Title: Clinical, economic and emotional burden of needlestick injuries and blood exposure on healthcare workers in the European Union

Introduction
• Needlestick injuries (NSIs) and blood exposure remains a serious safety
concern for healthcare workers (HCWs) across the European Union (E.U.).
With an imminent possibility of contracting bloodborne infections from NSI
or blood exposure, it is important to understand the clinical, economic and
emotional burden on HCWs associated with such events.
• The World Health Organization (WHO) estimated that almost 3 million of
37 million HCWs experienced at least 1 NSI in the past year.1 Over 25
pathogens can be transmitted via needles.2
• Blood exposure occurring from patients who tested positive for bloodborne
viruses, such as HIV, HCV and HBV, can put HCWs at a higher risk of
contracting the same bloodborne infections.
• Use of safety-engineered devices (SEDs) can reduce the risk of NSIs and blood
exposure among HCWs and reduce the cost burden on healthcare systems.
• This literature review aims to aggregate and investigate the available evidence
on NSI and blood exposure among HCWs as well as impact of SEDs in the E.U.
as no previous review has been conducted for this region.
Methods
• A targeted literature review of studies published in English from 2009 to 2019 was
conducted using PubMed and the Cochrane Central Register of Controlled Trials
(CENTRAL).
• Only high-quality studies that reported clinical, economic or emotional burden of
NSI or blood exposure in HCWs were included. Studies were limited to human
subjects. Eligibility criteria details are provided in Table 1.
• Titles and abstracts identified by the search were screened by one reviewer and
verified by another reviewer. The qualifying full texts

Results
• A total of 39 out of 1,330 studies were included. Distributions of outcome type
and countries are provided in Figures 2 and 3, respectively. Study details are
provided in Table 2.
• A significant risk for occupational exposures such as NSI, blood exposure,
mucocutaneous exposure, and percutaneous injuries/exposure is found among
HCWs within the E.U. Occupational exposures are associated with certain
healthcare professions, devices, lack of safety device use, training and
improper safety practices. Economic and emotional burden are
underreported in the E.U.
Discussion
• This targeted literature review highlights various burden associated with NSIs
and blood exposure for HCWs in the E.U.
• Burden of NSI and mucocutaneous exposure is high among European countries,
and nurses and physicians are impacted the most.
• Severe underreporting of occupational exposure exists in the E.U.
• Although prevalence of bloodborne infections is low, it represents a significant
burden among HCWs. SEDs and training programs can reduce the burden.
• NSIs and blood exposures are associated with fear of seroconversion and
significant anxiety among HCWs.
• This targeted literature review can improve the awareness of HCWs in the E.U. on
the burden associated with NSI and blood exposure.
• Limitation of these results stem from limited evidences for economic and
emotional burdens in the E.U. region.
Conclusion
• NSI and blood exposure impose significant clinical, economic and emotional
burden on HCWs in the E.U.
• Training and SEDs may reduce such burden and are cost effective within
certain parameters.
• Decision- and policy-makers at the hospital and national level should
promote the use of SEDs and training