This paper examines needle stick injuries (NSIs) in the healthcare setting, with particular focus on a documented incident involving a student nurse administering a heparin injection at a Sydney hospital. The paper identifies contributing factors — including lack of experience, inadequate supervision, stress, and long working hours — and reviews relevant literature on NSI prevalence, psychological consequences, financial costs, and prevention strategies. It concludes with outcome analysis and policy recommendations aimed at reducing NSIs among nursing students and healthcare professionals more broadly.
A needle stick injury occurs when the skin is accidentally punctured during the use of a needle. As the name suggests, these injuries are common within the healthcare field. Needle stick injuries normally occur in large hospitals and are responsible for approximately 80% of HIV/AIDS cases among healthcare workers. In 2005, it was estimated that 64 healthcare professionals were affected with HIV each year due to needle stick injuries alone. Bloodborne infections such as Hepatitis B, Hepatitis C, and HIV/AIDS are spreading serious risks through the medical world today.
As would be expected, no patient presents for the first time with a label indicating which disease they carry. For this reason, healthcare professionals need to exercise great care when handling needles and related equipment. Tasks such as drawing blood or maintaining an IV line are generally the sole responsibility of nurses. Nursing professionals are trained to handle these tasks carefully and to prevent such injuries. It is crucial to counsel nurses about such incidents because diseases like HIV cannot be eradicated from the blood once contracted.
Even though the task of using needles is not inherently difficult, mistakes do happen. The following sections discuss certain factors that increase the likelihood of needle stick injuries. In order to maintain a healthy clinical environment, it is important to reduce the number of these injuries on a broad scale.
This incident took place during a morning shift at 08:30 hours in a Sydney hospital. The individual involved was a student nurse who was administering a heparin injection to a patient. Although the student was performing the task under the supervision of a registered nurse (RN), she experienced a needle prick to the index finger of her left hand while disposing of the used needle and syringe. The needle had pierced her latex glove and caused the finger to bleed. Following the injury, the student immediately washed her finger under running water.
As would be expected, the student was not aware of the patient's health status. Panicked, she informed the registered nurse, and an incident report was created at 09:40 hours. After the student had reported the incident, both the student and the patient were tested for Hepatitis B, Hepatitis C, and HIV/AIDS. The student was also provided with all up-to-date immunizations.
Adams (2012) identified many factors that contribute to needle stick injuries. These include the type of device used, the procedure followed by the nurse, lack of knowledge and training in needle handling, and insufficient awareness of the consequences of such an injury. Beyond these, factors such as inadequate supervision, stress, and long working hours also increase the incidence of needle stick injuries. Given that this incident occurred in the morning, it is possible that the student nurse had been working a late night shift. Extended working hours may have caused fatigue and reduced the student's alertness while performing clinical duties.
Aziz et al. (2009) stated that practice deficiencies can be identified through proper observation of staff. In particular, the waste management practices of staff should be assessed carefully. Lack of supervision and control is a plausible contributing factor in this incident. Although the registered nurse was present, the student may not have followed the most reliable procedure. As Blenkharn (2009) noted, one reliable way to ensure staff are managing waste safely is to examine their clothing and the external surfaces of equipment. This incident therefore signals the need to review other potential hazards that may be going unaddressed.
It should be noted that not all nurses are experienced with all types of devices. Lack of familiarity with a specific device is a plausible contributing factor to the NSI that occurred in this case. Stress is yet another factor that may prevent a nurse from managing a given task properly — both before and after a needle stick injury occurs.
Deisenhammer et al. (2006) identified lack of dexterity in handling needle-syringe devices and limited knowledge of the consequences of NSIs as major contributing factors. Interestingly, stress arising from awareness of those consequences can itself contribute to the occurrence of an injury. In this scenario, however, the opposite may be true: as a student nurse, the individual concerned may not have been sufficiently aware of the consequences of a needle stick injury. It is known that Hepatitis B can survive outside the body for up to one week, while Hepatitis C can persist for up to two days.
A study carried out by Small et al. (2011) demonstrated that many student nurses are exposed to needle stick injuries during their clinical placements. This study is highly relevant to this scenario because it illustrates the prevalence of such incidents. The study showed that 17% of student nurses sustained needle stick injuries during 2008 alone. In 55% of cases where students were injured, they were not supervised or accompanied by a registered nurse (Small et al., 2011). While student nurses are expected to perform such tasks, adequate supervision is essential. As noted earlier, lack of experience and knowledge are plausible reasons for the NSI that occurred in this incident. Nursing students are required to administer injections, but their technique must be properly overseen.
Jagger et al. (1988) reported that 326 NSIs resulted from the use of hollow-bore needles in a university hospital in Virginia, United States. In this scenario, the exact device used by the student nurse is unknown, but if a hollow-bore needle was involved, it further supports the case for adopting safer device alternatives.
Costigliola et al. (2012) interviewed 634 nurses who had experienced an NSI while administering medications to diabetic patients. The nurses reported experiencing depression, anxiety, panic attacks, and crying spells following the injury, all stemming from fear of contracting a disease. This fear is psychologically present in most nurses during needle administration. Consequently, stress and fear of disease contraction — such as HIV or Hepatitis B — represent a significant contributing factor to NSIs.
Sharp needle injuries also impose a considerable financial burden on hospitals. To quantify this cost, Glenngard and Persson conducted a study across 18 Swedish hospitals. The researchers identified which injuries involved hollow-bore needles and estimated the costs associated with each. They also calculated the potential savings achievable through proper safety measures. Their findings showed that the majority of costs arose from post-injury investigations, with an annual cost of approximately 272 Euros per injury, or around 1.8 million Euros in total (Glenngard & Persson, 2009). The study further estimated that implementing adequate safety measures could result in cost savings of approximately 800,000 Euros. This clearly demonstrates the financial, as well as clinical, significance of preventing needle stick injuries.
Given the emotional distress and financial costs associated with NSIs, researchers have been exploring alternatives to conventional needle use. In a study by Chow et al. (2009), erythropoiesis-stimulating agents (ESA) — commonly administered by injection to hemodialysis patients — were delivered via a needle-free route through the venous bubble trap short line of the hemodialysis circuit in ten patients. The study examined nurses' experiences and whether they preferred this needle-free method. Results showed no needle stick injuries with this approach, and hemoglobin levels confirmed that ESA was equally efficacious by this route. Notably, 91% of nursing staff favored the needle-free administration method. The study concluded that drugs administered through detached-needle routes present promising avenues for reducing NSIs in the future (Chow et al., 2009).
Molen et al. (2011) demonstrated that education significantly reduces the occurrence of needle stick injuries. In their study, one group received both an interactive workshop and a needle safety device, while another group received only the safety device without educational training. All groups were assessed at six and twelve months post-intervention. The group that received both the education and the device displayed more positive attitudes toward needle safety and also sustained fewer needle stick injuries (Molen et al., 2011).
"Research on NSI rates, costs, psychology, and prevention"
"Post-incident protocol and policy change recommendations"
Small, L., Pretorius, L., and Walters, A. 2012. A surveillance of needle-stick injuries amongst student nurses at [University]. Health SA Gesondheid, 16(1).
Whitby, R.M. and McLaws, M.L. 2002. Hollow-bore needlestick injuries in a tertiary teaching hospital: epidemiology, education and engineering. Medical Journal of Australia, 177, pp. 418–422.
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