SAFER "SHARPS" FOR HEALTHCARE PROFESSIONALS

You've just given a patient an injection. Suddenly you feel a sharp pain in your finger. Ripping off your protective gloves, you look down at your hand -- and see a bright red spot of blood. Your heart sinks as you realize you've just pricked yourself with the used hypodermic.

It's a healthcare professional's worst nightmare -- and it happens all too often. Some 1 million healthcare workers in the U.S. are accidentally jabbed by hypodermic needles each year. Such accidents expose them to a variety of infectious diseases, including HIV, hepatitis B (HBV) and hepatitis C (HCV), as well as infection by other pathogens.

"For any professional handling needles on a daily basis, needlestick injuries are a common occupational hazard," says Eileen Finerty, RN, BSN, CIC, director of infection control at UMDNJ-University Hospital. "Accidents will always happen, but many of them can be prevented through proper safety measures."

In the last few years, needlestick injuries have been the subject of intense scrutiny and research. The focus of the research is on prevention, through the use of safer needles and "sharps." The safety devices include needles with covers, sheaths, or protective caps that slide over the needle after it's been used. Other needles are designed to retract intothe syringe after use.

"The best devices are like seat belts in a car -- you don't have to activate them because they activate automatically," says Finerty. Safety needle products are widely used at UMDNJ, and at many, but not all hospitals. (Their cost -- 50 to 100% more than traditional models -- is the reason they are not universally used.) As effective as these needles are, they have not eliminated the possibility of needlestick injuries.

If a UMDNJ staff member, student, or volunteer is exposed to blood, tissue or other body fluids, a strict protocol is followed. After the necessary first aid, the incident must be reported to a supervisor. Next, the affected person must report directly to the Occupational Medicine Service (OMS) for evaluation, counseling, and indicated treatment. If the OMS is closed, they must go to the Emergency Department. "Before deciding on a course of action, we evaluate the incident," says Lawrence Budnick, MD, OMS director and associate professor of medicine at UMDNJ-New Jersey Medical School. "Was it a suture or a large-bore needle? Was the needle used to draw blood or gain access to a vein? Was the employee's skin punctured, pierced, or scratched?" The patient who was being treated when the incident occurred is also evaluated. If he or she has not been tested for HIV, HBV or HCV, testing will be offered. However, if consent for HIV testing is refused, the patient cannot be forced to comply.

If the healthcare worker was vaccinated against HBV, or had a prior exposure and can document immunity via a positive HBV antibody test, HBV infection is ruled out. If not, he or she is given the HBV vaccine and possibly an injection of immune globulin. The risk of contracting HBV from a single needle exposure is as high as 30 percent; the risk of contracting HCV is 3 to 6 percent; and the risk of contracting HIV is 1.3 percent.

"We offer the HBV vaccine to all healthcare staff, but some refuse it," says Finerty. "It's unfortunate, since the vaccine is very safe -- and less painful than an injection of immune globulin." Unfortunately, there is no preventive treatment available for HCV infection.

If exposure to HIV is suspected, the healthcare worker is offered treatment with a combination of drugs that may reduce the risk of infection. One drug, zidovudine, can prevent infection after exposure. Other drugs, including lamivudine and the protease inhibitors, are believed to be helpful in prevention. They are recommended by the CDC for postexposure prophylaxis in certain circumstances, but have not been approved by the FDA for this indication.

Says Finerty, "Healthcare professionals are increasingly recognizing the risks associated with sharps injuries. UMDNJ has stepped up its emphasis on prevention and education of its staff and is committed to providing a safe workplace for all employees."