Occupational needlestick injuries in a metropolitan police force

doi:10.1016/S0749-3797(99)00137-3

American Journal of Preventive Medicine

Volume 18, Issue 2, February 2000, Pages 146-150

https://doi.org/10.1016/S0749-3797(99)00137-3 Get rights and content

Abstract

Objectives: Police officers are at risk of bloodborne diseases through needlestick injuries but few studies have addressed this problem. The purpose of this study was to assess the risk of needlestick injuries in law enforcement officers and to determine predictors of injuries and reporting rates.

Design: An anonymous, voluntary questionnaire was distributed to 1738 active-duty, metropolitan police officers. The survey included the number of needlestick injuries ever experienced, how often these were reported, activities at the time of injury and attitudes toward injuries.

Results: Of the 803 respondents (46.2% of survey population), 29.7% had at least one needlestick injury, and 27.7% of this group had two or more. Risk factors included evening shifts, pat-down searches, patrol duties, male gender and less experience. Only 39.2% sought medical attention for these injuries.

Conclusions: Needlestick injuries occur with considerable frequency in this group of law enforcement personnel, suggesting an increased risk of becoming infected with bloodborne pathogens, including hepatitis B, hepatitis C and HIV.

Introduction

With the heightened awareness of the relationship between needlestick injury (NSI) and bloodborne disease, the incidence of NSIs, especially among health care workers, has raised increasing interest and demanded more research.1, 2, 3, 4, 5, 6 In the last 15 years, NSIs have been well established as a cause of bloodborne diseases including hepatitis B, hepatitis C and human immunodeficiency virus (HIV).7 Estimates of needlestick transmission from infected individuals range from 3%–16% for hepatitis B, 0.35%–0.5% for HIV and approximately 4%–10% for hepatitis C.8, 9, 10a, 11b, 12, 13, 14 The prevalence of HIV seropositivity in intravenous drug abusers ranges between 5% and 33%, depending on the geographic location in the United States, with prevalence of hepatitis B and hepatitis C between 30% and 50% and 60% and 90%, respectively, in the same population.15 The risk of intravenous drug users’ (IVDU) needles being positive for the HIV virus ranges from 5% to 20%.16, 17 Individuals in police custody were found to be seropositive for HIV and hepatitis B in 4% and 25.7% of cases, respectively, in a 1994 British study.18

Few studies have focused on law enforcement personnel (LEP) NSIs, the associated risk factors and/or reporting patterns, despite their increased risk due to contact with drug-abusing clients. Most studies of LEP have evaluated only the seropositivity rates of hepatitis B, and have not found an increase over the baseline population.15 A study of 1333 police officers of the Denver Police Department focused on either blood or saliva exposure.19 Of the 42 documented exposures over a 1-year period, only 9.5% (four cases) were found to be the result of an NSI (57% from blood contact with non-intact skin; 14% from contact with intact mucous membrane; 14% from human bites; and 5% from lacerations by contaminated instruments). Paramedics and emergency medical services (EMS) personnel have been found to have hepatitis B seropositivity rates of 15%–23%, well above the general U.S. population seroprevalence of 3%–5%.20, 21

Only 43.4% of those exposed in the Denver study reported their injuries, a reporting rate consistent with health care workers. Hamory studied 726 hospital-based employees, of which 148 had sustained NSIs; only 40% reported their exposure.22 A Washington state study of refuse collectors found that only 10% of those with NSIs reported their injuries.23 Tandberg and colleagues studied nurses, physicians and paramedics in an emergency department and revealed that of 259 NSIs, only 35% were reported.24

The primary aim of this study was to assess the occurrence of NSIs in a major metro police department (San Diego). The secondary aim was to ascertain predictors of NSIs, determine the rates of reporting and assess the attitudes of LEP.

Section snippets

Methodology

The study population consisted of all active officers of the San Diego Police Department (SDPD) in 1996. Eighty-five percent of the study group were male. The average age was approximately 35, and the average for years of experience was approximately nine.

