Introduction: Needlesticks, bodyfluid exposure and bites (incident) put healthcare workers (HCWs) at risk of hepatitis B, C and HIV particularly if patients are infected (high risk incident). The risk of infection is greatest from bore-hollow needles. The aim of the study was to describe the epidemiology of reported incidents and evaluate underreporting by HCWs at Landspítali University Hospital (LUH).

Methods: A retrospective descriptive study of reported incidents during 1986-2011. The ratio of incidents was calculated according to the HCWs age and profession and distribution by source and wards. The ratio of high risk incidents and vaccination status against HBV at time of incident was determined as well as underreporting during 01.01.2005-31.12.2011.

Results: At least 4089 incidents occured during the study period but 3587 were reported and blood samples taken from 2578 patients. Approximately a third of the incidents were associated with non-compliance with standard precaution and 54,7% of needlesticks were associated with bore-hollow needles. Few reports came from physicians and medical students (17,9%). During the study period 50,3% HCWs were vaccinated against HBV at time of incident. High risk incidents were 94 (2.6%), mostly related to hepatitis C (64,9%). Two HCWs became infected with HCV. During 2005-2011 underreporting was estimated to be 28,0%.

Conclusion: Improved education of standard precaution when handling needles and sharps at LUH may reduce the number of incidents. Introduction of safety-needles and safety-devices may greatly reduce needlesticks as a large number of incidents were associated with hollow needles. Improved HBV vaccination among HCWs and reporting incidents should be encouraged.

Key words: Sharps and needlestick injuries, blood and bodyfluid exposure, health care worker, Bloodborne pathogens, HBV vaccination coverage, occupational health.

Correspondence: Ásdís Elfarsdóttir Jelle, asdiself@landspitali.is

Jelle AE1, Hafsteinsdottir EJG1, Gudlaugsson O2, Kristjansson M2

¹Department of quality and infection control, ²Department of internal medicine at Landspítali University Hospital.


Tables and figures:

Table 1.   Overview, numbers of reported injuries, proportion of high risk injuries and proportion of health care workers vaccinated against HBV at time of injury during1986-2011.

Year	Number of reported injuries	Proportion of high risk injuries	Proportion of health care workers vaccinated against HBV at time of injury
1986	9	0	0,0
1987	7	0	0,0
1988	91	4,4	2,2
1989	126	0,8	5,6
1990	114	0,9	29,8
1991	75	0,0	29,3
1992	133	2,3	39,8
1993	139	0,0	35,3
1994	132	3,8	36,6
1995	94	0,0	37,2
1996	137	2,2	39,4
1997	153	3,3	22,9
1998	140	2,9	37,9
1999	143	4,2	51,0
2000	158	4,4	48,1
2001	154	0,6	42,2
2002	145	2,8	46,9
2003	145	1,4	46,2
2004	204	2,0	58,3
2005	210	5,2	52,9
2006	166	4,2	73,5
2007	173	0,6	71,7
2008	165	1,8	81,8
2009	196	3,6	78,6
2010	166	2,4	76,5
2011	212	5,2	81,1

Table II.  Incidence of reported injuries at Landspitali University Hospital.

Year	2003	2004	2005	2006	2007	2008	2009	2010	2011
Incidence/100.000 patients-day	52,3	79,6	81,4	64,8	71,0	71,1	88,6	81,3	100,8
Incidence /100 occupaid beds	19,1	29,1	29,7	23,7	25,9	26,0	32,4	29,4	36,8
Incidence /100 full-time equivalents	Missing	Missing	4,9*	5,7	5,6	5,3	6,2	4,7	7,5

*   from 01.05.2005

Table III.  Number of individuals diagnosted with HBV, HCV eða HIV in Iceland per year, per 100.000 inhabitands. Based on data from the homepage of the Directorate of Health, www.landlaeknir.is    

Year	HBV per 100.000	HCV per 100.000	HIV per 100.000
1997	8	20	3
1998	5	24	3
1999	16	30	4
2000	17	31	4
2001	21	27	3
2002	14	24	2
2003	8	13	3
2004	13	21	2
2005	11	15	3
2006	5	18	4
2007	15	31	4
2008	19	29	3
2009	7	33	4
2010	9	19	8
2011	9	23	7

Figure 1: Proportion of reported injuries by wards during 1986-2011.

Figure 2:  Source of injuries by healt care workers professions during 1986-2011.