Needlestick injuries and infectious diseases in emergency medicine

Introduction

Needlestick injuries are an occupational hazard for junior doctors, especially in emergency medicine. The emergency department is involved in the management of injuries both in the hospital setting and in the community. The setting was in an innercity area with a high incidence of intravenous drug abuse, HIV, hepatitis B and hepatitis C. The study was to highlight areas for improvement in management.

Methods

A retrospective review of all emergency notes coded as needlestick injury for a 12-month period from 1 July 2001 to 1 July 2002. Information recorded included times, from incident, arrival at department, to be seen by doctor and to get postexposure prophylaxis (PEP) if indicated. Also the number of tetanus toxoid, hepatitis B immunoglobulin/vaccine, and HIV PEP given as well the number indicated. Risk of injury and exposure were assessed and follow-up was checked.

Results

There were 73 needlestick injuries, 35 (48%) presented during normal working hours (9–5 pm) and 38 (52%) outside these hours. Twenty-six (34%) were healthcare workers, 51(66%) were nonhealthcare workers. The average time from incident to arrival was 1.4 hours for healthcare workers and 22.6 hours for nonhealthcare workers. The median time from arrival in the department to being seen by a doctor was 90 minutes. Ten (13.7%) injuries were high risk. Antiretroviral agents were given to 15 (20.1%) patients and the average time from door to HIV PEP was 141 minutes.

Conclusion

Emergency medicine staff should be aware of the risks of blood-borne viral transmission as they have greater exposure than other healthcare groups. They are at higher risk of percutaneous injury and therefore should adopt universal precautions; shield and sheath devices would also reduce the risk of sharp injury. The HIV PEP is effective if given early, so these patients must be assessed urgently and antiretroviral agents given as soon as possible if indicated. Emergency medicine has had an increasing role in management of needlestick injuries in healthcare workers occurring outside working hours, out-of-hospital injuries and other attendances for HIV PEP. Greater education of emergency staff, other healthcare workers and the general public is required for optimal management of needlestick injuries.