautions,
lead to rushed procedures and increased risk of including the use of PPE, hand hygiene, and safe work
accidental punctures.
practices, is essential.
 Patient Factors: Patients with aggressive or  Needleless Systems: Whenever possible,
unpredictable behavior may pose a greater risk to
needleless systems should be used to reduce the risk of
HCWs.
injury.
 Incident Reporting and Surveillance:
Consequences and Implications: Thorough reporting and surveillance of NSIs are
crucial to identify trends, evaluate the effectiveness of
The consequences of NSIs are multifaceted: prevention strategies, and implement necessary
improvements.
 Health Risks:
o Transmission of Blood-borne Challenges and Future Directions:
Pathogens: The primary concern is the
potential transmission of infectious diseases, Despite advancements in safety technology and protocols,
including hepatitis B virus (HBV), hepatitis challenges remain:
C virus (HCV), and human
immunodeficiency virus (HIV).  Adherence to Safe Practices: Ensuring
o Other Infections: NSIs can also transmit consistent adherence to safety protocols in busy and
other blood-borne pathogens, though less stressful healthcare environments can be challenging.
common.  Accessibility and Affordability: Access to and
 Psychological Impact: NSIs can cause affordability of safety devices can vary across
significant anxiety, fear, and psychological distress healthcare settings.
among HCWs. The fear of contracting a serious  Emerging Technologies: The rapid evolution of
illness can lead to anxiety, depression, and post- medical technologies necessitates ongoing evaluation
traumatic stress disorder (PTSD). and adaptation of safety measures.
 Occupational and Economic Impacts: NSIs  Addressing Psychological Impact: Providing
can lead to lost work time due to medical evaluations, adequate support services, including counseling and
testing, and post-exposure prophylaxis (PEP). This
Subramanian et al. Page 1
https://internationalscholarjournal.org Vol.2 (1):2024 Research article
psychological support programs, is essential to
address the psychological impact of NSIs on HCWs.

Subramanian et al. Page 1

 https://internationalscholarjournal.org Vol.2 (1):2024 Research article
Conclusion
Needle stick injuries (NSIs) remain a significant occupational
hazard for healthcare workers (HCWs) worldwide. Despite
advancements in safety technology and protocols, these
injuries continue to occur, posing a risk of blood-borne
pathogen transmission and significant psychological and
economic consequences.

While substantial progress has been made in recent years,

several challenges persist:

 Adherence to Safe Practices: Ensuring

consistent adherence to safety protocols in busy and
stressful healthcare environments remains a
significant challenge.
 Accessibility and Affordability: Access to
and affordability of safety devices can vary across
healthcare settings, particularly in resource-limited
settings.
 Emerging Technologies: The rapid evolution of
medical technologies necessitates ongoing evaluation
and adaptation of safety measures to address new
risks and challenges.
 Addressing the Psychological Impact:
Providing adequate support services, including
counselling and psychological support programs, is
crucial to address the significant psychological impact
of NSIs on HCWs.

Addressing these challenges requires a multi-faceted approach:

 Continuous Improvement: Ongoing

evaluation and improvement of safety protocols and
technologies are essential to ensure they remain
effective in evolving healthcare environments.
 Stronger Regulatory Measures: Enforcing
stricter regulations regarding the use of safety devices
and the implementation of safety protocols can further
enhance workplace safety.
 Increased Awareness and Advocacy:
Raising awareness among HCWs and healthcare
institutions about the importance of NSI prevention
and the availability of effective safety measures is
crucial.
 Investing in Research: Continued research to
develop and evaluate new safety technologies and
interventions, such as improved safety devices and
more effective training programs, is vital.

