Journal of Hospital Infection (1991) 17, 151-154
Letters
to the Editor
Sir,
Needlestick
injuries
in junior
hospital
medical
staff
Information received casually last year led us to suspect that the incidence of needlestick injuries was unacceptably high at this hospital. Opportunity was therefore taken during a survey on the user compliance and acceptability of a recently introduced Vacutainer system to question all House Officers (HOs) and Senior House Officers (SHOs) about their personal experience of needlestick injury. They were questioned individually and in confidence, the result being kept anonymous. We found that HOs and SHOs had been taking blood for an average of 5 and 6 years, respectively, all having started as students. Table I shows the numbers of admitted needlestick injuries. Considering that any needlestick injury carries a risk of transmitting infection and is therefore unacceptable we thought the results were alarming, particularly as not unreasonably the incidence seemed to increase with exposure. Most of the injuries were stated to have occurred whilst resheathing. More worrying was the further result that only six of the 36 doctors having injuries had sought medical advice following an injury, since hepatitis B virus (HBV) infection is largely preventable retrospectively following injury by blood-contaminated sharps and counselling on causation may prevent further injury. A retrospective rate of needlestick injury of about 70% of staff in our study accords closely with that of 69.7% reported amongst North American paediatric house staff at a similar stage in their career by Melzer et al.’ at about the same time we were doing our study. Although there have been a number of other publications on the American experience of needlestick injuries (see review by Collins & Kennedy2), and attempts at their prevention3-’ the results are not entirely relevant to this country because of the differing types of staff predominantly performing venepunctures and because some studies excluded medical staff. Hamory6T7 found the rate of under-reporting to be 60% overall in a questionnaire survey of a hospital, but no specific mention was made of medical staff. In this country Waldron’ found a low prevalence of needlestick injuries amongst medical staff compared with domestic and portering staff based on voluntary reporting to an occupational health department but admitted that this may not represent the true picture. More recently Bailey’ reported a rate of 1.7 per 100 employee years in hospital doctors using spontaneous reporting by the staff. 0195%6701/91/020151
f04
$03.00/O
0 1991 The Hospital
151
Infectmn
Society
152
Letters
to the Editor
This seems to be a gross underestimate probably stemming from guilt in these staff from non-compliance with policy and on other factors. Jacobson, Burke & Conti” found that over a period of 30 months only eight of the 379 medical staff employed at a North American hospital reported injuries voluntarily, six of which were not caused by a needle, whereas in a subsequent survey using active questioning they found that all domestic staff sought treatment following a penetrating injury; unfortunately the medical staff were not surveyed similarly. McCormick & Maki” observed that only one of 500 HOs and staff physicians voluntarily reported a needlestick injury in nearly 4 years. Partly as a result of our findings, it is now contractually compulsory for all junior medical staff new to our District to attend a teaching session on the correct use of medical sharps. There is particular emphasis on safe methods of resheathing when this is occasionally necessary,12 the importance of minimizing risk to third parties by the safe disposal of sharps, and on reporting all injuries to the Occupational Health Department. A programme that is already in existence for actively immunizing all medical staff against HBY has been further improved so as to minimize the number of susceptible staff.
