The Mölnlycke O.R. blog
Needlestick injuries in Europe
by Professor Andreas Wittmann, University of Wuppertal, Germany
The aim of Directive 3020/32/EU (also known as the EU Sharps Directive) is to achieve standard protection against needlestick injuries throughout Europe for workers in the healthcare industry. This guideline created by consensus among the major social partners (EPSU for the workers and HOSPEM for the hospital operators) must have been incorporated into the national legislation of all EU member states by 11 May 2013.
Throughout Europe, needlestick injuries (NSI) are one of the greatest problems in health and safety. As early as 2005, a study by the World Health Organisation (WHO) found that workers in European healthcare services can expect between 0.64 and 0.94 needlestick injuries on average each year. Affecting around eight million employees in the healthcare sector, this corresponds to over five million injuries of this type each year1.
It is notable that the frequency as well as dangerousness of needlestick injuries vary greatly within Europe; the available literature on this subject also varies greatly, which means that for some countries several very good studies are available, and for some there are none.
The situation in Europe
Based on 2003 data from 375 hospitals, a commission of experts (GERES) discovered that there were around 32,000 reported needlestick injuries per year for France, an EU core country, with an estimated reporting rate of 50 percent2.
For Belgium, which is much smaller, a survey conducted between 2003 and 2007 with a reporting rate of 49.5 percent indicated over 12,000 actual needlestick injuries3.
In Spain as well, several scientifically sound data surveys have been conducted. There, the EPINETAC data indicate over 100,000 NSIs for the years 1998 to 20004.
For Ireland, unfortunately there is not much reliable data available. If you believe these studies, the injury rate in Ireland at only 0.1 NSI per employee per year, and a total of only 6,000 injuries, is extremely low by international standards5
For Greece there is also not much reliable data available. It also describes a record-breaking low injury rate: only 2.4 percent of employees in the Greek healthcare sector suffer from an NSI each year6.
For Sweden the published data also suggest an extremely low injury rate of just five reported NSIs per 1,000 employees each year, which, as the study designers themselves admit, can only be explained by an extremely high rate of underreporting7.
On the other hand, 28 percent of healthcare workers in Poland reported an NSI each year, which for 174,000 healthcare workers, would mean around 50,000 injuries per year8.
In the United Kingdom, studies show one of the lowest reporting rates for needlestick injuries of only nine percent9. However, needlestick injuries are counted among the most frequent injuries in the healthcare sector in the UK10. The figure of 100,000 NSIs per year would mean an injury rate of 0.38 needlestick injuries per employee per year11.
The good study situation in Italy is due to the fact that since 1986 studies have been regularly conducted to investigate the number and dangerousness of NSIs12. Officially, in 120 hospitals connected to a national reporting system, 26,000 of these injuries were reported in the long-term average, in which surveys indicated a reporting rate of around 44 percent13.
The situation in Germany largely corresponds to the European average: The approximately 50,000 NSIs reported to the largest accident insurance company (BGW) confirm the figures postulated of around 500,000 actual needlestick injuries per year14. Calculated on the basis of full-time employee positions, the rate in Germany is around 0.48 NSIs per employee per year15.
Today, needlestick injuries are among the most frequent accidents in the healthcare sector. Each of these injuries is associated with the risk of transmission of harmful infectious agents from the patient to the staff member. The widely varying risks for infectious patients could be a reason for the very large range in the postulated frequency of NSIs. In Sweden, which, with a rate of one reported NSI per 200 employees per year, is a world leader, the prevalence rates for the pathogens HCV, HBV and HIV are also extremely low, which certainly reduces willingness to report needlestick injuries.
- Prüss-Üstün A, Rapiti E, Hutin Y. Sharp Injuries: Global burden of disease from sharps injuries to heath care workers, Am J Ind Med. 2005 Nov 18;48 (6):482-490
- Elmiyeh B, Whitaker IS, James MJ, Chahal CA, Galea A, Alshafi K (2004) Needle-stick injuries in the National Health Service: a culture of silence. J R Soc Med 2004;7:326-7
- Leens E. Door het oog van de naald. Surveillance van accidenteel bloedcontact in Belgische ziekenhuizen. IPH/EPI Report 2008-xxx (in press)
- EPINETAC (2001) Estudio y seguimiento del riesgo biológico en el personal sanitario. Proyecto EPINETAC 1998-2000. Sociedad Española de Medicina Preventiva, Salud Pública e Higiene (SEMPSPH).
- O'Rourke N, Bennett M, Porter J, Gallagher DJ, Shorten G. Universal precautions: do Irish anaesthetists comply? Ir J Med Sci 2000;169:211-214
- Pournaras S, Tsakris A, Mandraveli K, Faitatzidou A, Douboyas J, Tourkantonis A (1999). Reported needlestick and sharp injuries among health care workers in a Greek general hospital. Occup Med (Lond). 1999;7:423-6
- Lymer UB, Schütz AA, Isaksson B. (1997) A descriptive study of blood exposure incidents among healthcare workers in a university hospital in Sweden. J. hosp. infect. 1997;35:223-235
- Bilski B (2005). Needlestick injuries in nurses-the Poznań study. Int J Occup Med Environ Health. 2005;3:251-4
- Elder A, Paterson C. Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices. Occup Med (Lond). 2006 Dec; 56(8):566-74.
- National Audit Office. A Safer Place to Work: improving the management of health and safety risks to staff in NHS trusts. Report by the Comptroller and Auditor General. HC623 Session 2002–2003. London: The Stationery Office 2003
- Safer needles Network. Needlestick injury facts. http://www.saferneedlesnow.net/ (accessed 4 May 2004)
- Ippolito G, Puro V, De Carli (1993) The risk of occupational human immunodeficiency virus infection in health care workers. Italian Multicenter Study. The Italian Study Group on Occupational Risk of HIV infection. Arch Intern Med 153:1451-8
- Ippolito G, Puro V, Petrosillo N, De Carli G, and the Studio Italiano Rischio Occupazionale da HIV (SIROH) group. Surveillance of occupational exposure to bloodborne pathogens in health care workers: the Italian national programme. Eurosurveillance 1999;4:33-6
- Wicker S, Rabenau HF. (2007) Nadelstichverletzungen im klinischen Alltag - Ergebnisse der Frankfurter Nadelstichstudie, Trauma Berufskrankh 2007:1-5 Available at http://www.springerlink.com/content/356464671244250w/fulltext.pdf
- Clarke SP, Schubert M, Körner T (2007). Sharp-device injuries to hospital staff nurses in 4 countries. Infect Control Hosp Epidemiol. 2007;4:473-8