Even a relatively minor – none can be described as trivial – sharps injury or blood or bloodstained body fluid exposure can result in short-term or longer-lasting psychological harm. This may manifest as post-traumatic stress and anxiety, sometimes affecting an entire family group, forcing a change of career or occasionally an inability to work at all. The loss of income exacerbates the stress impact, resulting in sometimes life-long change to lives.
We have discussed this many times previously on the Clinical Waste Discussion Forum, too often to list here. Users wishing to review these posts can use the site search function or browse the archive files, which are not included in the search system.
Now, in a short report by Zhang and Yu from The Second Affiliated Hospital of Soochow University, Suzhou, China (Zhang MX, Yu Y. A study of the psychological impact of sharps injuries on health care workers in China. Am J Infect Contr 2013; 41(2): 186-7) the level of concern of sharps injury for healthcare workers are noted to be related to a number of adverse effects, including both physical problems and economic burdens, as well as psychological impacts. The authors note that published research in this area is limited compared with reports describing the incidence of sharps injury, situations when it happens, risk factors, and economic costs.
361 subjects (180 males and 181 females; 186 nurses and 175 doctors) were recruited to the study, all of whom had experienced at least one sharps injury. The majority (64.3%) did not report their injury.
The data show that 15.2% of respondents reported manifestations of emotional distress, such as anxiety, worry, frustration, panic, and even extremity numbness, after experiencing a sharps injury. More than half (57.6%) reported feeling that they had been or would become infected from their injury.
93.9% of respondents indicated that the major factor inducing negative psychological changes was the fear of infection of themselves or family members.
Another factor that caused frustration in HCWs was the inability to completely protect their own rights and benefits. Over-excessive behavior can be induced by psychological stress; 39.6% of respondents reported engaging in over-excessive behavior, with a significantly higher incidence in women than in men (P <0.05).
67.9% reported that their careers had been affected by their sharps injury, including diminished professional recognition and reduced professional enthusiasm. These effects were greater in the younger respondents (aged 20-30 years; P <0.05).
The comparable results for ancillary workers and waste handlers are unknown since, as yet, no large study has been contemplated. In all probability, the results may differ from those noted for healthcare workers since education and understanding of the issues involved are likely to be markedly different, sharping responses to sharps injury, even with full engagement with an appropriate medical follow-up.
The outcomes of sharps injury in waste handlers has been poor, with many not reporting injuries as these are seen as something of an inevitability, becoming almost routine; splash exposure with blood or bloodstained body fluids are generally, and incorrectly, not recognised as risk events. First aid and follow-up support is often limited, even in larger companies with an effective and accessible occupational health service that is likely to be detached from the ‘shop floor’ and effectively inaccessible in any reasonable timescale.
A local Accident and Emergency Department is the best port of call, though where there is a choice travel to a larger city hospital is likely to be a wise choice since these may have the appropriate specialist services.
Demand attention. Don’t be fobbed off as a trivial injury that can be managed at home with just a band aid. A comprehensive clinical review, preferably with urgent referral to a specialist infectious disease service. Despite this, it is still inevitable that some will be turned away from A&E, or left to wait for many hours in circumstances where early administration of post-exposure prophylaxis antiviral drugs, if indicated, is time critical.
Council Directive 2010/32/EU won’t help. Though this requires that each healthcare service develops strategies to minimise sharps injury and introduces safety sharps these are likely to be discarded without activation, into flimsy waste sacks rather than sharps bins, in the same way as at present. A safety sharps device will not change that negative attitude to safety and the welfare of others. Elsewhere, Trusts are required to develop plans for effective and rapid management of sharps injury with referral of staff to specialist services. Though it is intended that this care will be extended to contract staff such as cleaners and porters working permanently on-site, those not working for a healthcare provided are not included in this legislation and are likely to be denied access.