Sarah Larney and Kate Dolan. Sarah Larney, BA BSc .... The authors wish to thank Alex Wodak, Gino Vumbaca and our contacts within the two jurisdictions ...
AJCSD
australasian journal of correctional staff development
Needlestick Injuries Among Prison Officers in Two Australian States Sarah Larney and Kate Dolan Sarah Larney, BA BSc (Hons) is Research Officer, Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales; Kate Dolan, PhD is Associate Professor, National Drug and Alcohol Research Centre, University of New South Wales.
INTRODUCTION Prison officers encounter a variety of situations that pose risks to their physical and mental health, including needlestick injuries, where a syringe needle pierces the skin. Of 259 U.S. correctional staff interviewed between 1992-1993, two and a half per cent reported a needlestick injury in the previous six months, compared to 0.9% of police officers [1]. Exposure to body fluids,be it through needlestick injuries or other means, carries a very low risk of transmission of blood borne viral infections (BBVIs) such as hepatitis B, hepatitis C and HIV. Studies of occupational needlestick injuries among healthcare workers have found that the risk of contracting HIV after needlestick exposure to blood from HIV positive patients is 0.3% [2], while the risk of hepatitis C seroconversion following needlestick exposure to infected blood is 0.6-0.7% [3, 4]. Caution should be taken in applying these figures to prison officers as very different circumstances apply. Occupational exposures in healthcare workers generally provide optimal conditions for seroconversion to occur, as the exposure is to fresh blood. Prison officers may be injured with needles that have not been used for several days or even weeks, meaning they are no longer infectious. There have been no reports of HIV or hepatitis C seroconversion in prison officers following accidental needlestick injuries.
Despite the low risk posed by accidental needlestick injuries, they remain a concern to prison officers. Very little is known about needlestick injuries in Australian prisons. This study was conducted to explore the prevalence of needlestick injuries among prison officers, the circumstances under which injuries occurred and the actions taken by injured officers. METHODS Cross-sectional data were collected from prison officers in two Australian states between January and May, 2006. In each state, notices were distributed to staff describing the study and how to participate. Surveys were then placed in employee sign-in areas for completion. Additionally, all prison officers who reported finding a needle and syringe during the study period were asked to complete the survey. Participation was anonymous and voluntary and no incentives to participate were provided. Ethical approval for this study was granted by the University of New South Wales Human Research Ethics Committee and the research ethics committees of each prison jurisdiction surveyed. RESULTS From 2,979 prison officers employed in the states surveyed, 246 (8%) completed surveys. Seventy percent of the sample was male, compared to 77% of the prison officer population. Almost 40% of survey respondents had worked in a prison for more than ten years (see table 1).
AJCSD
australasian journal of correctional staff development
Table 1: Participant demographics
Sex Male Female Missing
n 172 67 7
(%) (70) (27) (3)
Age < 26 26-35 36-45 46-55 > 55 Missing
8 39 74 85 36 4
(3) (16) (30) (35) (15) (2)
Years working in prison 10 Missing
27 46 19 55 95 4
(11) (19) (8) (22) (39) (2)
Total N
246
Two-thirds of participants (n=163) had found needles and syringes during the course of their work. Of these, 17, or 10%, had suffered a total of 21 needlestick injuries. This equated to 7% of the total sample. Participants who reported multiple injuries were asked to consider only the most recent injury in answering the remaining survey questions. Thus, data from 17 incidents was collected.
Most (n=11) needlestick injuries occurred during searches, with the remainder occurring during other routine duties. All injured officers reported receiving some form of first aid in the immediate aftermath of their injury. However, six of the seventeen officers were denied permission to leave the worksite immediately to seek further medical attention, against prison policies. All but one injured officer reported being tested for blood borne viral infections within two weeks of their injury. Fourteen participants also sought follow-up testing three or more months after their injury (see table 2). Table 2: Blood borne virus testing within two weeks and more than two months after needlestick injury
Timing relative to injury Within two weeks Two or more months after
HIV 14 13
n tested for blood borne viral infections Hepatitis B Hepatitis C Any test 13 11 16 12 12 14
Less than half of those injured (n = 7; 41.2%) accessed support services in the aftermath of their injury. Support services accessed included external counselling services contracted to provide services to department employees, private counselling services and general practitioners. Three injured officers took leave from their duties following the injury; however, one officer noted that leave had been planned prior to the injury. The remaining two officers both required more than three months leave following their injury. Regarding assistance to return to work sooner, one officer expressed disappointment with the lack of support provided by prison administration following his needlestick injury. DISCUSSION This study has demonstrated that a small proportion of prison officers in these jurisdictions have experienced needlestick injuries. Ten percent of
AJCSD
australasian journal of correctional staff development
those who had found needles and syringes in prison, or seven percent of the total sample, had suffered at least one needlestick injury. Caution should be exercised in interpreting this figure as the representativeness of the sample is uncertain. The majority of injuries were received during searches – of prisoners, their cells and other areas in the prison. Therefore it may be possible to reduce the incidence of needlestick injuries by improving the equipment provided to officers for use during searching, and by providing training focusing specifically on safer search techniques. The experiences reported by injured officers raise concerns as to the quality and consistency of follow-up care that is received. Six injured officers reported that they were not permitted to leave their position to seek immediate health care. Testing for blood borne viral infections was common, however, some participants reported being tested for a different set of infections at three-month follow-up than in the immediate aftermath of their injury. Officers would benefit from education about blood borne viral infections and clarification of procedures for accessing medical care. Few officers accessed support services following their injury. Australian prison administrations may wish to consider the benefits of promoting access to support services for all officers experiencing stress or other workrelated difficulties. There were several sources of potential bias inherent in the design of this study. Due to operational constraints, it was not possible to select a random sample of prison officers. All officers were informed of the study and encouraged to complete the survey whether or not they had experienced a needlestick injury. However, officers who had experienced needlestick injuries may have been more likely to complete the survey and thus may be overrepresented. Another potential source of bias was the reliance on prison officers’ recall of past events.
As an exploratory study, this work has highlighted a number of areas in need of further research. These include estimating the incidence of needlestick injuries among prison officers and the risk of blood borne virus transmission associated with needlestick injuries in this setting. The effectiveness of prison officer training in reducing the incidence of needlestick injuries should also be explored. REFERENCES 1.
2.
3. 4.
Averhoff, F.M., et al. (2004), ‘Occupational exposures and risk of hepatitis B virus infection among public safety workers’, Journal of Occupational and Environmental Medicine, vol 44, no 6, pp. 591596. Henderson, D.K., et al. (1997), ‘Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clincal exposures: A prospective evaluation’, Annals of Internal Medicine, vol 113, no 10, pp 740-746. Puro, V., N. Petrosillo, and G. Ippolito (1995) ‘Risk of hepatitis C seroconversion after occupational exposures in health care workers’, American Journal of Infection Control, 23, pp 273-277. Serra, C., M. Torres, and M. Campins (1997) ‘Occupational risk of hepatitis C virus infection after accidental exposure’, Journal of Hepatology, 27, p 1139.
This study was funded by Unilife Medical Solutions Ltd, an Australian listed manufacturer and supplier of single-use sharps safety devices. The authors wish to thank Alex Wodak, Gino Vumbaca and our contacts within the two jurisdictions surveyed for their assistance with this study.
