Accidental Needlesticks: The Silent Killer

By Karen Daley

We all know that doctors and nurses work long hours under trying conditions, particularly in hospital emergency rooms, to save lives and bring healing and comfort to the sick.

What too many people do not know is that healthcare workers face a potential silent killer every day that is so common it is routinely overlooked and ignored: accidental needlesticks.

Every year in the United States, more than 400 million blood draws are performed. Some of these are carried out during routine doctor visits, some in outpatient laboratory settings, many in the emergency room (ER) or ambulances, where workers and patients are under extreme stress, circumstances can be chaotic, and safety measures compromised in the rush against time.

Nearly every healthcare worker has a story about a needlestick or a near miss. Even the most experienced nurses and other practitioners, working long hours with no margin of error, will experience that sinking feeling of dread when the sharp end of a used needle accidentally punctures their skin with a potential to cause infection.

My own story is from the summer of 1998, when I was working as a nurse in the emergency room (ER) at Brigham and Women’s Hospital in Boston. Asked by a colleague to perform a blood draw on a patient with difficult venous access, I was able accomplish the task on my first attempt.

Unfortunately, when I went to dispose of the needle in the biohazard container on the wall behind me, I was accidentally stuck by another disposed needle poking out from the overfilled box.

Like many nurses, I’d been stuck before, maybe half a dozen times, and had only reported about half of them.

In this case, I decided to report my injury, at the supportive insistence of an ER colleague who witnessed it occur. Thank goodness I did, because it wasn’t long until I began having some vague symptoms that included weight loss, fatigue and malaise that concerned both me and my doctors. Five months later, I was diagnosed with HIV and hepatitis C, a result of that same inadvertent needlestick. In 1998, this meant a frightening and potentially life-threatening road ahead with long, intensive, and difficult treatment regimens.

I was not alone in the circumstances surrounding my needlestick injury. More than 2 million infectious needlesticks are sustained by healthcare workers each year across the globe, according to the World Health Organization (WHO), and more than 1.3 million people die annually as a result of unsafe injection practices. The reality is surely far grimmer: Surveys show that, like in my previous experiences, it is possible that as many as 50% of needlesticks may go unreported by healthcare workers.

Doctors, nurses, paramedics and EMTs tend to be battle-hardened and resilient. Often, after getting stuck, a nurse will make a quick calculation: Was the patient a high-risk individual? Is it worth going through the drawn-out, anxiety-inducing process of reporting the stick, taking toxic medications and enduring the subsequent health surveillance?

In some cases, healthcare workers might even be blamed for making the “careless mistake” of getting stuck. In a big-city ER, at the back end of a 12-hour shift, handling dozens of patients an hour – many of them frightened, unruly, violent, or otherwise challenging to provide care for – it is all too easy for a needle to miss its mark by a fraction of an inch and stick a healthcare worker.

Determined to use my own experience to prevent this from happening to others, I worked with my nurse colleagues in the American Nurses Association (ANA) along with others, including elected officials, to advocate for federal legislation to improve needle safety.

In 2001, during my term as president of the ANA affiliate in Massachusetts, President Clinton signed the Needlestick Safety and Prevention Act, which required hospitals to make safety-engineered sharps devices available to their workers whenever appropriate to prevent injuries similar to mine.

In the first year after the law went into effect, needlesticks dropped by as much as one-third, according to the Centers for Disease Control and Prevention (CDC).

Unfortunately, based on that early success and projected estimates for continued injury reduction in the intervening years, federal and state governments and the industry itself have not kept an adequate focus on the issue. In fact, the national injury surveillance system for healthcare workers operated under the CDC was discontinued after December 2007.

The Occupational Safety and Health Administration (OSHA), which is charged with regulatory enforcement, too often relies on employers to voluntarily comply with the law. Site surveys conducted by OSHA are normally triggered by confidential worker complaints or random OSHA inspections, which occur too infrequently.

Despite the fact that injuries persist and remain underreported, they are once again invisible. We cannot let that continue. More than 60 blood borne pathogens can be transmitted through needlesticks. Future efforts to reduce US sharps injuries will require revitalized surveillance and compliance enforcement efforts along with ongoing efforts by employers to prevent future injuries and exposures.

Hospitals are rightly focused on patient safety, and financial incentives exist that promote measures to be taken to protect patients from preventable illness and injury. It is important that institutional safety systems focus equally on worker safety as patient safety.

If workers are not safe, patients are less safe. The reality for injured workers is that needlestick injuries can create significant burdens for them (even when no disease is transmitted) as well as employers and have meaningful impacts on patient care.

My own injury and resulting infections have already given rise to over $1 million in healthcare costs and that is without even one hospitalization. If I had not reported my needlestick, those costs would have bankrupted me and likely ended my career, or even worse, my life.

The momentum we were able to harness following my injury resulted in crucial public policy reform that has saved lives. That positive momentum has dramatically slowed in recent years and now shows signs of completely evaporating.

We must do more to enforce the regulations that currently exist under that law and strengthen protections by taking advantage of new knowledge, new technologies and the increased awareness that experiences like mine have brought.

Each of us either has or will watch helplessly and hopefully as a loved one is wheeled into an operating room, a trauma center or lab for tests that could mean life or death. We put our trust and faith in the nurses and doctors who are caring for them. These healthcare professionals are owed the same care they give to us.

Karen Daley was a clinical nurse for 26 years prior to her injury and is the former president of the American Nurses Association. She is a longtime advocate of sharps safety for healthcare workers and patients.