 Fostering a Culture of Safety: Creating a

strong culture of safety within healthcare settings,

Subramanian et al. Page 1

https://internationalscholarjournal.org Vol.2 (1):2024 Research article

REFERENCES
14. Perkins, J. A., & Henderson, D. K. (2008). Needle stick
1. World Health Organization (WHO). (2016). injuries in healthcare settings: A review. American
Guidelines for the prevention of occupational Journal of Infection Control, 36(7), 507-514.
exposures to HIV and other blood-borne 15. World Health Organization (WHO). (2016).
pathogens in healthcare settings. Guidelines for the prevention of occupational
2. Centers for Disease Control and Prevention exposures to HIV and other blood-borne pathogens in
(CDC). (2023). Guidelines for prevention of healthcare settings.
occupational exposures to blood-borne pathogens. 16. CDC. (2023). Guidelines for prevention of
3. Perkins, J. A., & Henderson, D. K. (2008). Needle occupational exposures to blood-borne pathogens.
stick injuries in healthcare settings: A review. 17. Thomas, D. C., & Dixon, B. (2007). Needle stick
American Journal of Infection Control, 36(7), 507- injuries: A review. Occupational Medicine, 57(2), 113-
514. 118.
4. Thomas, D. C., & Dixon, B. (2007). Needle stick
injuries: A review. Occupational Medicine, 57(2), 18. Perkins, J. A., & Henderson, D. K. (2008). Needle
113-118. stick injuries in healthcare settings: A review.
American Journal of Infection Control, 36(7), 507-514.
5. Kim, Y. J., Kim, H. J., & Kim, M. J. (2014). 19. CDC. (2023). Guidelines for prevention of
Prevalence of needlestick injuries and associated occupational exposures to blood-borne pathogens.
risk factors among healthcare workers in Korea: A 20. Thomas, D. C., & Dixon, B. (2007). Needle stick
systematic review. Journal of Korean Medical injuries: A review. Occupational Medicine, 57(2),
Science, 29(1), 1-8. 113-118.
6. Park, J. Y., et al. (2013). Prevalence and risk
factors of needlestick injuries among healthcare 21. Perkins, J. A., & Henderson, D. K. (2008). Needle
workers in Korea: A multicenter study. Journal of stick injuries in healthcare settings: A review.
Korean Medical Science, 28(11), 1713-1719. American Journal of Infection Control, 36(7), 507-514.
7. World Health Organization (WHO). (2004). 22. CDC. (2023). Guidelines for prevention of
Global strategy for the prevention of mother-to- occupational exposures to blood-borne pathogens.
child transmission of HIV and the prevention and 23. Thomas, D. C., & Dixon, B. (2007). Needle stick
treatment of sexually transmitted infections. injuries: A review. Occupational Medicine, 57(2),
113-118.
8. Alavian, S. M., & Mahmoodi, M. (2012). Risk
factors for needlestick injuries among healthcare 24. Perkins, J. A., & Henderson, D. K. (2008). Needle
workers: A systematic review. Iranian Journal of stick injuries in healthcare settings: A review.
Public Health, 41(1), 1-10. American Journal of Infection Control, 36(7), 507-514.
9. Darzi, A., et al. (2006). Risk factors for needlestick 25. CDC. (2023). Guidelines for prevention of
injuries among nurses in Iran. Journal of Nursing occupational exposures to blood-borne pathogens.
Care, 15(3), 8-14.
10. MacDonald, K. L., et al. (2005). Risk factors for
needlestick injuries among healthcare workers in a 26. Cardoso, F. R., et al. (2012). Psychological impact of
large Canadian needlestick injuries among healthcare workers: A
11. hospital. American Journal of Infection Control, systematic review. Journal of Clinical Nursing, 21(17-
33(10), 596-601. 18), 2526-2537.
27. Kim, H. J., et al. (2013). Psychological impact of
needlestick injuries among Korean nurses.
11. Cardoso, F. R., et al. (2012). Psychological impact International Journal of Nursing Studies, 50(1), 104-
of needlestick injuries among healthcare workers: 111.
A systematic review. Journal of Clinical Nursing,
21(17-18), 2526-2537.
12. Kim, H. J., et al. (2013). Psychological impact of 28. Perkins, J. A., & Henderson, D. K. (2008). Needle
needlestick injuries among Korean nurses. stick injuries in healthcare settings: A review.
International Journal of Nursing Studies, 50(1), 104- American Journal of Infection Control, 36(7), 507-514.
111. 29. Thomas, D. C., & Dixon, B. (2007). Needle stick
13. World Health Organization (WHO). (2000). injuries: A review. Occupational Medicine, 57(2),
Occupational exposure to blood-borne pathogens: 113-118.
Guidelines for prevention and management.
Subramanian et al. Page 1
https://internationalscholarjournal.org Vol.2 (1):2024 Research article
30. CDC. (2023). Guidelines for prevention of
occupational exposures to blood-borne pathogens.
31. World Health Organization (WHO). (2000).
Occupational exposure to blood-borne pathogens:
Guidelines for prevention and management.

32. Perkins, J. A., & Henderson, D. K. (2008). Needle

stick injuries in healthcare settings: A review.
American Journal of Infection Control, 36(7), 507-
514.
33. Nursing Administration, 32(10), 444-450.
34. Aiken, L. H., et al. (2003). Hospital nurse
staffing and patient mortality, nurse
injury, .

36. World Health Organization (WHO).

(2016). Guidelines for the prevention of
occupational exposures to HIV and other
blood-borne pathogens in healthcare
settings.

Subramanian et al. Page 1