Hema Vijay turns the spotlight on the hazards posed to hospital staff by needle-stick injuries and exposure to medical waste

As Dilip, employed in the housekeeping department at a city hospital, carried out his daily chore of collecting medical waste for disposal he felt a sharp prick. A closer look revealed that the small injury was caused by the needle of a used syringe. Aware of blood-borne infections, he informed the hospital authorities about it. Then began a long period of anxiety, during which procedures were carried out to find out if Dilip had contracted any infection.

Most often, such incidents don’t get reported, leave alone followed up. “Transmission of infections from patients to healthcare workers doesn’t happen on a daily basis, but is not infrequent. For instance, at a health camp for nurses, we discovered quite a few of them tested positive for Hepatitis B they had contracted long ago,” informs Chennai-based infectious diseases consultant Dr. Abdul Ghafur.

How it happens

Remember, it’s not just doctors and nurses in the healthcare sector, but also lab technicians, paramedics and housekeeping staff, who interface with patients. “Unfortunately, there is not enough awareness among the majority of healthcare workers about staying clear of needle-stick injuries and infections contracted when handling material that’s infected.

Nor is there mass vaccination of healthcare workers for the most common needle-stick infection — Hepatitis B. Hospital administrators should take a proactive step to prevent such transmission,” says geriatric consultant Dr. R. Magesh, who is working to raise awareness about the issue.

Nurses sometimes accidentally prick themselves with the syringe, when they collect blood from patients. In the case of lab technicians, blood from samples might accidentally splash in the eyes or mouth, and through small abrasions in the skin while handling uncovered or spilled samples. Then again, healthcare workers who don’t use the N-95 mask may contract tuberculosis from sputum positive patients, who should be kept in isolation.

Flu is another disease that poses a risk to healthcare workers. “Many surgeons have had tiny drops of the patient’s blood splashing into their eyes or mouth during surgical procedures. If the patient carries an infection, it could possibly enter the surgeon’s body through tiny abrasions,” says Dr. N. Murugan, consultant hepatologist.

Avoiding infections

The importance of following standard procedures while handling needles or touching patients with open wounds should be reinforced in healthcare workers, insists Dr. Murugan. For instance, some nurses have the habit of recapping the needle after using it on a patient.

“That is extremely risky as that’s how most needle-stick injuries occur. Chances are they could miss inserting the needle into the cap and stick it into their finger instead,” points out Dr. Ghafur, adding, “Nurses must as a matter of habit carry syringes in a tray. If they walk about holding it in their hands, they might accidentally prick themselves or others with it.” Again, used needles may be dropped in the ‘sharp’ bins reserved for them. Disposal of medical waste should be outsourced to an ISO certified company. But a safer solution would be to put them through a needle cutter, which rules out reuse or contamination.

In the eventuality of a needle-stick injury, it must be immediately reported to the hospital supervisors, and a proper risk assessment, post exposure prophylaxis and treatment should be done. Many hospitals fail to do this.

“For instance, if the patient on whom the needle is used is HIV positive, the healthcare worker who got stuck accidentally with the needle should be given six weeks of HIV prophylactic treatment and tested for the virus after three months. For Hepatitis C, there is no prophylaxis. And if the worker had been vaccinated for Hepatitis B earlier, it has to be checked if he has enough antibodies in his blood; otherwise, he should be administered Hepatitis B immunoglobulin immediately, which confers immediate protection,” informs Dr. Ghafur.

Healthcare workers should ideally be vaccinated en masse for Hepatitis B. “It is an affordable 3-dose vaccine, costing around Rs. 500. Unfortunately, there is no vaccination for HIV and Hepatitis C viruses, as of now,” informs Dr. Murugan.

PROTECTIVE MEASURES

* Healthcare workers interfacing with patients should get vaccinated for Hepatitis B and other possible infections.

* Reinforce standard safety procedures for handling needles and touching patients with open wounds, such as use of gloves, desisting from recapping needles, etc.

* Needle cutters must be used to dispose of needles.

* Reusable medical instruments such as surgical instruments need to be sterilised properly before reuse.