With the assistance of the chief of police and the SDPD Medical Assistance Office, an anonymous self-administered questionnaire was developed, and an Internal Review Board review of the protocol and survey instrument were conducted and

Results

A total of 803 questionnaires were returned, yielding a response rate of 46.2%. Of the respondents, 82.5% were male. Nearly half of the respondents were aged 31–40. The largest subgroup had 6–10 years of experience (Table 1). These figures closely approximate the demographics of the total study group, which was 85% male, with an average age of 35 and an average 9 years of work experience on the force. A total of 238 respondents (29.6%) indicated that they had sustained an NSI during the

Discussion

This is the first large-scale study of a major metropolitan police department regarding the occurrence of NSIs. Other studies have focused mainly on the seropositivity of suspects rather than the reporting of needlestick exposures. The percentage of respondents who indicated they had at least one NSI was 29.6%; of those, 27.7% experienced multiple exposures. Given the high rates of bloodborne illnesses in arrested persons, this represents a serious health care risk for LEP.

The exposed

Conclusions

This study suggests the presence of a high risk of NSI in LEP, which appears to be underreported and undertreated, despite high levels of self-reported concern regarding these injuries. Needlestick injuries constitute a major occupational health problem in large at-risk population including police officers in metropolitan settings and “first responders” (firemen, police and paramedics). With self-reported NSIs occurring in almost 30% of the study population and estimates of HIV infection rates

