Select Committee on Public Accounts Minutes of Evidence

Supplementary memorandum submitted by the Safer Needles Network

  Further to our submission dated 2 May 2003[10] enclosing a memorandum with respect to the NAO Report, A Safer Place to Work, we have now had an opportunity to review the transcript of the evidence hearing which was posted on the Committee's website.

  At the conclusion of the hearing the Chairman mentioned part of the memorandum submitted by the Safer Needles Network as an example which would indicate the potential for serious consequences which might follow as a result of sero-conversion to a blood-borne virus such as HIV as a result of a needlestick injury.

  We have sought the expert opinion of the Health Protection Agency which provided the evidence on which the quoted element in our memorandum is based on. They have supplied us with the attached[11] article from the Public Health Laboratory Service publication, CDR Weekly dated 1 August 2002. This clearly indicates that there have been five cases in which transmission occurred in the UK. There are also 12 probable cases that have been reported in the UK. These 12 fall into the "probable" category, because no baseline negative specimen was obtained at the time of the needlestick injury. The five definite UK transmissions have been published in national journals.

  On another matter in connection with needlestick injuries Sir Nigel Crisp and Mr Gerry Steinberg had an exchange about the incidence of needlestick injuries.[12]

  Firstly, I would remind you that in relation to the scale of the problem of needlestick injuries we have estimated a rate of under-reporting in the range of 60-70% which is in the same range of 60% as that identified in the NAO Report for all incidents. I am also very keen to ensure that there is some clarity about the current state of research in connection with the way that needlestick injuries occur and therefore what remedial actions need to be taken to prevent their occurrence. Training is one of several important components of the solution to the problem. Data from a study conducted by the Health Protection Agency from July 1997 to December 2002 shows that the occurrence of exposure to blood-borne viruses breaks down as follows:

    During Procedure 59%

    Not reported 5%

    During/After Disposal 16%

    After Procedure (before disposal) 21%

  Thus, 37% of incidents do not relate to the actual medical procedure involved and 21% of those are not related to disposal so there is clearly a proportion of injuries which do arise where needles have been left lying around. There is therefore an ongoing need for further procedural or disposal training.

  In a parallel surveillance programme, called EPINet, of needlestick injuries conducted by the RCN, data from January to June 2002 shows that 57% of injuries occurred to the original user of the sharp item but 40% did not. In the same period, 26% of needlestick injuries occurred during the procedure, 21% after use before disposal, 8% placing in disposal, 8% in multi-step procedure, 7% device left in inappropriate place, 6% dissembling device and 3% recapping.

  Finally in, as yet, unpublished research conducted by the Scottish Centre for Infection and Environmental Health for the Scottish Executive, recently presented to the Safer Needles Network Conference on 22 May in London, out of a total of 1,022 reported sharps incidents:

    385 occurred during procedure

    260 after procedure

    204 after disposal

    101 due to unsafe disposal

  In addition, a series of expert panels estimated that between 40.7% and 52.7% of incidents could have been prevented if a safety device had been available or used.

  The research outlined above informs the Safer Needles Network in its firm belief that a dramatic reduction in the incidence of needlesticks can be achieved by the following combination of actions: implementing proper surveillance and reporting procedures; a range of preventative measures and safer working practices; and the adoption of "needle protection" technologies through the purchase of safety engineered devices that are made available to all healthcare workers in the place of work.

  We have been working very closely with the Department of Health over the last couple of years to achieve our objective of making a significant contribution to reducing the number of needlestick injuries and we are hopeful that shortly they will be able to say something more about how they will address all the issues and actions we have outlined above.

Dr Paul Grime


9 June 2003

10   Ev 23-25 Back

11   Not printed. Back

12   Qq 199-202 Back

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