Needle stick injuries in a tertiary eye-care hospital: Incidence, management, outcomes, and recommendations

Abstract

Purpose:The purpose of this study is to assess the incidence, management, and outcomes for needle stick injuries (NSIs) in a tertiary eye-care hospital and provide appropriate recommendations for its prevention.Methods:This was a retrospective database review of NSI recorded between 2010 and 2015 at a tertiary eye care center. All staff members who had NSI were managed with standard treatment protocol. The mode, location, health-care workers affected and/or at risk for NSI were analyzed.Results:One hundred and forty NSI were reported between 2010 and 2015, with ophthalmic fellows under training encountering maximum needle pricks (n = 33; 24%), followed by nursing staff (n = 32; 23%), and consultants (n = 30; 21%). Location wise, the highest incidence of NSI was found in the operating room (n = 94; 67%), followed by the laboratory (n = 17; 12%), and patients’ ward (n = 14; 10%). Maximum pricks (n = 10; 20%) occurred while passing sharp instruments, anterior segment surgeons (n = 23; 79%) being affected more than posterior segment surgeons (n = 6; 21%). None of the NSI incidents was attributed to anti-VEGF injections. None of the subjects with NSI had seroconversion to hepatitis B surface antigen, human immunodeficiency virus, or hepatitis C virus in the 5-year study period.Conclusions:NSI is the most commonly encountered in the operating room among training personnel while passing sharp instruments, especially anterior segment surgeons. A proper needle/sharp disposal mechanism, documentation of adverse event, on-going staff training, and prompt prophylactic treatment are essential components of the protocol for NSI management.

Seroprevalence, risk associations, and cost analysis of screening for viral infections among patients of cataract surgery

“…The reported incidence of needlestick injury in eye care in India is 0.07/1000 surgeries. [ 9 ] This means one needlestick injury would result after 14,286 ocular surgeries. The transmission (seroconversion) risk after percutaneous exposure averages 0.3% for HIV, 1.8% for HCV, and 6%–30% for HBV.…”

“…[ 8 ] The reported incidence of needlestick injury in eye care in India is 0.07/1000 surgeries. [ 9 ] The prevalence of these blood-borne viral infections is on the rise, and the World Health Organization (WHO) reported that 252 million people are infected with HBV and 71 million with HCV. [ 10 ] The WHO estimates that HIV has infected 36.7 million people globally.…”

Universal screening: To do or not to do

“…recently reported that the average annual incidence of needle-stick injuries (NSIs) among HCWs at a tertiary eye care center over a 6-year period was 23/year (almost 2 per month). [ 2 ] Yet, another report from one of the nation's busy multispecialty hospitals presented more alarming data. About 80% of HCWs in this particular institute reported one or more NSIs in their career, of which 17.6% involved a patient with known history of HIV, HBV, or HCV or intravenous drug use.…”

“…The costs of testing both HCW and patient after a NSI, postexposure prophylaxis, and the emotional strain suffered by HCW during this period are estimated to be significant. [ 2 ] Sometimes, the surgeries in these camps are performed sequentially without changing phacoemulsification tips risking disease transmission to other patients. The main argument in favor of universal screening is that foreknowledge of the patient's serological status will make the HCW alert, and implement safe practices known as universal precautions.…”

Universal screening versus universal precautions in ophthalmic surgery

“…[ 6 ] Use of ultra-sharp and short microsurgical instruments and sutures, working with high magnification, restricted visible surgical field while operating with a microscope, and suboptimal ambient illumination increase the relative risk of NSI in an ophthalmic surgical setting. [ 5 6 7 ] About 8% of vitreoretinal surgeons have reported NSI during the procedure of intravitreal injection. [ 8 ] Incidence of NSI in a tertiary care eye hospital in India was reported to be 0.07/1000 surgeries.…”