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Citation Excerpt :
The concern is largely centered on the fear of syringes being left in streets or parks, potentially leading to needlestick injury and transmission of bacteria and bloodborne viruses (e.g., HIV, viral hepatitis). While epidemiological studies confirm that PWID do sometimes dispose of syringes improperly (Quinn et al., 2014; Tookes et al., 2012; Wenger et al., 2011; Yang et al., 2015), viral transmission associated with needlestick injuries from improper disposal of syringes by PWID is extremely rare (Alter, 1994; Dierks and Miller, 2002; Drda et al., 2002; Hanrahan and Reutter, 1997; Lawitts, 2002; Lorentz et al., 2000; Papenburg et al., 2008; Russell and Nash, 2002). While no cases of HIV, hepatitis B virus or hepatitis C virus seroconversion have ever been recorded among children who incurred accidental needlesticks (Makwana and Riordan, 2005; Nourse et al., 1997; Papenburg et al., 2008; Russell and Nash, 2002; Thompson et al., 2003; Wyatt et al., 1994), improper disposal of syringes remains an important driver of local drug policy.
Community opposition to safe consumption sites often centers around improper syringe disposal. People are concerned these sites might attract people who inject drugs to the neighborhood, which might in turn lead to more used syringes left in public settings.
We evaluated an unsanctioned safe consumption site in an undisclosed United States city in 2018–2020 to assess whether use of the site was associated with improper syringe disposal practices. We recruited people who inject drugs (N=494) using targeted sampling methods, and interviewed participants at baseline, 6 months, and 12 months. We employed a quasi-experimental design involving inverse probability of treatment weighting using propensity scores. We used generalized estimating equations and Poisson models to calculate relative risk and incidence rate ratios of improper syringe disposal.
The risk of any improper syringe disposal was comparable among people who used and did not use the unsanctioned safe consumption site in prior 30 days (relative risk 1.03; 95% confidence interval=0.53, 1.17). The rate of improperly disposed syringes per number of injections in prior 30 days was significantly lower among people who had used the unsanctioned safe consumption site during the same period (incident rate ratio 0.42; 95% confidence interval=0.18, 0.88).
When people used this unsanctioned safe consumption site, they disposed of significantly fewer syringes in public places, including streets, sidewalks, parks, or parking lots, than people not using the site. This study helps allay concerns that implementing safe consumption sites in the US would lead to increases in improperly disposed syringes.
Occupational injuries among police workers: Patterns and contributing factors in an Australian jurisdiction
2020, Safety Science
Citation Excerpt :
While we did not have any information on rank/role in the present study, the results may reflect that the younger groups may have more exposure to situations such as arrest and restrain. This is supported by research in the U.S, where they found that younger age was associated with a range of injuries, such as injuries sustained during arrest and restrain, and exposure injuries (particularly needlestick) (Lorentz et al., 2000). A key finding in this study (involving a survey of 1738 active duty law enforcement officers) was that a large proportion of respondents (n = 803) had received at least one needlestick injury (30%), and a significant proportion of those who had received one needlestick injury went on to receive more (28%).
Police are regularly exposed to potentially traumatic events, which puts them at risk of physical and psychological injury. International evidence suggests that police have high injury rates relative to other occupations, however most research either focuses on specific situations (e.g., use of force); specific injury causes (e.g., weapons); or specific injury types (e.g. Post-traumatic Stress Disorder). Few studies have focused on understanding injury patterns across the workforce. Thus, the primary objective of this paper was to describe the rate, mechanisms, type and costs of occupational injuries experienced by police in one Australian jurisdiction.
Using administrative workers’ compensation claims data, claims records of police were examined for the period 2003/04–2011/12. Descriptive analyses were conducted to characterise the distribution of first and subsequent claims, stratified by claim type (minor, medical and time loss). Rates were calculated using labour force statistics (per 1000 full-time equivalent workers).
This study described a number of factors associated with the incidence of injury among police. Over the study period, there was a decrease in first claim rates and an increase in subsequent claim rates across all claim types. Key findings to inform prevention strategies included that younger males (in the 35–44 year age groups) made the most claims, and the greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying). Future research linking corporate statistics to operational/incident information would be beneficial to understand the specific incident factors that are important in outcomes.
The value of harm reduction for injection drug use: A clinical and public health ethics analysis
2019, Disease-a-Month
The US is facing dual public health crises related to opioid overdose deaths and HIV. Injection drug use is fueling both of these epidemics. The War on Drugs has failed to stem injection drug use and has contributed to mass incarceration, poverty, and racial disparities. Harm reduction is an alternative approach that seeks to decrease direct and indirect harms associated with drug use without necessarily decreasing drug consumption. Although overwhelming evidence demonstrates that harm reduction is effective in mitigating harms associated with drug use and is cost-effective in providing these benefits, harm reduction remains controversial and the ethical implications of harm reduction modalities have not been well explored.
This paper analyzes harm reduction for injection drug use using the core principles of autonomy, nonmaleficence, beneficence, and justice from both clinical ethics and public health ethics perspectives. This framework is applied to harm reduction modalities currently in use in the US, including opioid maintenance therapy, needle and syringe exchange programs, and opioid overdose education and naloxone distribution. Harm reduction interventions employed outside of the US, including safer injection facilities, heroin-assisted treatment, and decriminalization/legalization are then discussed. This analysis concludes that harm reduction is ethically sound and should be an integral aspect of our nation's healthcare system for combating the opioid crisis. From a clinical ethics perspective, harm reduction promotes the autonomy of, prevents harms to, advances the well-being of, and upholds justice for persons who use drugs. From a public health ethics perspective, harm reduction advances health equity, addresses racial disparities, and serves vulnerable, disadvantaged populations in a cost-effective manner.
