Needlestick injury, a nightmare for healthcare professionals
What is needlestick injury (NSI)?
A needlestick injury is a percutaneous injury caused by a needle or other sharp medical device that has been in contact with blood, body fluids, or tissue. Such injuries can transmit bloodborne pathogens and represent a significant occupational hazard for healthcare professionals. (1)
- Centers for Disease Control and Prevention (CDC) estimates: 600,000-1,000,000 NSIs occur annually in the United States. (5)
- Incidence: World Health Organization estimates approximately 4 NSIs per healthcare worker per year, highlighting a substantial global burden. (1)
In what settings can needlestick injuries occur?
NSIs occur in a wide range of clinical procedures involving sharp instruments, particularly during activities where needles are handled, manipulated, or disposed of. They frequently happen in high‑workflow environments and procedures requiring direct patient care. (1)
- Medicine delivery: Many NSIs occur while administering injectable medications, where exposed needles increase the risk of accidental puncture.
- Improper needle removal: Removing needles from devices or systems without appropriate safety techniques is a documented cause of NSIs.
- Needle recapping: One of the highest‑risk situations. NSI prevalence is strongly associated with recapping, especially in overloaded or high‑pressure environments such as emergency departments. Additional contributing factors include inadequate infection‑control training, long work hours, improper protective equipment usage, and hospital crowding.
- Blood sample collection: Blood‑drawing procedures require frequent needle handling, making them a recurrent source of NSIs.
- Surgical operations: Surgical settings involve continuous use of sharp instruments, increasing exposure risk for nurses and surgical staff. (1)
Who is most affected by needlestick injuries (NSIs)?
Nurses and nursing students are the professional groups most frequently affected by NSIs because of their continuous exposure to injections, blood sampling, catheter manipulation, and other sharp‑instrument procedures.
- Nurses present the highest risk of sustaining a needlestick injury compared with other healthcare professionals. In a large university hospital cohort, they accounted for 36.2% of all reported NSIs, making them the occupational group at greatest risk within the institution. (4)
- At a global level, this increased risk is reflected in prevalence data: a systematic review conducted across 35 countries reported that 41% of nurses had experienced at least one needlestick injury, confirming their high level of exposure worldwide. (1)
- Nursing students (interns) are also at high risk due to lack of clinical experience, insufficient occupational‑safety training, and unfamiliarity with procedures. (2)
- Manipulation of implantable ports is one of the procedures with the highest NSI risk due to the technical difficulty involved. (6)
Why are needlestick injuries underreported?
Underreporting is a major barrier to understanding the real NSI burden. The literature consistently shows that many injuries never make it into official records.
- The main reason nurses do not report NSIs is that they are too busy at the moment of injury, especially during the morning shift, when patient load is highest. (5)
- Many healthcare workers do not know how to file a report, leading to a substantial number of undocumented injuries. (5)
- Some workers forget the incident afterward, contributing to further underreporting. (1)
- Others underestimate the danger of the injury and assume it is not important enough to report. (1)
- Additional psychological barriers include fear of positive serological results (HIV, HBV, HCV) and fear of being perceived as incompetent in handling sharp instruments. (1)
What are NSIs risks?
NSIs expose healthcare professionals not only to infectious risks but also to psychological distress and significant financial implications for healthcare systems. The following sections summarize these risks and highlight why NSIs remain a major occupational hazard in clinical environments.
1. Health risks for healthcare professionals
Needlestick injuries expose healthcare workers to a wide range of bloodborne pathogens and can lead to severe infectious diseases.
- More than 20 bloodborne pathogens can be transmitted through a needlestick injury, including hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV. (2)
- Globally, occupational percutaneous injuries among healthcare workers result in 66,000 HBV infections, 16,000 HCV infections, and 1,000 HIV infections every year. (4)
2. Emotional burden for healthcare professionals
Beyond physical risks, NSIs carry an important psychological and emotional impact.
- No healthcare worker expects to contract a disease at work, and the anxiety created by a potential infection can be deeply disturbing and life‑changing.
- HBV, HCV and HIV are diseases with well‑known morbidity and mortality, making the emotional impact of a NSI particularly significant.
- NSIs can lead to anxiety, stress, and reduced productivity, which are classified as “indirect costs” in occupational‑health economics. (7)
- Between 42% and 60% of nurses and healthcare workers report experiencing stress and depression following a needlestick injury. (1)
3. Economic costs for healthcare establishments
NSIs generate significant financial burden for institutions due to medical treatment, staff replacement, testing, and follow‑up.
- Direct costs include tests for the injured staff, medical visits, treatments, and potentially replacement staff during sick leave. (7)
- Indirect costs include loss of productivity, administrative time, emotional distress, and reduced performance. (7)
- At the international level, the average combined cost (direct + indirect) of managing a single NSI is $747, based on a systematic review of 14 economic evaluations. (7)
How can we reduce the number of NSIs?
Developed countries tend to show lower NSI prevalence thanks to the implementation of structured prevention programs, regular training, and clear protocols for NSI management. (1)
The use of safety devices that cover the needle‑tip has been shown to reduce NSI risk by 43.4% to 100%, depending on the device and setting. (3)
Since the 1990s, the introduction of safety‑engineered devices, particularly for implantable port manipulation, has played a major role in reducing NSI prevalence in developed countries.
