Persistent needlestick injuries posing hidden threat to healthcare workforce

By Mukhtar Alam

KARACHI: Despite growing awareness and policies on paper, needlestick and sharps injuries (NSIs) continue to silently endanger healthcare workers across the country. From major public hospitals in Karachi to small private clinics in interior Sindh, experts say this largely underreported occupational hazard remains pervasive, sustained by gaps in training, weak safety cultures, and inconsistent policy enforcement.

Interviews with healthcare administrators, public health officials, regulators, and professional associations reveal a consensus: while the risks of NSIs are widely acknowledged, implementation of prevention measures and reporting protocols often lags, particularly in high-pressure and resource-constrained environments.

Dr Samreen Sarfaraz

A hazard hiding in plain sight

“In many Pakistani healthcare settings, there is no structured framework to address sharps injuries,” said Dr Samreen Sarfaraz, Chair of Infection Control Services at the Indus Hospital and Health Network (IHHN). “Training is sporadic, sharps disposal is often improper, and underreporting is alarmingly common.”

At IHHN, all NSIs are promptly reported, investigated, and followed by timely prophylactic interventions. But this institutional approach remains the exception, not the norm, she said. “There’s no national accreditation system, so safety protocol enforcement is not standardised,” Dr Sarfaraz said. “Even where guidelines exist, implementation is inconsistent.”

Dr Abdul Ghafoor Shoro, Secretary General of the Pakistan Medical Association (PMA), concurred: “The issue is widely recognised, but meaningful action requires more than just policy on paper. Regular hands-on training, retraining, and consistent use of safety devices are still lacking—especially in high-pressure public sector environments.”

Even within large tertiary hospitals, healthcare workers often face an uneven culture of safety. “In many departments, NSIs are considered an individual’s mistake rather than a systemic failure. That mindset must change,” Dr Shoro said.

Underreporting undermines prevention

Sharps injuries, including needlestick wounds, can expose healthcare workers to serious blood-borne infections such as HIV, hepatitis B and C. However, frontline workers—particularly nurses, paramedics, and cleaning staff—often do not report injuries, either due to fear, stigma, or lack of follow-up care.

One of the most persistent challenges is the chronic underreporting of NSIs, with estimates suggesting that only 15–76% of incidents are officially documented.

“Healthcare workers often fear blame or stigma, or simply assume a minor injury isn’t worth reporting,” said Dr Sarfaraz. Without structured reporting mechanisms or dedicated occupational health units, many cases never enter institutional records—creating blind spots in both prevention and policy formulation.

Dr Shoro added that surveillance gaps are compounded by cultural perceptions: “Many staff members accept NSIs as just part of the job. This complacency contributes to unsafe practices.”

The result is a disconnect between ground realities and administrative records, which hinders evidence-based policymaking. “If we don’t see the problem in data, it doesn’t exist for many decision-makers,” Dr Sarfaraz said.

Risk is everywhere

Dr Abdul Ghafoor Shoro

NSIs can happen in any healthcare setting—not just in surgical theatres. “They occur in wards, labs, ICUs, ERs—even during patient transfers,” said Dr Sarfaraz. “Nurses, doctors, lab technicians, and even housekeeping staff are all at risk.”

This calls for a hospital-wide and system-wide approach to safety. “Every staff member, regardless of department, must be trained to follow standardised sharps handling protocols,” Dr Shoro said.

Dr Atiq Qureshy, Medical Superintendent at Government Hospital Liaquatabad, also echoed these concerns. “NSIs are not limited to critical care areas. The problem is systemic—high patient loads, staff fatigue, and erratic training all contribute.”

Agreeing with other experts that NSIs are not confined to operating theatres, the medical superintendent says: “These injuries can occur in wards, emergency departments, laboratories, and even during routine injections or blood draws.”

Prof Dr Farhat Jafri, Dean of Community Medicine at Karachi Metropolitan University, stressed the urgency: “The non-serious attitude of both regulatory and implementing authorities is the root of the problem. Until that changes, we can’t expect meaningful progress.”

He described the issue as one of “scarcity”—in both training and enforcement. He called for education and awareness starting at the grassroots level: “This must begin at schools and colleges, and policy-making should start from union council level.”

The policy-implementation disconnect

Most experts agreed that while relevant authorities—such as the Ministry of Health, Sindh Healthcare Commission (SHCC), and various medical associations—do recognise the occupational risks of NSIs, their interventions fall short of what’s needed.

