An Old Pro Stays in the Fight Against Needlesticks
May 1, 2024
At age 78, with more than 50 years of clinical consultation and research on needlesticks, sharps injuries, and medical waste, Terry Grimmond, FASM, BAgrSc, GrDpAdEdTr, says he retired at the end of 2023 but is still winding his career down with a few final projects.
It is hard to believe. Grimmond has an enthusiasm and passion for protecting healthcare workers that belies his age. If anything, Grimmond looked tanned, rested, and ready in a Zoom interview he agreed to do with Hospital Employee Heath, the transcript of which has been edited for length and clarity. Grimmond originally hails from Australia, but now calls New Zealand home.
As founder and owner of Grimmond and Associates, Microbiology Consultancy, Grimmond has spoken and consulted in more than 20 countries, also volunteering for a stint in Sierra Leone during the 2015 Ebola outbreak. Ebola has been transmitted through needlesticks, Grimmond reminds, as have scores of other pathogens.
HEH: There has been a lot of progress in developing post-exposure prophylaxis and treatment for HIV, a vaccine for hepatitis B virus (HBV), and curative treatment of hepatitis C virus (HCV). Why are needlesticks still so important?
Grimmond: When I speak on this, I say, “How many bloodborne pathogens do you think can be transmitted with a needlestick injury?” Most people give me the classic three: HIV, HBV, and HCV. Well, there are actually 60.1
HEH: A paper included Ebola and mosquito-borne malaria, but not at least two needlesticks that led to transmission of Zika virus in the lab after the mosquito-borne virus appeared in the United States in 2015.2
Grimmond: Yes, if you think about it with malaria [or Zika], a syringe containing infected blood is just a mosquito without wings. Nobody ever thinks about that. Well, organisms are always smarter than we are. They will find a way of getting into us. That’s part of their remit, to infect and multiply, and that means there are lot of organisms that can get into us. As a young microbiologist, I was always interested in how organisms got from one person to another — disease transmission. Bloodborne or blood and body fluid exposures enter through three mechanisms: needlesticks, a splash to the mucosa, or contaminating an existing scratch or skin broken due to dermatitis. I think in 1984, when the first healthcare worker contracted HIV, I began to change [my practice]. Instead of protecting patients from healthcare-associated infections, I moved my research to protecting healthcare personnel from getting infected by patients.
HEH: You estimated that there were 800 needlesticks a day in the United States about five years ago, but say that these injuries are significantly undercounted today.
Grimmond: We believe that healthcare personnel are reporting less of their injuries. I think a lot of healthcare workers aren’t as concerned. I sometimes get healthcare personnel, when I’m speaking on this, who say, “But Terry, you can cure HIV now. You can cure HCV. You can’t cure HBV, but it does have a very effective vaccine against it.” But that is only three — what about all the other pathogens that you could get through that needlestick injury? When you look at a needlestick injury, and you do the interviews if it’s a deep injury in particular — in other words, if you can see blood and it’s bleeding profusely — [the healthcare worker] has a greater risk of acquiring a disease if the patient has a disease. The bigger the needle bore, the deeper the injury, and if the patient has a disease. About 1.5% of people in the U.S. carry either HIV, HBV, or HCV. You don’t know what they have, and they don’t have to tell you. You can assume they are positive.
But, in general, needlesticks have fallen off the radar. There’s a marked reduction in the number of papers being published on sharps injuries in the Western world, and a small group of us in the U.S. are trying to remedy that by publishing and reminding people these are still occurring. You can still get infected. Sometimes, there are physical injuries caused by needlesticks. A young nurse in the United Kingdom put a needle through the palm of her hand, and it entered a nerve and sinew. After several surgeries, even a year later, she still could not fully use her hand. Surgeons have the highest rate of sharps injuries than anyone in healthcare because they’re dealing with scalpels and needles. I’ve had surgeons say to me, “It comes with the job.” You name one other industry where somebody comes to work expecting to get injured. There aren’t any. You look at the big construction industries with huge signs at their entrance or on their gate saying, “324 days since the last accident.” I’ve never seen one of those signs at a hospital.
HEH: You recently published an article about prefilled safety syringes that have been used for years despite a defect that has sometimes caused needlesticks when activating the safety mechanism.3 It was impressive that you and co-authors at the Association of Occupational Health Professionals in Healthcare (AOHP) studied 12 years of data to determine your findings.
