Exposure of healthcare workers to bloodborne viruses

Editor—Evans et al try to measure the exposure of healthcare workers to bloodborne viruses by including incidents that are required to be reported under the 1995 regulations for reporting injuries, diseases, and dangerous occurrences.¹ We do not, however, know the denominator—namely, the total number of needlestick injuries received by healthcare workers.

This denominator is an iceberg, the tip of which has been described by Evans et al. From the up to date surveillance data, which include additional information and extend to December 2000, hepatitis C is more common than HIV and hepatitis B combined in infected patients. A large London study showed, however, that most patients found to be infected with hepatitis C have not been previously identified by epidemiological risk factors.² Therefore, by reporting on the injuries of patients known to be infected, the comparatively huge number of needlestick injuries in which hepatitis C positive patients are not known to be infected may be forgotten.

We have previously shown that surgeons report only one in 20 known needlestick injuries they receive.³ This is reflected in the paper's reported number of nurses' needlestick injuries—which is higher than that of doctors—and in the fact that over three times as many injuries are reported in wards as operating theatres. We should recognise that these reported figures do not scratch the surface of the actual number of occupational sharps injuries to healthcare workers.