Needlestick injuries in an era of HIV: technical and personal aspects

Hospitals are workplaces in which HIV has double significance. Needlestick accidents link patients, healthcare workers and cleaning staff through the risk of occupational exposure to HIV. Additionally, concern over needlestick injuries may embody HIV stigma, discrimination and fear. This paper draws on qualitative research from a one-year case study at a large, private South African healthcare company that runs a number of hospitals across the country. Issues surrounding needlestick injuries were discussed with hospital managers, union members, infection-control nurses, health and safety representatives, HIV/AIDS counsellors, and general nursing staff. Needlestick injuries presented a complex set of technical and personal concerns. The research shows that cost-management, human rights, health and safety procedures, stigma and discrimination, and the quality of patient care are all relevant to needlestick injuries in an era of HIV. Participants' concerns focused on: establishing safety procedures, the cost and efficacy of waste disposal systems, access to post-exposure prophylaxis, legal implications, and baseline HIV tests following needlestick injuries. The last topic revealed numerous other issues, including the possibility of health workers 'legitimising' sexually acquired HIV infection by passing it off as an occupational accident. Healthcare facilities should ensure procedures that minimise occupational exposure to HIV and that minimise infection risk in the event of accidents. We propose that hospitals ought to directly encourage staff to learn their HIV status and seek disease management when needed. Likewise, better approaches to dealing with HIV stigma and discrimination are needed, especially to dispel myths of good and bad ways of contracting HIV.