Needle-stick injuries in the National Health Service

Abstract

Elmiyeh and co-workers (July 2004 JRSM1) report a culture of silence on needle-stick injuries. As they indicate, clinicians do not easily change their practice.2 The case for post-exposure prophylaxis is well grounded3 though not yet (understandably) proven by a randomized controlled study. In the UK, the needle-stick injury needs to be reported in order to access such treatment, via occupational health or emergency services. However, there are other less tangible reasons for reporting. Criminal liability has been established for actions taken by a person who knew himself to be HIV-positive.4 What about the liability of doctors who know they have sustained a potentially infecting needle-stick injury? The Selby train crash showed that the driver who knew he was too tired to drive was liable for the consequences of falling asleep.5 Therefore there is a risk of liability for actions while hazardously infected, through an act of omission. This can only be determined by a legal test case, which I would not wish to be part of. The final benefit is the certainty that comes from appropriate and conclusive infectious status testing. It was the above factors rather than the system-wide implications that I found most motivating—plus, as stated by Elmiyeh et al.1 the possibility of invalidating insurance cover—when several months ago I reported my own needle-stick injury from a high-risk case.