Health professionals still at risk of bloodborne viruses through work

27 November 2008

Healthcare workers are still being put at risk of bloodborne viruses through occupational exposure and a significant number of these incidents are preventable, according to a report released today by the Health Protection Agency.

'Eye of the Needle', the Agency's bi-annual report into the occupational exposure of healthcare workers to bloodborne viruses, reviews the trends and number of incidents involving exposures, via needlestick injury or sharp objects, to patients with hepatitis B, hepatitis C and HIV.

In total there were 914 incidents where healthcare workers were put at risk, over the last two years (2006/2007). Four healthcare workers were reported as having acquired hepatitis C infection as a result of their injury.

Between 2000 and 2007, most occupational exposures involved nursing professionals (48% 1447/3039). A recent report by the Royal College of Nursing showed the concerns of nursing staff about occupational exposure to bloodborne viruses and how one third of them feel at risk of contracting diseases such as HIV and hepatitis C following such injuries. Latest figures collected by the Agency for 2007 show that, for the first time, medical and dental professionals reported a higher proportion of significant occupational exposures to bloodborne viruses (46% compared with 44% among nursing staff).

The Agency's research found that some healthcare workers injured at work with sharp objects or needles are still not going for appropriate tests and follow-up checks for hepatitis C. This puts them at unnecessary risk of developing chronic infections.

78% of those who had been put at risk of hepatitis C may not have been followed up adequately, potentially leaving some cases of hepatitis C undiagnosed without treatment or care. If untreated, hepatitis C can lead to chronic liver disease or eventually cancer of the liver.

Professor Mike Catchpole, Director of the Health Protection Agency's Centre for Infections, said: "Although the numbers of reported healthcare workers infected with hepatitis C following their injury were few, these cases should never have occurred. We all need to do everything we can to prevent occupational exposure injuries occurring. It is important for healthcare workers to report incidents of occupational exposure. Testing and follow up checks are vital as infections can remain undetected for many years. However, our main aim should be doing everything we can to prevent occupational exposure injuries occurring in the first place."

"Many incidents of occupational exposure can be prevented if there is proper adherence to standard precautions for the safe handling and disposal of clinical waste."

On the whole, the report shows encouraging results on the implementation of national policies in the management of these exposure incidents, with the exception of testing and follow-up for hepatitis C.

The report found that guidelines on the use of HIV post-exposure prophylaxis (PEP), administered to healthcare workers to help prevent them contracting HIV, were being adhered to. Other than the five HIV seroconversions reported up to 1999, no new cases of HIV have occurred in the UK among healthcare workers through occupational exposure. This is despite injuries involving HIV infected source patients representing 22% of all occupational exposures through needlesticks and other sharps, between 2000 and 2007.

Dr Fortune Ncube, Consultant Epidemiologist at the Health Protection Agency, said "It is so important that guidelines around the use of PEP are followed and that treatment is provided quickly. This can make the difference between good health or contracting a life-long infection."

"Healthcare workers must be vigilant in reporting possible exposures to infected patients. There is no place for complacency, contracting bloodborne viruses through occupational exposure is a real risk."

Notes to editors

The Report
Eye of the Needle: United Kingdom Surveillance of Significant Occupational Exposures to Bloodborne Viruses in Healthcare Workers November 2008 is produced by the Health Protection Agency Centre for Infections, National Public Health Service for Wales, CDSC Northern Ireland and Health Protection Scotland

The report includes all occupational exposures to blood borne viruses in healthcare workers that occurred between 1st January 1997 and 31st December 2007, and were reported to the Health Protection Agency Centre for Infections enhanced surveillance system by 31st August 2008.

The report is available to download at www.hpa.org.uk/needle

Surveillance
The active surveillance of significant occupational exposures in England, Wales and Northern Ireland for bloodborne viruses was implemented in July 1997. Under the scheme, occupational exposures include percutaneous exposures, where the skin has been broken by a needle/other sharp object, human scratch or bite and mucocutaneous exposures, where the mucous membranes (mouth, nose or eyes), or non-intact skin have been contaminated. A significant exposure is a percutaneous or mucocutaneous exposure to blood or other body fluids from a source that is known to be, or as a result of the incident found to be, hepatitis B surface antigen (HBsAg), hepatitis C, or HIV positive.

Risk of infection
The risk of infection following a percutaneous injury (or injury through the skin), especially deep penetrating injuries involving a needle or a device visibly contaminated with blood, has been estimated at

1 in 3 for Hepatitis B
1 in 30 for Hepatitis C
1 in 300 for HIV
Exposure to hepatitis C remains the greatest risk, (exposure to patients with hepatitis C represented 48% of cases between 2000-2007, 1113/2296 exposures).

Where do incidents occur?
Over a third of incidents occurring between 2000-2007 in the ward or in Accident & Emergency (43% and 37% respectively), and around 20% in intensive care and in operating theatres (22% and 20% respectively) would have been preventable with proper adherence to universal precautions and safe disposal of clinical waste.

Risk from sharps
Between 2000-2007, 68% of injuries caused by needles and other sharps were attributed to hollowbore needles (hollow needles able to contain liquid), 19% to solid needles (such as those used for suturing during surgery), and 13% were stated as 'other' sharps, such as scalpels and dental probes.

Health Protection Agency press contacts

For further information please contact the Health Protection Agency's Centre for Infections press office on:

Kate Swan 020 8327 7097
Alexandra Baker 020 8327 7098
Georgina Fletcher 020 8327 6690
Louise Brown 020 8327 7080
David Daley 020 8327 6647

Last reviewed: 27 November 2008