Needle sticks and adverse outcomes in office-based allergy practices

In 1984 the first case of needle stick transmitted human immunodeficiency virus was reported. In 1986 Occupational Safety and Health Administration was petitioned by various unions representing health care employees to develop a standard which protects employees from occupational exposure to blood-borne diseases. Congress passed the Needle Stick Safety and Prevention Act. This specifies that "safer medical devices, such as sharps with engineered sharps injury protections and needle-less systems" constitute an effective engineering control, and must be used where feasible. This has been mandated in California as part of the labor code. Blood-borne pathogens of concern in needle stick injuries are human immunodeficiency virus, hepatitis virus B, and hepatitis virus C.

The objective of this study was to determine the incidence of accidental needlesticks (ANSs) and disease transmission in the allergy setting.

A retrospective survey of most California allergy practices and a few large multi-physician allergy practices. We received and used 121 of 400 surveys.

Analysis of the survey data showed an overall incidence of 45 ANSs with 7.026 million 26-/27-gauge needles reported. There was zero rate of disease transmission; 6.41 ANSs per million compares favorably with an estimated 267 ANSs per million in the general medical setting.

The rate of ANSs in the allergist's office is 2% that of general medical ANSs. The current "safety" needles have no proven effectiveness. There is no reported disease transmission in the allergist's office setting using existent methods. This solution needs further study before there is generalized implementation of the engineering devices of no proven effectiveness that may in fact increase ANSs.