“There’s recognition, yes—but efforts are often conventional, underfunded, and poorly enforced,” said Dr Jafri. “Authorities keep doing the same old things without changing outcomes.”

Prof Dr Farhat Jafri

Dr Shoro described this gap as a “disconnect between stated policy goals and field implementation”. Dr Qureshy noted that “without real-time data or national-level compliance monitoring, hospitals aren’t held accountable.”

While public and private hospitals vary in resources and capacity, safety enforcement remains patchy across the board.

“In better-resourced private hospitals, safety audits and retraining may be routine,” Dr Shoro noted. “But in the public sector, budget constraints and administrative inertia often mean these measures are either absent or irregular.”

Dr Qureshy added: “Training is often a one-time orientation, with no follow-up or accountability. Even when policies are in place, enforcement is weak.”

Dr Jafri believes the issue is rooted deeper. “Preventive culture must begin before healthcare workers even enter the field.”

Panelists pointed out that the frequency and quality of training on safe handling of sharps—and on the use of safety-engineered devices—varies significantly between institutions.

“In well-resourced private hospitals, retraining and evaluation of safety protocols may occur regularly. But in the public sector, competing priorities and limited budgets often push NSI prevention lower on the agenda,” said Dr Shoro.

Dr Atiq Qureshy

Dr Qureshy noted that some progressive institutions do conduct regular trainings, but that national-level data on compliance and outcomes is lacking or outdated.

Dr Jafri was blunt: “Hospitals often keep going with fixed practices rather than prioritising fresh evaluations.”

Training gaps and variable prioritisation

Dr Ahson Qavi, CEO of the SHCC, noted that the regulatory body requires all healthcare establishments in Sindh to implement quality standards that include policies for prevention of NSIs. These include mandatory training and awareness programmes, incident reporting protocols, infection prevention strategies, and proper disposal of sharps.

However, he acknowledged that implementation remains uneven: “While the policies exist, reporting may not be happening as frequently as it should be. There’s often a fear factor, especially among support staff who experience most of these injuries.”

Dr Qavi reinforced the importance of tracking data and using it to improve systems: “NSI incidents must be recorded and analysed to enhance safety protocols. Refresher training is not just a formality—it is essential to reducing repeat injuries.”

One of the gravest challenges cited by all experts was underreporting. “Yes, NSIs are both serious and underreported. This is well recognised,” said Dr Qavi. He added that the majority of incidents occur among support staff such as nurses and paramedics, many of whom may not formally report their injuries. “They might mention it to a supervisor, but it rarely gets documented at the facility level.”

Dr Ahson Qavi

Dr Qureshy cited fear, stigma, and lack of follow-up care as key reasons for underreporting. Dr Shoro agreed, noting that even though health authorities like SHCC and PMA recognise the problem, gaps remain in enforcement and surveillance.

In Dr Jafri’s view, this underreporting is a symptom of a broader “non-serious attitude” among regulatory bodies. “There’s recognition, yes—but the effort to create true awareness and policy acceptance is still very conventional, not transformational,” he said.

Dr Sarfaraz shared a similar view: “NSIs are massively underreported. There’s fear and lack of clarity on what happens after reporting. Many staff just avoid the hassle.”

Toward stronger systems

Experts proposed several strategies:

• Institutionalising training: Continuous, mandatory sessions rather than one-time orientations.
• Improving access to safety devices: Prioritising procurement of safety-engineered sharps.
• Ensuring accountability and protection: Safeguarding workers while holding institutions responsible.
• Data transparency: Provincial and national incident tracking.
• Stronger enforcement: Inspections and penalties for non-compliance.

The human cost of inaction

Dr Shoro cautioned that neglecting NSIs harms both health and morale. “Imagine the psychological toll when a young nurse has to wait six months for HIV test results after an accidental prick. The emotional and financial stress is immense,” he said.

Dr Qavi added that unless all frontline healthcare workers—right down to janitors and lab technicians—feel protected and empowered, NSIs will continue to undermine staff well-being and patient safety.

Experts agree the country must bridge the gap between policy and practice. “Without urgent systemic reforms, NSIs will remain a silent epidemic in an already strained health system.”

Report courtesy: Social Track, Karachi (July 25, 2025)