Needlestick and risk in Uganda

Clinical bottom line

Needlesticks were common in a Ugandan medical school. The risk from a single needlestick injury for HIV infection was about 1 in 400 to 1 in 2,000, and for hepatitis B infection was 1 in 200 to 1 in 45.

Reference

DH Newsom, JP Kiwanuka. Needle-stick injuries in an Ugandan teaching hospital. Annals of Tropical Medicine & Parasitology 2002 96: 517-522.

Study

A voluntary, anonymous questionnaire was circulated to 280 healthcare workers in a Ugandan teaching hospital in November 1999. It explored recall of needlestick injuries in the previous year, the circumstances, and the action taken. It also examined local prevalence of HIV and HBV infection in patients, and calculated the risk of infection from a single needlestick.

Results

The response rate was 64%. one hundred of 180 respondents (55%) reported at least one needlestick injury in the previous year, with 336 injuries in total, giving an average of two injuries per healthcare worker per year. Interns suffered most injuries, followed by nurses and medical students. Most injuries occurred when patients moved during procedures, or when re-sheathing needles.

Most (61%) respondents took blood without wearing gloves.The most common action was to squeeze the puncture site and then wash it with bleach.

Blood from 435 anonymous patients was tested, and the seroprevalence of HIV was 26% and HBV was 3%. The risk of infection following a single needlestick injury, using literature data for transmission, was:

For HIV:

For a single needlestick 0.08% (1 in 1,250, ranging from 1 in 400 to 1 in 2,000 in different departments)
The cumulative risk for a doctor by the end of a two years as a student and a one year internship was calculated as 0.6% (1 in 1,600)

For HBV:

For a single needlestick 0.14% (1 in 700,but up to 1 in 200 to 1 in 45 in some departments)
The cumulative risk for a doctor by the end of a two years as a student and a one year internship was calculated as 1% (1 in 100)

One student reported developing acute hepatitis B infection, but no-one disclosed their HIV status.

Comment

These are high risks, and high cumulative risks. The paper also reports and comments on the psychological effects of needlestick injury, especially where post-exposure prophylaxis is not commonly available.