NEEDLESTICK

Needlestick injuries are frequent occurrences in healthcare settings and can lead to serious complications. While the introduction of universal precautions and safety conscious needle designs has led to a decrease in needlestick injuries, they still do occur. Awareness of needlestick injuries started to develop soon after the identification of HIV in the early 1980s. However, today the major concern after a needlestick injury is not HIV but hepatitis B or hepatitis C. Guidelines have been established to help healthcare institutions manage needlestick injuries and when to initiate post-exposure HIV prophylaxis. The Centers for Disease Control and Prevention (CDC) has developed a model that helps healthcare professionals recognize when to start antiretroviral therapy. This activity describes the evaluation and management of needlestick injuries and highlights the role of the interprofessional team in improving care for affected patients.

Objectives:

  • Identify the epidemiology of needlestick injuries.
  • Review the risk factors for needle stick injuries.
  • Describe the risks of contracting a blood-borne pathogen secondary to needlestick injuries.
  • Explain the importance of improving care coordination amongst interprofessional team members to improve outcomes for patients affected by needlestick injuries.

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Evaluation of different safety-engineered protection mechanisms of port access needles using a lifelike model of vascular access routes

Port access needles, used for accessing implanted ports, play a crucial role in providing reliable and convenient access to the vascular system (1). Despite their significance, issues related to safety and the potential for needlestick injuries remain a concern (2–4). In this context, various safety-engineered protection mechanisms have been introduced in the clinical setting to solve the general problem of needlestick injuries (5). Nevertheless, needlestick injuries still occur, even after education and training with devices containing safety-engineered protection mechanisms (6). Looking at factors affecting the occurrence of needlestick injuries on the level of tool and technology factors, the use of personal protective equipment had the highest relative weight followed by the safety design of devices (7).

For designing safety-engineered protection mechanisms, detailed specifications such as the ability to activate the device with one hand are described by current regulations (8–10). To date, a wide range of devices with safety-engineered protection mechanisms have been introduced, including blood collection needles, winged blood collection needles, peripheral intravenous catheters and port access needles. Several studies have been conducted to evaluate different types of safety-engineered protection mechanisms (2, 11–14). These investigations repeatedly found that most injuries occur before or even during activation of the safety-engineered protection mechanism, highlighting the impact of the mechanism itself on the prevention of needle-stick injuries and the need for ongoing optimization of safety-engineered protection mechanisms (15–19).

In the context of available frameworks for implementation of sharp injury preventing programs (8, 10, 20), we proposed a systematic model-based user evaluation of devices with safety-engineered protection mechanism prior to clinical implementation (21). To date, only few user-acceptability studies prior to introduction of safety-engineered port access needles into the clinical area have been published (22–24). New promising approaches focus on virtual reality and corresponding haptic simulation methods, enabling training, evaluation and design optimizations (25–28); however, virtual reality technology is still challenging to simulate fine motor interactions (29). In a previous study, the Polyperf® Safe (PPS) Huber needle was evaluated in cancer patients (22). Compared to the standard Gripper® needle in this study, most nurses were convinced that the PPS needle was safer than the Gripper® needle. However, this study was solely based on questionnaire evaluations with no further information regarding safety aspects. Hence, a systematic comparison of different safety-engineered port access needles and their underlying fundamental mechanisms has not been conducted. Therefore, we expanded our model-based user evaluation of devices with safety-engineered protection mechanism using a lifelike simulation model for port access needles.

In this randomized lifelike model-based study, we hypothesized that significant differences in product characteristics and inexperienced healthcare personnel would reveal user preferences of safety-engineered protection mechanisms of port access needles.

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Needlestick program promotes care team safety at Keck Medical Center of USC

An ounce of prevention is said to be worth a pound of cure — but it’s not always enough when the unexpected happens. That’s what one surgeon discovered when he was accidentally stuck with a needle containing blood from an HIV-positive patient during a complicated 12-hour procedure in late 2023.  

