The reported incidence of NSIs in this population was higher than in any previous studies of veterinary personnel (4
), but was not surprising, based on anecdotal information about NSIs in veterinary practice. In some respects, it was surprising that 7% of technicians did not report having experienced a NSI in the past; however, 44% of those who did not report a NSI had worked in veterinary practice for ≤ 1 y. The number of individuals who reported recent NSIs was striking, with 8% having experienced an NSI in the past week and 23% in the past month. These data clearly indicate that NSIs are a common occurrence in veterinary technicians, at least in Ontario.
Despite the lack of significant concern about bloodborne disease transmission, NSIs can be associated with adverse effects through physical trauma, exposure to non-bloodborne infectious agents and exposure to drugs. Adverse effects that have been reported in veterinary personnel and animal owners include severe local inflammation, abscess formation, joint infection, localized necrosis, skin slough, local nerve damage, brucellosis, severe allergic reaction, psychedelic experience, bronchial and laryngeal spasm, chronic granulomatous reaction, ischemic necrosis requiring finger amputation, miscarriage, and blastomycosis (5
). Severe reactions, including death, have been reported in association with inadvertent injection of tilmicosin (14
). While medical care was not commonly required for NSIs in this study, it is important to consider that 3.5% of individuals required medical care for an NSI, and 0.9% had lost time at work. Reports of allergic reactions and infections are concerning because of the potential severity of such reactions. While these are not common events, they should be considered in the context of the large number of veterinary technicians, the preventable nature of NSIs, and the possible legal ramifications for veterinary practices that do not adequately address NSI prevention and reporting (15
). In addition to drug exposure, NSIs can cause significant pain and discomfort, which were reported by a large number (37%) of technicians. Infection can also develop from needle contents (fine-needle aspirates, needles contaminated with bacteria from the skin of an animal) or because of secondary infection.
A variety of factors were cited as contributing to NSIs. The most common was time constraint, which is not surprising as rushing to complete procedures can result in suboptimal practices. The high number (27%) of technicians reporting that needle handling practices by veterinarians contributed to NSIs was concerning and highlights the necessity for education on needle handling for all members of the veterinary healthcare team. Nineteen percent of individuals reported that inadequate assistance with restraint of animals was a contributing factor. Whether this involved poor quality of restraint by assistants or lack of adequate personnel is unclear, but this is an area that should be addressed. The potential for increased injury rates should be considered when evaluating veterinary clinic staffing and workload. Inadequate access to sharps containers, reported by 7.5% of technicians, can be easily rectified in clinics, and all clinics should review their sharps container numbers and placement.
Technicians were exposed to a variety of substances from NSIs. Animal blood was the most common. This is much less concerning than in human medicine, based on the very low prevalence of significant bloodborne zoonotic pathogens in companion animals in North America. However, this should not be taken as an excuse to ignore NSIs, since zoonotic diseases continue to emerge and veterinary personnel may be among the first individuals exposed to emerging zoonoses (15
). The high rates of exposure to antimicrobials, sedatives, anesthetic agents, and euthanasia agents were concerning because of the potential problems from the direct effects of these drugs or allergic reactions. While rare, exposure to chemotherapeutic agents and prostaglandin is of concern, as veterinary technicians are predominantly women, and exposure may result in adverse reproductive effects (17
). Wilkins and Bowman (5
) report miscarriage in a veterinary technician following an NSI involving prostaglandin.
While most technicians (81%) stated that they had received adequate training regarding NSIs, their reported needle handling practices indicate that this training was either inadequate or routinely disregarded. Unsafe handling practices were very common and it is unclear whether or not technicians understand that their current practices are considered unsafe. Particularly concerning practices were manual recapping and placing needles in “temporary”storage containers. Manual recapping is a leading cause of NSIs (18
), through missing the cap and puncturing a finger or driving the needle through the side of the cap and into a finger. Use of temporary storage containers, although common, is considered unacceptable. The use of temporary containers leads to a need for someone to subsequently transfer the needles to an approved container, an unnecessary additional handling step that presumably increases the risk of NSI. This is a completely unnecessary risk based on the ease and low cost of placing approved sharps containers in all areas where needles are used. Other concerning and completely preventable situations that resulted in NSIs include handling garbage and laundry. There is absolutely no reason for sharps to be in laundry or garbage if basic handling practices are adhered to, and any such injury should be investigated as a serious breach in protocol. These can be particularly concerning for a clinic from a liability standpoint if there are injuries to personnel from external cleaning or laundry agencies. Injuries that occurred while taking a needle from a co-worker are also completely preventable using safe and logical handling practices that would preclude passing uncapped needles. It was quite surprising that 8.4% of individuals had experienced an NSI reaching across a countertop, indicating poor needle handling or disposal practices. That type of injury should also be completely avoidable.
Despite NSIs clearly being occupational injuries, reporting of them was uncommon and few clinics had mandatory reporting policies. It is likely that NSIs are so common and typically minor that they are considered an inherent part of veterinary practice, so they are not reported. The perception that employers would not want or need to know also likely leads to low reporting rates. Documentation of NSIs is important for various reasons. Most NSIs are inconsequential, but serious sequelae can occur, and it may be important for the worker to have documented an occupational injury should complications develop. Failure to report and record NSIs prevents the veterinary community from understanding the scope of the problem and limits the identification of changes in rates over time or in response to different interventions.
This study did not identify any factors that were statistically associated with the likelihood of NSI; however, this should be taken in the context of the study population and other results. Needlestick injuries and poor needle handling practices were very common, and the relatively homogenous nature of the population with respect to needle handling practices limits the ability to identify factors associated with NSIs. It is possible, if not likely, that many of the poor needle handling practices documented in this study predispose to NSIs. It is also possible that the sample size was inadequate to detect some true statistical associations.
Potential biases must be considered. This study only involved OAVT members. Membership is not mandatory for veterinary technicians and there may be differences between OAVT members and non-members. The survey was only accessible online, but considering widespread Internet access, this is unlikely to have significantly biased the results. It is possible that this selected for a younger population, something that must be considered, since the mean duration in practice was only 6.6 y. Possible effects of this are unclear. It was not surprising that most respondents were engaged in small animal practice, considering the nature of veterinary practice in Ontario; however, it was surprising that 7.5% of respondents worked in laboratory animal facilities. This is presumably disproportionate to the general technician population and could have biased results; however, it is reasonable to assume that laboratory animal facilities would have stricter needle handling and NSI reporting practices. Considering how common poor needle handling practices are, the effects of this potential bias were likely limited. Another potentially important consideration is non-response bias. Because a minority of invitees participated, selective response must be considered, and it is possible that people who have a greater interest in NSIs, or who have had more serious problems with NSIs, would be more likely to respond.
This study has demonstrated that NSIs are very common in technicians in veterinary practice, and that potentially unsafe needle handling practices are widespread. Veterinary practices and individuals need to consider NSIs as occupational injuries that can result in adverse effects and take logical and proactive measures to reduce the rate of injury (15