At The Same Time, Needles Are Responsible For An Alarming Number Of Medical Injuries [TOP]

A number of jurisdictions have used regulation to promote the adoption of safety-engineered needles as a primary solution to reduce the risk of needlestick injuries among healthcare workers. Regulatory change has not been complemented by ongoing efforts to monitor needlestick injury trends which limits opportunities to evaluate the need for additional investment in this area. The objective of this study was to describe trends in the incidence of needlestick injuries in Ontario prior to and following the establishment of regulation to promote the adoption of safety-engineered needles.

At The Same Time, Needles Are Responsible For An Alarming Number Of Medical Injuries

Needlestick injuries represent an important burden of occupational injury in the health care sector. A number of jurisdictions, including the province of Ontario, Canada, turned to regulation to accelerate the adoption of safety-engineered needles (SENs) for the prevention of needlestick injuries. In 2005, 3-years prior to regulation being established in Ontario, a national survey of the work and health of nurses in Canada found that nearly half of surveyed nurses reported being injured by a needle or another sharp tool at some point during their career and 11% reported such an injury in the previous year [1].

Rates were calculated by dividing the total number of needlestick injuries by the estimate of annual hours worked expressed per 10,000 full-time equivalents. It is important to note that emergency department records do not include a coding scheme to identify specific industries or occupations. Therefore, records of needlestick injuries from this data source include injuries that occur both within and outside the health and social services sector. The ratio of the frequency of compensation claims associated with needlestick injuries in the health and social services to the frequency of claims associated with needlestick injuries in all sectors was used to estimate the number of work-related emergency department records associated with needlesticks in the health and social services. Percent changes in the rates were estimated for two time periods: 2004 vs 2012 and 2006 vs 2011 (the time period available for both data sources). As a result of low counts of needlestick injuries in specific rate groups in the health and social services, rates were only calculated for three rate groups (i.e., long-term care; hospitals, nursing services).

An important strength of this study is the use of two independent administrative data sources to examine trends in the incidence of needlestick injury during a period of regulatory change that promoted the uptake of SENs in the provincial health care system. The results of this study should be interpreted with the following cautions. Not all needlestick injures will require emergency services, result in a lost-time claim, or result in a form being submitted to the Program for Exposure Incident Reporting. As a result, the ascertainment of needlestick injury is incomplete. While the administrative records used in this study have the advantage of describing trends overtime, it is important to acknowledge the potential for changes in reporting behavior over this time period. Increased attention to needlestick injury prevention during the period of regulatory change may have resulted in increased reporting of needlestick injuries. Alternatively, an increase in injury risk may have also occurred as healthcare workers learned to adapt to the new technology. Finally, we acknowledge that the true incidence of needlestick injuries is underestimated in both emergency department records and compensation claims: a number of studies that have examined levels of under-reporting among front-line workers suggest anywhere from 30-90% of needlestick injuries go unreported [15-21]. The need to identify further opportunities to reduce needlestick injuries was emphasized on the occasion of the tenth anniversary of the Needlestick Safety and Prevention Act [22]. A Consensus Statement and Call to Action drafted by members of a multi-stakeholder steering committee acknowledged that while substantial progress has been made, preventable sharps injuries and blood exposures continue to occur in healthcare settings. The committee recognized that one cannot assume that all issues will be resolved following the enactment of regulatory standards to promote the uptake of safety-engineered medical sharps and that a renewed commitment was needed to achieve further progress [22].