Sunday, 27 September 2009

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Needle stick injuries: who gets hurt and why

Healthcare professionals routinely refuse care to positive people, or charge them more for treatment. Part of this is certainly just plain prejudice. But some are also afraid of HIV infection. Are healthcare staff trained and equipped to prevent occupational exposure to blood borne infections?

A paper by S T Jayanth and others in the January 2009 issue of the Indian Journal of Medical Microbiology reported an analysis of one of the better tertiary care hospitals in the country where there are protocols for the management and follow-up of needle stick injuries (NSIs), and Hepatitis B vaccines and HIV prophylaxis are given when necessary. A register for recording NSIs has been maintained since 1993 and contains details of each incident including whether universal precautions were followed.  

In the 296 NSIs in 2006-2007, almost half the staff members involved had less than one year’s work experience. The majority of injuries occurred during procedures like blood collection and surgery but 8.45% were from improper disposal of sharps and 14.86% from recapping a needle.  

Some 33.1% of staff who sustained NSIs were not adequately immunised for Hepatitis B though this is standard prevention practice for healthcare staff, and especially so in tertiary care hospitals.  

The authors conclude that more than 75% of NSIs occurred when universal precautions or standard procedures were not followed. It would be useful to know the mechanism by which 25% of NSIs occurred despite following “adequate” precautions.   

Some 293 of 296 people in this review were followed up for six months. At the end of this period, none had sero-converted.  

This is the case in one of the better run hospitals in the country. We can safely assume that staff in the average nursing home are not as well trained or protected from infection, and injuries are not properly recorded, reported and followed up. Inadequately trained staff will always be at greater risk of blood borne infections.

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