Sharps injuries: Global burden of disease from sharps injuries to health-care workers
Environmental burden of disease series No. 3
Although the occupational transmission of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) has been documented in healthcare personnel, and a number of countries have national surveillance programmes for occupational infections, the burden of disease from such infections has not yet been estimated at the global level.
We modelled the incidence and fraction of HBV, HCV and HIV infections that were attributable to a workplace percutaneous injury with a needle or sharp contaminated with bloodborne pathogens. The model was based on probabilities for the occurrence of joint events or states, including the probability of injury, the prevalence of active infection in the population, the susceptibility of the worker, and the percutaneous transmission potential. The model assumed that the risk of infection increased almost proportionally to the number of infectious individuals in the population, and was applied to 14 geographical regions, grouped on the basis of the WHO Region and mortality strata (Annex). For developed regions, the effects of PEP for HBV and HIV were included in the model.
The proportion of health-care workers in the general population varied substantially by region (0.2%–2.5%), as did the average number of injuries per health-care worker (0.2–4.7 sharps injuries per year). The annual proportions of health-care workers exposed to bloodborne pathogens was 2.6% for HCV, 5.9% for HBV and 0.5% for HIV, corresponding to about 16 000 HCV infections and 66 000 HBV infections in health-care workers worldwide. According to the model, 200–5000 HIV infections would also be caused (with an expected value of 1000 HIV infections). In developing regions, 40%–65% of HBV and HCV infections in health-care workers were attributable to percutaneous occupational exposure. In developed regions, by contrast, the attributable fraction for HCV was only 8%–27%, and that for HBV was less than 10%, largely because of immunization and PEP. The attributable fraction for HIV in the various regions ranged between 0.5%–11%.
Health-care workers are frequently exposed to percutaneous injuries with contaminated sharps, which cause a large proportion of all HCV, HBV and HIV infections in this group. These infections could largely be prevented, as shown by the lower numbers of infections in regions where efforts have been made to reduce such exposures.