CDC: Better needlestick reporting required
Post-exposure protocol expected to improve rates
A recent study of percutaneous injuries from phlebotomy devices fell in line with previous studies showing that only about half the injuries were reported to hospital surveillance systems. Now that post-exposure prophylaxis appears to reduce occupational HIV transmission, health care facilities and their workers must further assess reasons for under-reporting and devise ways to improve them, such as adding 24-hour hotlines and possibly even tying reports to paychecks, say officials from the Centers for Disease Control and Prevention.
The CDC study, published in the Morbidity and Mortality Weekly Report, found that 302 of 563, or 54%, of needlestick injuries sustained from all types of needles during a year’s evaluation were reported. Reporting rates varied by occupation, with 91% of injuries reported among phlebotomists, 68% among nurses, 35% among medical students, and 31% among residents.
Hazard assessment compromised
Health officials are concerned about the overall low reporting rate among health care facilities because it compromises post-exposure management, including preventive therapy for HIV and hepatitis B virus and assessment of occupational hazards and preventive interventions.
There are several reasons why needlesticks are under-reported, says Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Research and Resource Center in Charlottesville, VA. In some cases, workers don’t consider the needlestick a high-risk event, and therefore don’t bother to report it. At the opposite end, some workers are so afraid they were exposed to a bloodborne pathogen that they don’t want to deal with the consequences of infection. And then there are workers who fear their jobs will be threatened if they report an injury, or they don’t believe anything can be done to protect them once they have been injured.
That last group of workers should diminish as word gets out that the CDC now has evidence that immediate treatment with antiviral drugs does appear to reduce the risk of transmission.
"We are speculating on what the impact of the post-exposure recommendations will be, but we hope it will help improve reporting," says CDC epidemiologist Scott Campbell, RN, MSPH.
With the CDC now recommending post- exposure prophylaxis (until last year there weren’t enough data to make a recommendation), this is a good time for a "blitzkrieg" of information about the importance of reporting and what can be done to reduce transmission of HIV, he says.
Another way to improve reporting is to establish 24-hour hotlines tied to a facility’s employee health and infection control programs. Several large hospitals, particularly those that treat a high number of AIDS patients, have seen their needlestick reporting rates improve by making reporting more convenient and confidential, he says.
"It lets employees know that the institution is looking out for their best interest and wants to get them taken care of as soon as possible," Campbell says.
From anecdotal reports, it appears that more facilities have established 24-hour hotlines since the recommendations were made, Jagger says.
If setting up hotlines and disseminating information doesn’t improve rates adequately, more stringent steps may need to be taken, such as making reporting tied to one’s paycheck, he adds. While that has not been done yet, hospitals have tied tuberculosis testing and other occupational health control measures to employment.
Too soon to measure impact
The response to the new guidelines both in terms of how many exposed workers undergo preventive therapy, and their outcomes won’t be known for a year or so as data are compiled from the CDC’s anonymous registry for occupational exposure and post-exposure preventive therapy. Not only will the registry be valuable for assessing how well health care workers respond to combination therapy, but it will offer for the first time a more complete surveillance of needlestick injuries, HIV seroconversions, and the type of HIV strains being transmitted to health care workers.
"We want to know whether transmission is occurring even with the use of post-exposure prophylaxis," says Harold Jaffe, MD, director of the HIV surveillance branch at the CDC. "We also want to know whether they had a drug-resistant virus. One of the reasons combination therapy was recommended is we know a certain proportion of isolates are resistant to AZT, maybe 10% to 15%, so it seems reasonable, with a significant exposure, to take more than one drug. However, as the use of these drugs becomes more common in the community, presumably there will be more drug-resistant strains, and we don’t know yet whether they will be transmitted to health care workers."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content