Ow! Why we need to pay more attention to needle stick injuries

In the past five years, the Veterinary Medicines Directorate (VMD) has received multiple notifications of needle stick injuries associated with the administration of veterinary products. The impact of these events can be permanent and life changing.

The dangers of needlestick injuries

On initial presentation to these injuries may seem minor, and not warrant follow-up treatment. The reality is different; outcomes from needle stick injuries can range from soft tissue injuries from the needle, infection from dirty needles, or live viral or bacterial vaccines to extreme tissue irritation, inflammation and necrosis, and potentially amputation.

The VMD holds many reports of people suffering from prolonged pain, inflammation, and restrictions to mobility because of a veterinary needle stick injury. The demographic of people at risk from such injuries is wide-ranging, from staff of clinical veterinary facilities, mainly nurses and vets, to farmers administering routine medication to large numbers of livestock.

Are veterinary teams taking things seriously enough?

It is thought that there are many needle stick injuries within veterinary practice that are not reported formally. Instead, they are dismissed at best as unimportant and at worst, as an inevitable side effect of the job.

One of the biggest differences between medical practice and veterinary practice that I observed when I moved from a career in veterinary nursing to human-centred nursing was the attitude towards handling sharps.

In human centred medicine, it is widely accepted that recapping needles is a critical risk factor in needle stick injuries and all healthcare staff are educated to never recap a needle. In medical practice, the stakes are high. The risk of contracting serious blood-borne viruses such as Hepatitis B or Human Immunodeficiency Virus (HIV) is real. The potential for harm from needle stick injuries is reflected in the formal mandatory processes in place designed to address the problem in human healthcare.

This was all quite new to me, as I regularly recalled recapping needles in veterinary practice, even believing to some extent that doing so actually made having them around safer.

The first time I did recap a needle in a human-centred hospital was the last. The nurse supervising me was appalled I had such poor sharps handling technique and made her feelings on the subject very clear.

Bad habits

On reading around the subject, I discovered I was not alone in my bad habits. Data from a study performed in Canada (Anderson and Weese, 2015) demonstrates a culture of complacency around handling sharps in veterinary practice. In 1353 observations of needle use in veterinary practice consultations, needles were recapped in 84% of those uses. Additionally, there was evidence that one member of the team under observation sustained a needle stick injury when they handled an unsheathed needle that had been disregarded. Such data stimulates shocked and horrified reactions in my medical colleagues.

More recently, anecdotal data reported on social media (in 2019), demonstrated that carefully recapping a needle to transport it to a sharps pot was considered ‘safe practice’ by veterinary staff, reports which again would dismay human healthcare staff.

There has been a shift in paradigm, in human healthcare with movement away from individual behaviour modification, treatment and management of injuries, to prevention. Emphasis on a no-blame reporting culture, acknowledgment of the impact of psycho-social factors such as working hours and stress have led to an ongoing culture of respect for sharps.  These policies and attitudes must be extended across the veterinary sector to prevent the number of these injuries continuing to rise.

Prevention is better than cure, but don’t ignore your injury

It is critical that people with veterinary needle stick injuries seek medical advice quickly. They must provide the medical team with details of the substance that may have been injected to ensure that the appropriate treatment can be delivered. In some cases, surgical debridement may be indicated.

Veterinary needle stick injuries may be ill-understood, and under-estimated in human-centred healthcare. Those involved should not be afraid to question if the treatment they are receiving is correct, especially if oil-based products may have been injected which can have the potential to cause severe necrosis and may justify early surgical debridement.

It is time for shift in approach; prevention must be prioritised and there is a need for increased awareness amongst veterinary staff to ensure that they offer needles the respect they truly deserve.

What to do if you think you have suffered a needlestick injury:

• Assume the needle has penetrated the skin, even if there is no visible reaction
• Find and read the product information
• Seek immediate medical treatment, showing the team the product information
• Warn medical staff that further symptoms can be expected
• Emphasise the need for surgical attention if mineral oil-based substances are involved
• Report the incident to the VMD via the online reporting form