He completed the surgery late at night, then found that the steps for preventing transmission were harder to take than anticipated. With pharmacies closed for the night, and then understocked the following day, it took a runaround for him to access antiviral drugs for postexposure prophylaxis, or PEP. While he received his initial PEP course within the recommended 72-hour window after exposure, treatment arrived perhaps too close for comfort, and after too much confusion.

“It shouldn’t have been that difficult,” said Earl Strum, MD, medical director of Employee Health at Keck Medicine of USC and interim chair and clinical professor of anesthesiology at the  Keck School of Medicine of USC. “We keep track of data on needlesticks, but the story of the surgeon made the issue bubble up. It was personal, and it was scary. We didn’t want anyone to go through that again.”

Spurred to action, Strum and Employee Health nursing director Yolee Casagrande, DPN, RN, spearheaded an initiative to improve needlestick protocols at Keck Medical Center of USC. They collaborated with a wider group including leaders at the on-campus pharmacy and the Keck Medicine administration to ensure there wouldn’t be a repeat of the travails the surgeon had gone through. The result of these efforts is a system for fast response whenever anyone working at the medical center is exposed, along with an ongoing training component.

“This program has empowered our people to do the right thing, and do it quickly.”

~Yolee Casagrande, DPN, RN

One crucial difference, making PEP readily available on the fly, was implemented in fall 2024. During business hours, Employee Health provides a kit on hand with three days’ worth of medication. After hours, PEP can be obtained at the Evaluation and Treatment Clinic in Keck Hospital of USC.

“Getting medication to someone on the spur of the moment — any time of day or night — is not an easy thing,” said Strum, who is also affiliated with the Department of Population and Public Health Science. “It had to be a 24/7 program. ‘Come back the next day’ just wasn’t good enough.”

In addition to PEP, the protocols for an exposure include a battery of lab tests. The Employee Health initiative speeds up the response with a power plan now preloaded into the medical center’s computer system. With ease, physicians can pull up every step needed for testing and treatment.

“This program has empowered our people to do the right thing, and do it quickly,” said Casagrande, associate administrator for nursing at Keck Medical Center and an adjunct clinical assistant professor of population and public health sciences at the Keck School of Medicine. “It’s removed any confusion from the process.”

Meanwhile, Employee Health offers training sessions on needlestick reduction. The four-minute video covers risk factors for needlesticks, best practices for avoiding needlesticks, and instructions for how to handle them when they occur. The first sessions took place in spring 2025, and the goal is for everyone with a patient-facing role to complete it.

The entire endeavor is motivated by concern for the health and wellbeing of every staff member at Keck Medical Center. After all, while infection from a needlestick is unlikely, the stress that someone experiences can be overwhelming.

“We have good HIV medications, but still, no one wants to be infected with a serious disease while treating their patients,” Strum said. “Exposures are nerve-racking. You don’t know whether your life will change. It’s watching, waiting, getting blood tests to ensure you’re free and clear. So it was important to make it a simpler process here.”

Casagrande added, “I think most of us have suffered a needlestick at some point. This program is just us taking care of our own Trojan Family in a better way.” 

For more information about needlestick reduction training, please contact Maria Saballos, RN, at (323) 442-8509.

Accidental Needlesticks possible in Farm Work

STARKVILLE, Miss. — Of all the dangers imagined existing on the farm, accidental needlesticks are probably not high on most people’s lists.

But Leslie Woolington, safety specialist with the Mississippi State University Extension Service, said the reality is that needlestick injuries can happen when working around livestock.

“Needlestick injuries are usually minor, but they can be serious,” said Woolington, who is also risk manager with the Mississippi Agricultural and Forestry Experiment Station. “The most common injuries are skin infections and allergic reactions, but they can cause deep tissue wounds that require surgery.”

