Quantifying environmental health impacts

Sharps injuries: Assessing the burden of disease from sharps injuries to health-care workers at national and local levels

Environmental burden of disease series No. 11

By E. Rapiti, A. Prüss-Üstün, Y. Hutin

This guide provides a method for public-health and occupational-health professionals who wish to determine the burden of disease in health-care workers from sharps injuries at national, regional, or local levels. Sharps include syringe needles, scalpels, broken glass and other objects contaminated with blood from a source patient. Health outcomes from percutaneous injuries include infections with hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV). Exposure is assessed from the number of sharps injuries in health-care workers each year, and from the infection prevalence in source patients. The immunization rate against HBV, and the post-exposure prophylaxis (PEP) coverage are also needed to assess the disease burden. The assessment provides the incidence of HBV, HCV and HIV infections caused by sharps injuries to health-care workers, and the fractions of the infections attributable to sharps injuries. The number of infections that could be prevented by PEP can also be estimated. The data can be used to assess the distribution of disease burden by category of health-care worker, by ward or by activity, which would allow protection measures to be more-specifically targeted.

Globally, it is estimated that sharps injuries cause about 66 000 HBV, 16 000 HCV and 2005000 HIV infections among health-care workers each year (see Environmental Burden of Disease Series No. 3). For health-care workers worldwide, the attributable fractions for percutaneous occupational exposure to HBV, HCV and HIV are 37%, 39% and 4.4%, respectively. These bloodborne infections have serious consequences, including long-term illness, disability and death.