J. M. Wilson D. S. Reeves
Department
of Medical Microbiology, Southmead Hospital, Westbury-on- Trym, Bristol BSlO 5NB
References 1. Melzer SM, Vermund SH, Shelov SP. Needle injuries among pediatric housestaff physicians in New York City. Pediatr 1989; 84: 211-214. 2. Collins CH, Kennedy DA. Microbiological hazards of occupational needlestick and ‘sharps’ injuries. J Appl Bacterial 1987; 62: 3855402. 3. Straub S, Lumish R, Rycheck R, Yee P, McVay J. Patterns of needlestick injuries following change of the disposal system. AJ Infect Control 1986; 14: 84. 4. Krasinski K, La Couture R, Holzman RS. Effect of changing needle disposal systems on needle puncture injuries. Infect Control 1987; 8: 59-62. 5. Edmond M, Khakoo R, McTaggart B, Solomon R. Effect of bedside needle disposal units on needle recapping frequency and needlestick injury. Infect Control Hosp Epidemiol 1988; 9: 114-116. 6. Hamory BH. Under-reporting of needlestick injuries in a university hospital. Am J Infect Control 1983; 11: 174-177. 7. Hamorv BH. Error in ‘under-renortina of needlestick iniuries’ was ‘under renorted’. Am J Infect Control 1984; 12: 68. 8. Waldron HA. Needlestick injuries in hospital staff. Br MedJ 1985; 290: 1285. Bailev M. Occupational HIV infection risk. Lancet 1990: 1: 1104-1105. 1:: Jacobson JT, Burke JP, Conti MT. Injuries of hospital employees from needles and sharp objects. Infect Control 1983; 4: 100-102. 11. McCormick RD, Maki DG. Epidemiology of needle-stick injuries in hospital personnel. Am J Med 1981; 70: 928-932. needle pricks. Lancet 1986; 1: 1096. 12. Green ST. Avoiding _
I
Letters Table
I. Needlestick
injuries
Number of needlestick injuries 0 : 3
to the Editor
in house medical staff found
by retrospective
survey
House officers (N = 20)
Senior house officers (N = 33)
6 (30%)
11 (33%) ;
112 1 0
>3
153
1:
Sir,
Quantitative
bacterial
air tests-a
potential
source
of error
We wish to draw attention to a potential source of error when carrying out quantitative bacterial air studies using the ‘Biotest RCS’ centrifugal air sampler and agar strips. On a number of occasions recently we noticed a Bacillus sp. colony to be dispersed along several divisions of the agar strip. This is shown in Figure 1, which shows samples of air studies recently carried out. The problem was whether this appearance represented several colonies of Bacillus sp. or whether it was due to a single colony. In order to investigate this we inoculated the first two vertical divisions of 10 agar strips with a strain of Bacillus sp. and incubated the strip for 48 h. as on the actual test samples was found, The same appearance demonstrating the potential for quantitative error (Figure 2). It seems that this problem is more likely to be found with motile strains of Bacillus sp. We repeated the experiment with three separate isolates of swarming Proteus sp. and they certainly swarmed over several divisions, but this appeared to us to be obvious swarming from one source over the whole surface of the agar and not the migration along the edge that the Bacillus sp. demonstrates. We suggest when enumerating colonies of Bacillus sp. on strips with this appearance, that only one colony forming unit is counted.
J. M. Levey R. Bradbury
Microbiology &’ Infectious Diseases, Repatriation General Hospital, Hospital Road, Concord NSW 2139 Australia
Letters
to the Editor
Sir,
Needlestick
injuries
in junior
hospital
medical
staff
Information received casually last year led us to suspect that the incidence of needlestick injuries was unacceptably high at this hospital. Opportunity was therefore taken during a survey on the user compliance and acceptability of a recently introduced Vacutainer system to question all House Officers (HOs) and Senior House Officers (SHOs) about their personal experience of needlestick injury. They were questioned individually and in confidence, the result being kept anonymous. We found that HOs and SHOs had been taking blood for an average of 5 and 6 years, respectively, all having started as students. Table I shows the numbers of admitted needlestick injuries. Considering that any needlestick injury carries a risk of transmitting infection and is therefore unacceptable we thought the results were alarming, particularly as not unreasonably the incidence seemed to increase with exposure. Most of the injuries were stated to have occurred whilst resheathing. More worrying was the further result that only six of the 36 doctors having injuries had sought medical advice following an injury, since hepatitis B virus (HBV) infection is largely preventable retrospectively following injury by blood-contaminated sharps and counselling on causation may prevent further injury. A retrospective rate of needlestick injury of about 70% of staff in our study accords closely with that of 69.7% reported amongst North American paediatric house staff at a similar stage in their career by Melzer et al.’ at about the same time we were doing our study. Although there have been a number of other publications on the American experience of needlestick injuries (see review by Collins & Kennedy2), and attempts at their prevention3-’ the results are not entirely relevant to this country because of the differing types of staff predominantly performing venepunctures and because some studies excluded medical staff. Hamory6T7 found the rate of under-reporting to be 60% overall in a questionnaire survey of a hospital, but no specific mention was made of medical staff. In this country Waldron’ found a low prevalence of needlestick injuries amongst medical staff compared with domestic and portering staff based on voluntary reporting to an occupational health department but admitted that this may not represent the true picture. More recently Bailey’ reported a rate of 1.7 per 100 employee years in hospital doctors using spontaneous reporting by the staff. 0195%6701/91/020151
f04
$03.00/O
0 1991 The Hospital
151
Infectmn
Society
152
Letters
to the Editor
This seems to be a gross underestimate probably stemming from guilt in these staff from non-compliance with policy and on other factors. Jacobson, Burke & Conti” found that over a period of 30 months only eight of the 379 medical staff employed at a North American hospital reported injuries voluntarily, six of which were not caused by a needle, whereas in a subsequent survey using active questioning they found that all domestic staff sought treatment following a penetrating injury; unfortunately the medical staff were not surveyed similarly. McCormick & Maki” observed that only one of 500 HOs and staff physicians voluntarily reported a needlestick injury in nearly 4 years. Partly as a result of our findings, it is now contractually compulsory for all junior medical staff new to our District to attend a teaching session on the correct use of medical sharps. There is particular emphasis on safe methods of resheathing when this is occasionally necessary,12 the importance of minimizing risk to third parties by the safe disposal of sharps, and on reporting all injuries to the Occupational Health Department. A programme that is already in existence for actively immunizing all medical staff against HBY has been further improved so as to minimize the number of susceptible staff.
