Needlestick injuries, management and education: a role for emergency medicine?

INTRODUCTION: The objectives of the study were to study the pattern of needlestick injuries presenting to an inner city emergency department, and to highlight areas where greater training is required. The emergency department is involved in the management of injuries both in the hospital setting and in the community. The setting was an inner city area with a high incidence of intravenous drug abuse, HIV, hepatitis B and C.

METHODS: A retrospective review of all emergency notes triaged as needlestick injury for a 12-month period from July 2001 to July 2002. Information studied included times from incident, arrival at department, to be seen by doctor and to get post-exposure prophylaxis (PEP) if indicated; also the number of tetanus toxoid, hepatitis B immunoglobulin/vaccine, HIV PEP given as well the number indicated. The risk of injury and exposure were assessed and follow-up was checked.

RESULTS: There were 73 needlestick injuries, 35 (48%) presented during normal working hours (09.00-17.00 h) and 38 (52%) presented outside these hours. Twenty-six (34%) were in healthcare workers, 51 (66%) were in non-healthcare workers. The average time from the incident to arrival was 1.4 h for healthcare workers and 22.6 h for non-healthcare workers. The median time from arrival in the department to be seen by a doctor was 90 min. Ten injuries (13.7%) were high risk. Antiretroviral agents were given to 15 patients (20.1%) and the median time from door to HIV PEP was 90 min (average 141 min).

CONCLUSIONS: There is a delay and lack of urgency in the presentation of needlestick injuries for assessment and treatment. Education of emergency staff, other healthcare workers and the general public is needed to reduce the needle-to-door and needle-to-PEP time for the effective management of needlestick injuries and prevention of hepatitis and HIV seroconversion.