To support these devices, training in best practices was implemented to ensure correct and consistent use, further reducing NSI risk. (6)
In a German University Hospital, the introduction of safety devices across all services, combined with dedicated training to master the new equipment, led to a decrease in NSIs from 448 cases to 350 cases within two years, a reduction of 21.9%. (4)
Overall, the evidence clearly demonstrates that the implementation of safety devices, together with educational and training programs, has a significant positive impact on reducing the number of NSIs.
Healthcare professional's experiences on needlestick injuries
The following testimonials come from Gladys Florimont, a Nurse Manager working in a Day Hospital in France, and Gemma Hervás Jiménez, a Nurse in an Oncohaematology Day Hospital in Spain. Despite working in different healthcare systems and national contexts, both professionals share first‑hand experiences of needlestick injuries, illustrating that NSIs remain a common occupational risk across countries, with comparable clinical, emotional, and organizational consequences in daily nursing practice.
Have you ever experienced an accidental needlestick injury during your work?
Gladys:
“Yes, I have been involved in accidental needlestick injuries, both as a witness and through the reporting of occupational accidents within the team.”
In what context did these incidents usually occur?
Gemma:
“They happened during periods of heavy workload or when the procedure was technically difficult, such as removing infusion sets with compacted dressings, excessive fixation, or when patients were wearing restrictive clothing.”
What were your immediate feelings after the incident?
Gemma:
“I felt angry and worried at the same time, angry because everything had to stop in a very busy setting, and worried about possible infection risks.”
What measures do you consider most effective in preventing needlestick injuries?
Gladys:
“Raising awareness through training and data and ensuring the use of safer needles and protective equipment.”
What message would you like to convey to other professionals or managers?
Gladys:
“Mastery of procedures does not exclude the need for protection; safety must always come first.”
Gemma:
“Please provide high‑quality materials and a range of options adapted to different patients, because good equipment truly reduces risk.”
Conclusions
Needlestick injuries remain a major occupational hazard in healthcare, especially for nurses and nursing students who perform high‑risk procedures daily. These injuries occur through many clinical activities and are often underreported due to time pressure, lack of knowledge, and fear of the consequences. NSIs carry serious health risks along with significant psychological distress such as anxiety and depression. They also impose substantial financial costs on healthcare institutions. However, strong evidence shows that safety‑engineered devices combined with continuous training and clear reporting protocols significantly reduce NSI incidence. Improving prevention and education is therefore essential to protecting healthcare workers and ensuring safer clinical environments.
FAQ's
1. Are NSIs completely preventable?
Not entirely, but their incidence can be reduced by up to 100% with proper safety devices and staff training.
2. What is the first thing to do after an NSI?
Wash the area with soap and water, let the wound bleed slightly if it does so naturally, inform a supervisor or occupational health service, and seek prompt medical evaluation.
3. Do gloves prevent NSIs?
Gloves reduce blood exposure but cannot stop needle penetration. They are necessary but not sufficient.
4. How long does NSI follow‑up last?
Typically 3-6 months, depending on the patient’s serological status (HBV, HCV, HIV).
5. Who is responsible for NSI reporting?
The injured healthcare worker must report immediately, but employers must ensure easy, clear systems to do so.
Bibliography
- Abdelmalik, M. A., Alhowaymel, F. M., Fadlalmola, H., Mohammaed, M. O., Abbakr, I., Alenezi, A., Mohammed, A. M., & Abaoud, A. F. (2023). Global prevalence of needle stick injuries among nurses: A comprehensive systematic review and meta-analysis. Journal of Clinical Nursing, 32, 5619-5631. https://doi.org/10.1111/jocn.16661
- Chen M, Zhang L. Prevalence of needlestick injuries among nursing interns: a systematic review and meta-analysis. Ann Palliat Med 2021;10(7):7525-7533. doi: 10.21037/apm-21-703
- Cooke, C. E., Stephens, J. M. (2017). Clinical, economic, and humanistic burden of needlestick injuries in healthcare workers. Dovepress, 10, 225-235. http://dx.doi.org/10.2147/MDER.S140846
- Hoffmann et al. Reduction of needlestick injuries in healthcare personnel at a university hospital using safety devices. Journal of Occupational Medicine and Toxicology 2013;8:20.
- Joukar F, Mansour-Ghanaei F, Naghipour M, Asgharnezhad M. Needlestick injuries among healthcare workers: Why they do not report their incidence? Iranian J Nursing Midwifery Res 2018;23:382-7.
- Pellissier, G. (2007). Role of Safety-Engineered Devices in Preventing Needlestick Injuries in 32 French Hospitals. Infection Control and Hospital Epidemiology. https://doi.org/10.1086/510814
- Mannocci A, De Carli G, Di Bari V, Saulle R, Unim B, Nicolotti N, Carbonari L, Puro V, La Torre G. How Much do Needlestick Injuries Cost? A Systematic Review of the Economic Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel. Infect Control Hosp Epidemiol. 2016 Jun;37(6):635-646. doi: 10.1017/ice.2016.48. Epub 2016 Mar 29. PMID: 27022671; PMCID: PMC4890345.