J. M. Wilson D. S. Reeves
Department
of Medical Microbiology, Southmead Hospital, Westbury-on- Trym, Bristol BSlO 5NB
References 1. Melzer SM, Vermund SH, Shelov SP. Needle injuries among pediatric housestaff physicians in New York City. Pediatr 1989; 84: 211-214. 2. Collins CH, Kennedy DA. Microbiological hazards of occupational needlestick and ‘sharps’ injuries. J Appl Bacterial 1987; 62: 3855402. 3. Straub S, Lumish R, Rycheck R, Yee P, McVay J. Patterns of needlestick injuries following change of the disposal system. AJ Infect Control 1986; 14: 84. 4. Krasinski K, La Couture R, Holzman RS. Effect of changing needle disposal systems on needle puncture injuries. Infect Control 1987; 8: 59-62. 5. Edmond M, Khakoo R, McTaggart B, Solomon R. Effect of bedside needle disposal units on needle recapping frequency and needlestick injury. Infect Control Hosp Epidemiol 1988; 9: 114-116. 6. Hamory BH. Under-reporting of needlestick injuries in a university hospital. Am J Infect Control 1983; 11: 174-177. 7. Hamorv BH. Error in ‘under-renortina of needlestick iniuries’ was ‘under renorted’. Am J Infect Control 1984; 12: 68. 8. Waldron HA. Needlestick injuries in hospital staff. Br MedJ 1985; 290: 1285. Bailev M. Occupational HIV infection risk. Lancet 1990: 1: 1104-1105. 1:: Jacobson JT, Burke JP, Conti MT. Injuries of hospital employees from needles and sharp objects. Infect Control 1983; 4: 100-102. 11. McCormick RD, Maki DG. Epidemiology of needle-stick injuries in hospital personnel. Am J Med 1981; 70: 928-932. needle pricks. Lancet 1986; 1: 1096. 12. Green ST. Avoiding _
I
Letters Table
I. Needlestick
injuries
Number of needlestick injuries 0 : 3
to the Editor
in house medical staff found
by retrospective
survey
House officers (N = 20)
Senior house officers (N = 33)
6 (30%)
11 (33%) ;
112 1 0
>3
153
1:
Sir,
Quantitative
bacterial
air tests-a
potential
source
of error
We wish to draw attention to a potential source of error when carrying out quantitative bacterial air studies using the ‘Biotest RCS’ centrifugal air sampler and agar strips. On a number of occasions recently we noticed a Bacillus sp. colony to be dispersed along several divisions of the agar strip. This is shown in Figure 1, which shows samples of air studies recently carried out. The problem was whether this appearance represented several colonies of Bacillus sp. or whether it was due to a single colony. In order to investigate this we inoculated the first two vertical divisions of 10 agar strips with a strain of Bacillus sp. and incubated the strip for 48 h. as on the actual test samples was found, The same appearance demonstrating the potential for quantitative error (Figure 2). It seems that this problem is more likely to be found with motile strains of Bacillus sp. We repeated the experiment with three separate isolates of swarming Proteus sp. and they certainly swarmed over several divisions, but this appeared to us to be obvious swarming from one source over the whole surface of the agar and not the migration along the edge that the Bacillus sp. demonstrates. We suggest when enumerating colonies of Bacillus sp. on strips with this appearance, that only one colony forming unit is counted.
J. M. Levey R. Bradbury
Microbiology &’ Infectious Diseases, Repatriation General Hospital, Hospital Road, Concord NSW 2139 Australia
