Annual percutaneous injury figures for the USA
Clinical bottom line
Information from the CDC and EPINet suggests many hundreds of thousands of percutaneous injuries and exposure to blood occur every year in the USA.
Data for the USA is captured from 45 EPINet hospitals. The estimate of percutaneous injuries and blood and body fluid exposures in one year (based on 1996 data) was calculates as follows:
- 30 injuries per 100 occupied hospital beds reported (from national EPINet data for 1996)
- 600,000 occupied hospital beds in the USA
- 180,000 injuries in one year reported in hospitals (0.3 x 600,000)
- 39% of incidents not reported (according to surveys conducted in 6 EPINet hospitals in 1996-1997) = 295,082 injuries occurred in hospitals
- double this figure because 50% of health care workers work outside of hospital settings (total = 590,164 percutaneous injuries)
- according to EPINet data for 1996, an additional 1/3 of reported exposures (total = 196,721 mucocutaneous exposures) involve skin/non-intact skin or mucous membrane contact with blood or at-risk biological substances with can also transmit HIV, HBV, HCV
Thus the total annual percutaneous and mucocutaneous exposures to blood or at-risk biological substances in the U.S. in 1996 = 786,885.
In an updated report (Advances in Exposure Prevention, 2000, Vol. 5, No. 2, p.19.), the CDC increased the estimate of annual percutaneous injuries for healthcare workers in hospitals to 384,325.
Occupational infections
Based on transmission rates of 0.2-0.4% for HIV, 6-30% for HBV and 0.4-1.8% for HCV, the calculations for occupational infection are:
- The CDC estimates that 400 new occupational HBV infections occurred in 1995 among U.S. health care workers, down from 17,000 in 1983. (Arch Intern Med 1997;157:2601-2603)
- Assuming that between 1% and 2% of patients are HIV-positive (and therefore that 1% to 2% of needlesticks are HIV-contaminated) between 18 to 35 new occupational HIV infections would occur from percutaneous injuries each year. Infections resulting from blood exposures to non-intact skin or mucous membranes would add between 2 to 4 cases (based on a transmission rate of .09% for a mucous membrane exposure).
- Assuming that between 2% and 10% of patients are HCV-positive, between 59 to 1,180 new occupational HCV infections would occur each year. Infections resulting from blood exposures to non-intact skin or mucous membranes would add between 16 to 393 cases (assuming that the transmission rate was between 0.4% and 1.8% per exposure).