Mumbai/ Pune: From her office tucked into a corner of the sprawling Ruby Hall Clinic, a leading health care institution in Pune, Dr Nita Munshi leads an initiative to protect hundreds of health care workers and support staff from the deadly and infectious dangers of needle-stick injuries.
“It is not always easy. Many times, when they don’t pay attention, I have to actually scare them by saying that their families can become destitute if they die of some disease,” says the head of pathology and microbiology. Needle-stick injuries are wounds caused by needles that accidentally puncture the skin—a hazard for people who work with hypodermic syringes and other needle equipment.
Health care worker safety has rarely been considered a high priority by hospitals across the country. Now, a network of hospitals in Pune is implementing various initiatives to minimize needle-stick injuries, a source of potentially life-threatening infections, making it a model for improving occupational safety in the country’s growing health care sector.
The infection-control team at the clinic holds meetings with the staff during shift change time, when they gather workers from various shifts to tell them about the lurking dangers as they try to save the lives of others.
Needle-stick injuries to health care workers is increasingly viewed with concern by the industry globally, as it exposes workers to a range of life-threatening infections such as the human immunodeficiency virus (HIV), hepatitis B and hepatitis C.
A 2005 study published in the American Journal of Industrial Medicine estimates that overall, 16,000 hepatitis C, 66,000 hepatitis B and 1,000 HIV infections may have occurred in 2000 worldwide among health care workers due to their occupational exposure to injuries.
While there is no India-specific data on needle-stick injuries, experts say that the situation could be even more alarming. Industry estimates indicate that more than 1.7 billion syringes are sold in the country annually and about 5 billion injections administered, sometimes by inadequately trained staff.
“Considering that reuse of injections continues unchecked in many parts of the country, the risk of acquiring an infection through a needle-stick injury is multiplied manifold,” says Rajnish Rohatgi, a general manager at Becton Dickinson India Pvt. Ltd, a medical technology company that manufactures and markets safety devices and diagnostic products.
According to Dr Vikram Padbidri, head of microbiology and infection control at Pune’s Jehangir Hospital, a private hospital under the Apollo Hospitals group, one of the key issues that hospitals face is under-reporting of needle-stick injuries. “People just didn’t think it was important enough,” he says.
Nurses, ward boys, housekeeping staff and those working in the surgical departments are at the highest risk of getting needle-stick injuries and are, as a result, most vulnerable to acquiring blood-borne infections.
As head of the Pune chapter of the Hospital Infection Society of India, Munshi has joined hands with infection control experts across various city hospitals, including government facilities such as the Armed Forces Medical College and Hospital, to improve the safety of workers across 12 leading hospitals in Pune.
The hospitals in this network have developed standard operating procedures to deal with needle-stick injuries. They educate workers on the hazards of needle-stick injuries, on what they can do to protect themselves and what they need to do in case they are so injured. Some of the hospitals have even proactively immunized all their health care workers against hepatitis.
Recently, almost all the hospitals have seen a big increase in the number of injuries being reported. At the Jehangir Hospital, it is estimated that about three years ago only 10% of the injuries were reported. But now that figure has risen to 80%. All reported injuries are treated and tracked on a regular basis.
All the hospitals involved in the network are trying, when possible, to switch to safety devices that are specially designed to ensure that sharp tips of objects, such as needles, are covered with a protective sheath after use.
A single pack of a needle with a protective sheath for one time use costs about Rs60. Hospitals typically use these on patients in the private wards, but even they complain when this is added to their total bill, says Munshi.
Many hospitals in the network are also installing a software called EPINet (exposure prevention information network) to help them further improve their efficiency in tracking and analyzing needle-stick injuries. EPINet provides standardized methods for recording and tracking injuries, and blood and body fluid contacts. The system consists of mechanisms to report various injuries and exposures to blood or body fluids, and also has a programme to help hospitals analyse the data.
As a result, Ruby Hall Clinic has seen a significant reduction in needle-stick injuries to about 10% from the earlier levels of about 15-20%. The infection control experts from Pune are hoping to put together evidence that the investment into health care worker safety will pay dividends in terms of minimizing treatment costs to them. This, in turn, will trigger similar initiatives in hospitals across the country. But it seems like a long haul.
While countries such as Hong Kong, China, Australia and the Philippines are undertaking massive work on this front, Indian hospitals are just waking up to the challenges of not putting such a mechanism in place. In the US, it is mandatory for such prevention and safety mechanisms to be present. Munshi says the only way to rein in hospitals who do not want to invest in the safety of their workers is to bring in legislation that penalizes non-compliance.
“Because the risk is highest in the lower strata of the health care workers’ hierarchy, most hospitals did not consider prevention of needle-stick injuries important,” says Probir Das, another GM at Becton Dickinson India. “It’s only now that some hospitals are taking baby steps.”