Needlestick injuries and other body substance exposures among police officers in a city police department
2019, American Journal of Infection Control
Citation Excerpt :
Among the reported needlestick injuries at another metropolitan department, 42% of respondents reported that the incidents occurred during second shift or evening. The most common circumstances were pat-down searches (36%), searches incident to arrest (25%), property searches (10%), and vehicle searches (10%).1 In the police department we evaluated, needlestick injuries most commonly occurred during pat-down searches of a suspect and during searches of a suspect's property or vehicle, which is similar to previous findings.1
We determined the incidence and circumstances of needlestick injuries and other body substance exposures among police officers in a city police department.
We analyzed data extracted from the city's centralized human resource database on all incidents from January 1, 2011, to December 31, 2016, and characterized their circumstances. We calculated the annual incidence of needlestick injuries per 1,000 officers and per 10,000 reactive calls. We ran a Poisson regression model to determine the trend in the annual incidence over time.
We found 13 needlestick injuries and 37 additional body substance exposures involving city police officers. Needlestick injuries most commonly occurred during pat-down searches and searches of property or vehicles; 9 source persons tested positive for hepatitis C. The annual incidence of needlestick injuries ranged from 0-5.1 per 1,000 police officers and from 0-2.5 per 10,000 reactive calls for service without a significant trend. Most body substance exposures consisted of spitting, human bites, and other contact with blood. No incidents reportedly led to transmission of bloodborne viruses.
Although these appear to be rare events, police officers in this department are at risk for needlestick injuries and other body substance exposures. We recommended engineering, administrative, and personal protective equipment control improvements.
Danger in the streets: exposures to bloodborne pathogens after community sharp injuries in Rio de Janeiro, Brazil
2017, Brazilian Journal of Infectious Diseases
Exposures to sharps injuries occurring in the community are relatively frequent. We describe characteristics of community sharp exposures reported in the city of Rio de Janeiro from 1997 to 2010.
A cross-sectional analysis of exposure reports to sharps in the community reported to a surveillance system, designed for health care workers, of the Municipal Health Department of Rio de Janeiro. The characteristics of exposed individuals analyzed included types of exposure, the circumstances of the accident, and the prophylaxis offered.
582 exposures were studied. Median age was 30 years and 83 (14%) involved children with less than 10 years of age. Two hundred and seventeen (37%) occurred with sharps found in the streets. The exposure was percutaneous in 515 (89%) and needles where involved in 406 (70%) of them. The sharps were present in the trash in 227 (39%) or in the environment in 167 (29%) of the reports. Professionals who work with frequent contact with domestic or urban waste were 196 (38%). The source was known in 112 (19%) of the exposures and blood was involved in 269 (46%). Only 101 (19%) of the injured subjects reported a complete course of vaccination for hepatitis B. Antiretroviral prophylaxis was prescribed for 392 (68%) of the exposed subjects.
Sharps injuries occurring in the community are an important health problem. A great proportion would be avoided if practices on how to dispose needles and sharps used outside health units were implemented.
Drug use in business bathrooms: An exploratory study of manager encounters in New York City
2017, International Journal of Drug Policy
Citation Excerpt :
People who inject drugs experience a need for privacy and immediacy, as previously discussed, after procuring drugs in order to quickly alleviate withdrawal symptoms or suppress cravings and business bathrooms in close proximity to drug markets may fulfil this need. Over a third of managers found improperly disposed syringes in their business bathrooms, a hazard for transmitting HIV, HCV and HBV to other PWID, community members and staff (Blenkharn, 2008; Lawitts, 2002; Lorentz, Hill, & Samimi, 2000; World Health Organization, 2015) though the transmission of these viruses via accidental needle sticks is uncommon (Papenburg et al., 2008; Russell & Nash, 2002). Regardless, post-exposure medical care, blood testing, and post-exposure prophylaxis (PEP) can produce considerable amounts of anxiety and stress on individuals who are injured in this manner (Parkin & Coomber, 2009; Sohn, Kim, Kim, & Han, 2006).
Though public bathroom drug injection has been documented from the perspective of people who inject drugs, no research has explored the experiences of the business managers who oversee their business bathrooms and respond to drug use. These managers, by default, are first-responders in the event of a drug overdose and thus of intrinsic interest during the current epidemic of opioid-related overdoses in the United States. This exploratory study assists in elucidating the experiences that New York City business managers have with people who inject drugs, their paraphernalia, and their overdoses.
A survey instrument was designed to collect data on manager encounters with drug use occurring in their business bathrooms. Recruitment was guided by convenience and purposive approaches.
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The results from this study underscore the need for additional research on the experiences that community stakeholders have with public injection as well as educational outreach efforts among business managers. This research also suggests that there is need for a national dialogue about potential interventions, including expanded overdose recognition and naloxone training and supervised injection facilities (SIF)/drug consumption rooms (DCR), that could reduce public injection and its associated health risks.

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Research ArticlesOccupational needlestick injuries in a metropolitan police force

Abstract

Introduction

Section snippets

Methodology

Results

Discussion

Conclusions

Am J Infect Control

Ann Emerg Med

Ann Emerg Med

J Hepatol

Ann Emerg Med

Am J Infect Control

Ann Emerg Med

Analysis of significant exposures to blood and body fluids of emergency medical personnel in a large metropolitan fire department

Epidemiology of sharps accidents in general surgery

J Royal Coll Surgeons–Edinburgh

Needle-stick injuries in medical students

J Social Occupational Med

Needlestick injuries in ophthalmology

Ophthalmic Surg

Microbiological hazards of occupational needlestick and “sharps” injuries

J Appl Bacteriol

Research Articles
Occupational needlestick injuries in a metropolitan police force