The COVID-19 pandemic has highlighted the importance of health care worker safety. At the height of Italy’s battle against the virus in March, 20% of frontline health care workers were infected. In India, over 87,000 health care workers tested positive for COVID-19. But while infectious disease outbreaks such as COVID-19 illustrate the gaps in protecting frontliners during emergency situations, health care workers regularly face a minefield of risks that are rarely considered.
The prevalence and impact of needlestick injuries is an underrecognized global health issue. The U.S. Occupational Safety and Health Administration, or OSHA, estimates that 5.6 million workers in the health care industry are at risk of occupational exposure to bloodborne pathogens, such as hepatitis B, hepatitis C, and HIV. Injuries most often occur among nurses and surgeons, but OSHA has found that 25% of all injuries in health care facilities occur downstream to the nonoriginal user of the device, such as environmental service personnel and waste haulers.
Devex teamed up with medical technology leader BD to survey more than 1,000 health care workers and interview more than a dozen health care practitioners, needlestick safety experts, and policy thought leaders to find out more about the causes of needlestick injuries: The policies, protocols, and devices that can mitigate the risk, and to learn about their perceptions of health care worker safety and how to overcome barriers to offering more protection.
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The report, “Safety First: Perceptions and recommendations from health care workers on needlestick injuries,” aims to raise awareness of this important topic, and makes the case for better and smarter investments to keep health care workers safe from unnecessary and avoidable injuries in the wider context of health system strengthening in low- and middle-income countries.
1. Needlestick injuries among health workers are more common than you think — especially in LMICs
Needlestick and other sharps-related injuries expose health care and hospital workers to bloodborne pathogens, a significant hazard for global health professionals. Any worker handling sharp devices or equipment, such as scalpels, sutures, hypodermic needles, blood collection devices, or phlebotomy devices, is considered to be at risk. According to the Devex survey, recapping needles is the top needlestick injury event, followed closely by drawing blood and using a solid sharp, such as a scalpel or suture.
The World Health Organization estimates that about 90% of needlestick or sharps-related injuries occur in LMICs, although limitations in reporting data make it difficult to track exact figures. According to the Devex survey, 60% of respondents in Europe have either sustained or know someone who has sustained a needlestick injury. However, among respondents in sub-Saharan Africa, this figure increases to 71%.
“In low-resource settings, the health workforce are often not sufficient to deal with the high number of women coming into the maternal and newborn wards. With few staff and many patients, health care workers are often busy trying to look after everybody,” said Florence West, a midwife advisor at the International Confederation of Midwives.
“Needlestick injuries happen when they’re rushed and don’t take good care when they’re using a needle. In some low-resource settings they may even reuse a needle, so recapping is a practice that can lead to needlestick injuries and is not recommended,” West said.
2. Health care workers understand the risks, and COVID-19 shines the spotlight on health care worker safety
Occupational exposure to bloodborne pathogens due to sharps injuries is a well-known risk among health care workers and typically covered in pre-service education and regular workplace hazard training. In fact, almost all survey respondents acknowledge that needlestick and other sharps injuries can lead to infections such as HIV, HBV, and HCV. Linked to this awareness is the knowledge about preventing sharps injuries among health care professionals — the vast majority of the respondents are either very or extremely aware of the precautions against sharps injury.
The current pandemic has drawn attention to the urgency of protecting health care workers from infections in the workplace — 95% of respondents agreed that the pandemic has increased awareness of health care worker protection issues in their workplace, and 93% also agreed that the current pandemic has sharpened the focus on the availability and proper use of personal protective equipment.
Respondents also note better infection prevention and control measures. 80% agreed that aside from PPE use, other protection measures including needlestick and sharps injury prevention, have improved in their workplace since the onset of the pandemic.
But beyond training and growing awareness, Devex interviewees emphasized the importance of building a culture of safety in the workplace. Safety culture refers to the collective commitment and values that management and employees share to ensure safety within a work environment.
Employees must share in the responsibility of seeing that they are being protected in the workplace, said Sheja Innocent, secretary-general of the Rwanda Nurses and Midwives Union. “Health care workers must be protected by employers and the government, but in turn workers must also respect regulations and protocols to protect themselves.”
3. Safety devices are crucial, but access remains an issue for many
PPE, safety-engineered devices, and sharps disposal containers have become instrumental in ensuring health care worker safety. But the disparity in access to these tools between high- and lower-income regions is apparent.