The Centers for Disease Control and Prevention estimate that more than 80% of farm workers vaccinating animals have accidentally stuck themselves. That makes vaccines the most common type of drug involved in needlestick injuries.

If accidentally stuck with a needle on the farm, the first step is to wash the area immediately with soap and water. Report the injury to a supervisor and call a healthcare provider with information about the substance involved. Poison Control can provide specific help when calling 800-222-1222.

Certain products require extra care when handling. Information provided by the Upper Midwest Agricultural Safety and Health Center state that these include sedatives, oil-based products or vaccines and modified live vaccines. Other specific products that require extra care are the antibiotic Tilmicosin, Brucella abortus Strain RB51 vaccine and Johne’s vaccine.

“Anyone who is pregnant should be especially careful around injectable hormones, and anyone with a known antibiotic allergy should be careful around those products,” Woolington said.

Ways to avoid getting stuck with a needle start with restraining animals properly and not rushing when giving an injection.

“Don’t recap needles, but immediately dispose of them in approved sharps containers,” she said. “Don’t store needles or syringes in your pocket or hold caps in your mouth. And always discard bent or dull needles.”

Mary Nelson Robertson, MSU Extension health specialist, said a person who has been accidentally stuck with a needle may show symptoms such as swelling or itching within a few minutes.

“Other times, it may take hours or even days for signs to appear, such as a fever or redness from a bacterial infection that starts slow but builds over time,” Robertson said. “It really depends on what was in the syringe and the person’s own bodily response to what was accidentally injected.”

She said anyone in this case who feels a bit off and is possibly lightheaded or nauseated, or one who notices the affected area getting warm or puffy should act early rather than wait and see what happens.

“It is important to clean the area with soap and water, report it and get checked out by a healthcare provider after an accidental needlestick,” she said. “Even if it seems small, taking action early can make a big difference.”

Robertson said there is still a risk even if the syringe was empty when the needlestick happened.

“An empty syringe can still carry bacteria or medication residue, so it is not risk-free,” she said. “Always take needlesticks seriously. There is no such thing as a ‘safe’ needlestick.”

Jessica Halfen, Extension dairy specialist, said taking blood samples for experimental trials presents another opportunity for accidental needlesticks.

“Often, we are in a hurry to collect samples and get them to the lab, and in those situations, needles sometimes end up in pockets, which can later cause injuries,” Halfen said. “In some cases, needles have even remained in farm coverall pockets for months, creating an even more dangerous situation as they can become rusty.”

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Needlestick Injury Rates in Nurses and Students in Pakistan

As healthcare professionals operate at the frontline of patient care, the prevalence of needlestick injuries among nurses and nursing students remains a pressing concern. With the healthcare environment becoming increasingly intricate, the risk of needlestick injuries has only amplified, creating a critical need for comprehensive understanding and effective mitigation strategies. Recent research conducted by Ghanei Gheshlagh, Ebrahimi, Masih, and their colleagues offers vital insights through a meta-analysis of observational studies focusing specifically on Pakistan, revealing significant data regarding the prevalence of these injuries among healthcare workers.

The study serves as a crucial wake-up call, highlighting that the issue of needlestick injuries is not just limited to procedural shortcomings or lack of training but is deeply rooted in the healthcare infrastructure of the country. The analysis synthesizes data from various observational studies performed across Pakistan, showcasing the gravity of the situation faced by nurses and nursing students who are often exposed to a plethora of infectious agents through these injuries. This situation is further exacerbated by insufficient training, inadequate safety protocols, and a general culture of safety that can be described as lacking.

Empirical evidence suggests that needlestick injuries can lead to exposure to various blood-borne pathogens, including HIV, hepatitis B, and hepatitis C, posing not only physical risks but also emotional and psychological repercussions for healthcare workers. The psychological toll of such injuries can lead to anxiety and stress among nurses, which in turn affects their quality of care and overall well-being. The findings underscore the necessity for health systems to prioritize not only physical safety measures but also mental health resources for their staff.

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