Grimmond: We think it was a combination of two factors. You know, nurses tend to put themselves second when they’re dealing with patients. Also, as a general rule, when they injure themselves with a safety device ... because it’s called a “safety device,” they automatically assume it’s safe. But not all safety devices are safe. I think this is a classic example of it. When [the device] malfunctioned, a lot of the nurses put in their report when they were injured: “My fault. I must have done something wrong.”
It was probably the fact that the nurses were saying it was their fault that the reports weren’t coming up of a malfunctioning device, which probably would have invoked immediate action. Although I have to say several of the occupational managers said they reported it. Secondly, I think the FDA is under-resourced. We contacted the FDA and carefully looked at their MedWatch system. Their words were something along the lines of, “We will work with the institution to gain more information on this.” The inference was that the FDA would then go back to the manufacturer and inquire about it. We wrote to the FDA, and they said, “We cannot discuss an ongoing investigation.” We were hopeful that that meant they were actually looking into it. The manufacturer did reply to us and said that they have taken steps to remedy it by working with a third party that manufactures the syringe.
HEH: The EXPO-S.T.O.P. needlestick survey by AOHP was discontinued during the pandemic. However, you and your AOHP colleagues are working on a 2024 survey for U.S. hospitals. You said you have reduced the number of questions to five to try to increase participation by busy employee health professionals.
Grimmond: Yes, we’ve absolutely contracted it to the bare minimum to try and make it easier for people to participate. Therein lies a large problem in terms of employee health workloads. But if you can get enough hospitals participating to get a national incidence rate, you can actually break the hospital sizes up in terms of beds or [full-time] staff, teaching and nonteaching hospitals. Then, we can benchmark the incidence rate. That is extremely valuable to hospitals in the U.S. because they can exactly match their size and teaching status against the benchmark. We’ve been encouraging hospitals throughout the U.S. to submit their data and look at their data in more detail. Look for trends. Is there a device that’s cropping up? Is there a time of day? Is there a group of people? Is there a department? Is there a drug associated? Is there a certain procedure that is cropping up more than ever? Go back and interview the people again, or go back and reread their words [in the incident report].
HEH: Why are we still seeing so many needlesticks when hospitals have been required for years to review and possibly implement new needle safety devices?
Grimmond: Under OSHA [Occupational Safety and Health Administration] law, you are required annually to look at your sharps injuries. If you notice a trend with a device, you are obliged by law to examine other commercially available devices. You’re not obliged to use them, but you’re obliged to evaluate them. That’s OSHA law. I don’t think a lot of people are doing that because a lot of hospitals aren’t picking up the trends. It all comes down to workloads. Our employee health managers have very high workloads, and it takes a lot of time to drill down through all your injuries and reread all of the explanations. That’s one of the reasons.
Another reason is that there are insufficient resources to carry out effective training and education of staff. We [researched] hospitals that have significantly fewer injuries than other U.S. hospitals and [found that one factor] was they educate and train to higher degrees. They teach people how to use the safety device when they start work, every year, and every time they have an injury.
When we put that idea to other occupational health managers, they said, “Oh my goodness, we don’t have the resources to do that.” It comes back to resources. There’s an old adage: “No data, no problem, no worry.” If you don’t collect the data — so if people don’t report their injuries — and healthcare professionals during COVID were so busy, we believe reporting dropped off. Once again, putting the patient first. If you don’t get a report — if you don’t have data to feed to your leadership team — it’s considered no problem. No one knows about it.
REFERENCES
- Tarantola A, Abiteboul D, Rachline A. Infection risks following accidental exposure to blood or body fluids in health care workers: A review of pathogens transmitted in published cases. Am J Infect Control 2006;34:367-375.
- Hills SL, Morrison A, Stuck S, et al. Case series of laboratory-associated Zika virus disease, United States, 2016-2019. Emerg Infect Dis 2021;27:1296-1300.
- Grimmond T, Gruden M, Hurst BJ, Crutchfield LF. Sharps injuries with Lovenox and generic enoxaparin prefilled safety syringes: A 12-year retrospective cross-sectional analytical study. Nursing 2023;53:53-61.
At age 78, with more than 50 years of clinical consultation and research on needlesticks, sharps injuries, and medical waste, Terry Grimmond, FASM, BAgrSc, GrDpAdEdTr, says he retired at the end of 2023 but is still winding his career down with a few final projects.
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