Needlestick injuries (NSI) continue to pose a significant risk to healthcare workers (HCWs) worldwide. Though the risk of acquiring bloodborne viral infection is low, it is not negligible. The psychological consequences of exposure can also be significant. Many exposures are entirely preventable. Applying the hierarchy of risk controls, a much used concept in the discipline of occupational hygiene, is important in addressing all occupational hazards. Elimination or isolation of a microbial hazard, though possible in the laboratory, is not an option in the clinical setting. However, engineering controls have been evolving in recent decades. In the 1990s, the safety technology advocated was costly and impractical so that prevention of exposure largely relied on education and training to optimise human behaviour in handling sharps. A decade later, safety engineered devices (SEDs) had become more technically sophisticated. However, diverse mechanisms of action ensure that their correct use is not always intuitive so training and supervision are required. These activities are administrative controls, and, though costly, are less effective in the hierarchy than are engineering controls. Personal protective equipment has a lesser role to play in protecting HCWs from NSI but is useful for preventing mucocutaneous exposures.
The scientific literature has confirmed the efficacy of engineering controls and this has been underpinned by legislation, led by the United States in 2001, followed by the European Council Directive on Sharps in 2010.
However, technical solutions alone are insufficient to mitigate this hazard. In working to reduce injury in our organisation, we identified significant systemic obstacles within the hospital which when addressed, helped to reduce our injury rates. We also suggest that an understanding of the psychology of behaviour change at both individual and organisational levels is helpful in providing support for NSI prevention programmes.