5.1 Although needlestick injuries may result in local trauma, the principal associated health risk is transmission of blood-borne viral disease, in particular hepatitis B and C and HIV infection. However, the transmission of a number of other diseases has been linked to needlestick injuries (UNISON, 2000).
HEPATITIS B
5.2 Hepatitis B can be transmitted from an infected patient to a health care worker, and all staff who encounter blood or bloodstained body fluids in the course of their work are advised to have a complete course of hepatitis B immunisation. Those who fail to respond to immunisation can be given hepatitis B immunoglobulin following a known, or suspected exposure.
HEPATITIS C
5.3 There is no world-wide register of documented cases of occupationally acquired hepatitis C in health care workers. The risk of transmission of infection from an infected source to a health care worker is generally estimated to be of the order of 3%, although a recent study in Italy estimated a transmission rate of 0.44%. Between July 1997 and December 1999, 360 cases of occupational exposure to hepatitis C were reported in England and Wales, with only one known seroconversion. These figures were obtained from a voluntary study. Over the same period in Scotland there were 41 reported exposures with no seroconversions identified. On the information available at present the group's best estimate of the rate of seroconversion in Scotland is that there would be a healthcare worker HCV seroconversion every two years.
HIV INFECTION
5.4 The risk of occupationally acquired HIV infection is extremely small. World-wide, up to the end of December 1999, a total of 102 seroconversions to HIV infection had been recorded among health care workers; of these 35 were European cases, including 5 from the UK. In addition there were 217 HIV infections world-wide which were possibly acquired occupationally; of these 68 were from Europe, including 8 from the UK. All 8 probably acquired infection outwith the UK.
5.5 The overall rate of HIV transmission from a single percutaneous exposure
to HIV infected blood is of the order of 0.3%. Post-exposure prophylaxis (PEP)
has been shown in one study to reduce this rate by 80%. UK guidance on HIV PEP
was first issued in July 1997 and revised in July 2000. Since 1997, national
surveillance of occupational health exposure to blood-borne viruses has been
in place. By the end of 1999, 255 incidents involving an HIV positive source
had been reported in England, with one seroconversion to HIV. These figures
are based on a voluntary scheme and the true figures may be higher (Communicable
Disease Report, PHLS). Over the same period in Scotland there were 19 reports
of occupational exposure to HIV, with no seroconversions.
On the information available at present the group's best estimate of the rate
of seroconversion in Scotland is that there would be a health care worker
HIV seroconversion every forty years (presuming PEP is not given, every 200
years if it is).
5.6 The relatively low rates of transmission of blood-borne viral infections through needlestick injuries must not be an excuse for complacency.
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Recommendation 26 |