While 83% of respondents in high-income regions such as North America, Europe, and East Asia agreed that their workplace provides, and is adequately stocked with, devices equipped with a sharps injury prevention feature, such as shields or retracting needles, 72% of respondents from LMICs find that this is the case.
Limited access to affordable and adequate tools and devices, especially in LMICs, increases the incidence of otherwise avoidable injuries. Health care workers highlighted ways product innovation can address safety equipment shortages in LMICs. Through innovative low-cost solutions, these safety devices and treatments can be made more accessible. For example, the University of Virginia School of Medicine has partnered with the University of Kampala nursing school to address the shortage of protective gear in Uganda by training nurses in PPE production.
“In poor areas, cost will always be an issue. But with medical knowledge, you can make the right decisions to get closer to ensuring health worker safety,” Dr. Janine Jagger, a former epidemiologist at the university, said.
“We’re not just teaching nurses how to sew PPE; we’re teaching them the principles behind PPE, about disease transmission and infection control so that nurses have a clear understanding of how to prevent infections,” Jagger said.
Regular safety training on health facility protocols is another crucial component to realize health care worker safety. 85% of Devex survey respondents identified establishing clear policies and training programs as the most effective way to address needlestick and other sharps injuries.
4. Understanding and dismantling barriers to reporting empowers health care workers
While awareness of the risks associated with needlestick and sharps-related injuries is high among health care workers, underreporting remains a significant issue regardless of location.
According to the Devex survey, 61% of respondents believed other health care workers are underreporting needlestick and other sharps injuries. A lack of awareness of the proper reporting protocols was cited as the top reason for not reporting a needlestick injury. Reporting protocols vary at health facilities but underreporting often occurs due to stigmas attached to needlestick injuries, lack of awareness, or downplaying possible consequences.
Forty-four percent of survey respondents believed that there is a stigma attached to reporting needlestick injuries in their facility, which tends to increase among respondents in Asian societies and decrease among respondents in the West.
Post-injury reporting can be strengthened by removing stigmas and setting up reporting mechanisms at the facility level that are clear and easily accessible to health care workers. Surveillance systems such as Exposure Prevention Information Network, or EPINet, help mitigate reporting stigma by tracking exposure events, rather than individuals. Because EPINet data is collected in aggregate, reporting can remain anonymous and free of all personal or facility identifiers.
With over a quarter of survey respondents unaware of needlestick injury reporting protocols, Karen Daley, former president of the American Nurses Association, emphasized the need to strengthen data tracking.
Devex sits down with Amber Mitchell, president and executive director of the International Safety Center, to talk about global health surveillance, the use of data, and health care worker safety.
“Just as with coronavirus, unless you test, you don’t know what the level of infection in the general population is or how well you’re controlling it,” she said. “It’s no different with sharps injuries. If the number of injuries are not monitored, then we don’t know where we are and where the problems exist,” Daley said.
5. Effective safety policies require strong support and consistent enforcement
Finally, reducing and mitigating needlestick injuries requires implementing certain protocols and regulations through consistent enforcement and sustained compliance. While many countries have legislation on needlestick and sharps-related injuries, the implementation of government regulations and laws has scope to improve.
Survey results indicate that while 71% of respondents believed current legislation, regulations, standards, and/or facility policies on preventing needlestick and other sharps injuries are effective, 40% believed they lack enforcement.
Policies and their implementation can be inconsistent and can be further weakened by competing health priorities and strained resources, especially in LMICs, where only 15% of respondents felt strongly that current government and facility policies and regulations are being sufficiently enforced. Devex interviewees emphasized that even with standards in place, sharps safety outcomes ultimately depend on sustained compliance, particularly for health care settings that count on facility safety policies to keep sharps injuries in check.
With the upcoming 20th anniversary of the Needlestick Safety and Prevention Act in the U.S., needlestick safety experts recognize that more work needs to be done to reduce the prevalence of needlestick injuries in the workplace.
International Safety Center President And Executive Director Amber Mitchell noted that while the procurement of devices with sharps injury prevention features may be increasing, OSHA compliance demands that safer devices are being evaluated, considered, and implemented annually.
A combination of investing in continuous and comprehensive sharps education, developing accessible and affordable safety tools and equipment, and strengthening national- and facility-level protocols and standards are key to preventing needlestick injuries and protecting health care workers.
Read the full report for more best practices and case studies on how to better address needlestick injuries among health care workers.