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A Sharp Practice? Needle-stick Injuries and their Relevance from a Clinical Negligence Perspective

View profile for Kimmo Boote
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A needle-stick injury is, unsurprisingly, one where the skin is breached by contact with a sharp object such as a needle.

What is surprising is that it is quite a common injury in clinical practice, with large numbers going unreported.

Of those that are reported or lead to a complaint against the Hospital/Trust concerned, the scale of the problem is not insignificant in terms of the financial costs and worry for the affected person, be they a member of staff or patient who received the stick injury.

In reply to a Freedom of Information request in 2012, the NHS Litigation Authority (NHSLA) posted the following:

‘During the year 01/04/10 - 31/03/11 we were notified of 277 claims relating to Sharps Injuries'

249 specify 'needle' or 'needle-stick', 6 refer to a surgical item, such as a scalpel, 2 kitchen equipment, 3 stationery items, with the remainder simply referring to 'sharps' or not specifying. 

As at 29/02/12, 190 of these claims have closed, 20 of them with no damages paid. The total damages paid for the 170 that settled with damages is £284,300 with the average settlement being £1,670'.

However, please note that Trusts have an excess of £10,000 per claim on Employer's liability claims, so a number of needle-stick claims will have been settled in-house and will not have been reported to the NHSLA.

Complications that can be caused by a needle-stick injury

There is a risk for the transmission of a blood borne agent causing an infection in the patient who received a needle-stick injury. Over 20 infecting organisms have been shown to be transmissible following a needle-stick injury.

The most common of these are Hepatitis B and Hepatitis C, whilst HIV has a relatively low occurrence by this route of transmission.

Along with the medical problems that may arise, psychological harm can come to the people with the needle-stick injury owing to the worry of the possibility of having been infected by this means.

Prevention

Each Trust should have a needle-stick policy as it is important to be consistent about the advice given. http://www.hse.gov.uk/healthservices/needlesticks

The Health and Safety Executive have made the following recommendations about care that should be delivered following such an injury:
 
What to do if you receive a sharps injury

If you suffer an injury from a sharp which may be contaminated:

  • Encourage the wound to gently bleed, ideally holding it under running water
  • Wash the wound using running water and plenty of soap
  • Don't scrub the wound whilst you are washing it
  • Don't suck the wound
  • Dry the wound and cover it with a waterproof plaster or dressing
  • Seek urgent medical advice (for example from your Occupational Health Service) as effective prophylaxis (medicines to help fight infection) are    available
  • Report the injury to your employer.’

Medico-legal aspects

There are certain procedures that are known to linked with an increased likelihood of a needle-stick injury.

These are: the insertion of a cannula into a vein or an artery, taking venous blood, using a butter-fly needle and the administration of drugs using an open needle technique.

The details of the procedure, what the steps were taken after the incident occurred (were the steps as listed above followed by the individual and was there a risk assessment undertaken as to the likelihood of infection-was the occupational health department involved if a member of staff was involved) and how the Trust then arranged for follow up and support are key in demonstrating that all reasonable measures were taken after the needle-stick injury happened.

This is a frequent event that is relatively underreported as compared with the frequency of its occurrence. Noteworthy is that a number of claims are settled for smallish sums and a number do not proceed, which may indicate that good practice after the event occurred, so diminishing the chance of a successful litigation.

If you want further information about this particular topic, or wish to discuss the possibility of bringing a claim for this type of injury, or indeed any other type of injury, please contact the Dutton Gregory Clinical Negligence Team on (01202) 315005, or email k.marden@duttongregory.co.uk