Risk reduction through testing, screening and infection control precautions--with special emphasis on needlestick injuries.

Transmission of the hepatitis B virus (HBV) and human immunodeficiency virus (HIV) pose substantial risks to institutional healthcare employees working with blood. While the risk of contracting hepatitis B in the hospital setting is much greater than the probability of acquiring HIV, the cost of treating the acquired immunodeficiency syndrome (AIDS)--if it develops--is much greater in both dollars and human suffering. In addition to the risks posed by the presence of HIV infection in the hospital increase daily. By the end of 1990, one of every 14 hospitalized patients will be an HIV carrier. Of all hospital-related injuries to employees, the highest percentage (35%) is caused by needlestick/"sharps" punctures. Over a 12-month period, approximately 18,000 hepatitis cases reportedly have been caused by needlestick accidents. After nurses, housekeeping personnel--victims of incorrectly disposed needles--are most at risk. Nurses incur 58% of needlesticks when needles are broken, cut or recapped. Currently, there are products on the market specifically designed to eliminate contact with needles. These cartridge-needle safety units allow for only one-time use, thus doing away with the possibility of recapping. Initial expenditures for new equipment are well worthwhile; the implementation of revised safety precautions are not only worthwhile but also required by law. The dollar costs imposed on hospitals by accidental transmission of bloodborne diseases include tests for the employee, treatment, outpatient visits and wages. One pilot study prevention program conducted in an 800-bed hospital resulted in a 53% reduction in needlestick injuries.