1. Strauss, Kenneth MD

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Sharps injuries are the most frequent occupational hazard faced by healthcare workers (HCWs). Such injuries are particularly dangerous in view of their potential for transmitting life-threatening pathogens. In the United States, the matter has already been taken forcefully in hand. On November 6, 2000, President Clinton signed into law the Needle Stick Safety and Prevention Act,1 requiring all healthcare facilities in the United States to purchase and provide needle protective devices to their staffs. Healthcare employers in the United States are now required under law to maintain a sharps injury log and involve nonmanagerial HCWs in the evaluation and implementation of needle protective devices.1,2 In most US healthcare settings, HCWs are protected from sharps injuries by safety devices and have been for nearly a decade now. These devices are now in routine clinical use in most settings.


This is not the case in Europe. There is no universal European Union (EU) legislation akin to the US law. Two countries do have partial coverage. In 2006, the Madrid autonomous region of Spain passed legislation similar to the US law,3 and since then, 3 more of the 17 Spanish autonomous regions (each of which is responsible for passing its own health laws) have followed the Madrid example. Rules have recently been passed in Germany,4 but these do not have the force of law.


Awareness of the health risks of accidental blood exposure is just as high in Europe as in the United States. In the United Kingdom, the Royal College of Nursing and the union UNISON raised awareness of sharps injuries and occupational transmission of bloodborne pathogens.5 A "Safer Needles Network" was subsequently organized, made up of healthcare professionals with an interest in sharps awareness. Moreover, the UK Department of Health recommended a reduction in the use of sharp devices wherever possible and consideration of needle protective devices,6 but specific legislation has not yet been introduced. In other countries of the EU, awareness is growing, a direct result of studies showing that there is a serious problem7-9 for which currently available solutions exist.


European nurses are the most vulnerable HCW group, accounting for nearly 2 out of 3 accidental sticks. Many nurses are young women, often in their prime reproductive years, and for them, a needlestick can be utterly devastating. Most of these injuries are with hollow-bore needles from injecting syringes, blood-drawing devices, or intravenous catheters-the everyday tools of the nursing trade and the most deadly, as they contain residual blood. An accidental stick by one of these used devices carries the risk of transmitting the AIDS virus as well as the 2 most deadly varieties of hepatitis, types B and C. The cost associated with each inoculation injury has been estimated to range between 15,000 to 1,000,000 euros for an injury resulting in transfer of a bloodborne virus.10


The number of needlestick injuries reported may not accurately indicate the size of the problem.11,12 Underreporting may be due to several reasons: too time consuming, too busy, and underestimation of the risks associated with such an exposure.11,13 Doctors rank second to nurses in absolute numbers of needlesticks, but they rarely report injuries when they happen. A surprisingly large number of needle injuries occur to persons other than the user of the sharp. Downstream workers, such as housekeeping staff, are also frequently stuck.


There are now a wide variety of carefully designed safer sharps: spring-loaded retractable needles, guards that shield the dangerous tips, puncture-resistant sharps containers, needle destructors, blunt sutures, and needle-free access valves for intravenous sets. Safety devices have been proven to reduce the rate of needlestick injuries in HCWs to nearly 0 in some studies.14,15 Recent studies by the Groupe d'Etude des Risques d'Exposition des Soignants aux Agents Infectieux (GERES) in France have shown similar findings.16


The EU has had a start/stop approach to needlestick legislation. So far, no clear legislative initiative has been forthcoming. Rather, time is spent on activities such as surveying various stakeholder groups and writing impact assessments. Meanwhile, most European HCWs continue to risk their lives and careers using unprotected devices with no binding legislation anywhere on the horizon. Should they continue to be asked to take this risk when solutions that prevent needlestick injuries are now readily available and legislation that drives enforcement has already been proven effective?




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