A 35-year-old dairy worker accidentally injected her leg with an unknown amount of a cephalosporin antibiotic. The needle was contaminated with “farm material.”
Dr. Jeff Bender, veterinarian and director of the Upper Midwest Agricultural Safety & Health Center, explained more about the case: “She presented to her healthcare provider 24 hours later with significant inflammation around the injection site. Over the next week, they removed inflamed tissue and put her on antibiotics, but there was further swelling and evidence of bacterial infection. There was recurrent inflammation and abscess formation for months, and she still had problems one year later.”
The accidental injection was on the woman’s thigh and required multiple skin grafts and resulted in significant impairment in walking.
Bender said worker safety while administering drugs to livestock is neglected. Contact with livestock pharmaceuticals via needle stick can be dangerous, and several drugs are especially risky for workers.
Statistics show that most needle sticks occur to the hand – usually the opposite hand of the one administering the injection. Other accidental stick locations include legs, arms and chests.
“A fair percentage [of products] involve oil adjuvant vaccines,” said Bender. “These cause a lot of inflammation and can be problematic, especially depending on the location of the injury.”
In some cases of oil adjuvant needle sticks, surgery is necessary to remove the injected product.
It’s unclear how many actual sticks happen annually because statistics only apply to those who seek medical attention. In reviewing outcomes after known needle sticks, Bender stated that 15 people had a complete recovery within two weeks, one died and 14 had residual swelling after the stick. Three people required multiple surgeries and were out of work for three to six months. Three workers were unable to return to work one year after the injury.
Although these examples are the worst of the worst, there are many unreported incidents that aren’t included in safety data or medical literature.
Needleless injectors may seem safer but are not. “High pressure injectors actually have the same number of injuries,” said Bender, “and those injuries are often more severe and associated with higher cost.”
If a worker mentions to a coworker that they stuck themselves with a vaccine and asks if it’s a problem, the answer from someone who isn’t aware of the potential danger might say “Don’t worry, this is for animals and it won’t affect you.” Someone else may suggest a doctor visit, especially if the needle had been dropped in manure. A safety officer might suggest a tetanus shot, and others may say “We have no idea what to do.”
“Some of these injuries can be quite serious,” said Bender. “Needle stick injuries due to a modified live Johne’s vaccine causes a fair amount of granulation and significant injury.”
The injectable products of most concern are modified live vaccines with zoonotic potential, such as anthrax vaccine, and vaccines with oil adjuvants. Also problematic are antibiotics for those who are sensitive to specific antibiotics such as penicillin or other antibiotic classes. Long-acting antibiotics such as oxytetracycline can cause serious problems, as can sedatives.
Some products can be life-threatening if injected into humans. Tilmicosin, marketed as Micotil 300®, is labeled to treat respiratory disease in cattle and sheep. However, human exposure to even a miniscule amount of this drug can result in serious cardiac damage and possibly death.
Employees should be trained in proper technique for loading syringes and administering medications and be familiar with species-appropriate animal restraint. Photo by Sally Colby
Most human exposures to this drug are the result of needle sticks, through drug contact with open cuts or sores or contact with mucous membranes. Those who handle and/or administer this drug should wear goggles and puncture-resistant gloves and wash their hands after handling it. The CDC recommends proper training for those who administer tilmicosin.
Another drug that poses a danger to those who handle it is altrenogest, a progestin that suppresses heat in mares synchronizes estrus in young pigs. Altrenogest is commonly marketed under several brand names including Regu-Mate® (for mares) and MATRIX® (for swine). Women who are pregnant or may be pregnant should not handle altrenogest products, nor should individuals with clotting disorders, liver dysfunction or a history of heart disease or stroke.
Needle safety involves thought and planning. Assemble all supplies prior to working, and make sure animals are correctly and humanely restrained to prevent sudden movement. Team up with a buddy when working with medications so someone can get immediate help in the event of a needle stick. Resist the temptation to carry needles in pockets.
Fill one syringe at a time and keep the needle covered until the animal is safely in place and ready for the injection. Workers should take extra care when removing the needle from the syringe and disposing of the needle. Syringes should not be held in one’s mouth while moving cattle into chutes or working with gates.
To decrease the risk of a needle stick when recapping a needle, use the one-hand scoop method. Rest the needle cap on a solid surface and guide the used needle into the cap against a solid surface so no hands or fingers are in the way.
Attempting to straighten a bent needle is risky and can result in a needle stick to the worker or a weakened needle that may break off in the animal. Dispose of bent needles rather than trying to straighten and use them.
Those working with injectables should have proper training and not be fatigued when working. “Make sure workers know how to handle a needle,” said Bender. “Are animals restrained appropriately, and is the area well-lit? Is the footing surface for the worker and animal non-slip? Do workers have adequate assistance, and is their work pace such that they can take the appropriate amount of time?”
Workers should know what to do if a needle stick happens despite precautions.
“The obvious precaution is to slow down and don’t rush,” said Bender. “Use proper equipment and technique. Make sure workers know they can ask for and receive assistance if necessary.”
Workers should know about the product they are using and understand the potential risks.
Bender suggested instructing workers to stop what they’re doing if they experience a needle stick or drug exposure while working, wash the affected area with soap and water and notify a supervisor. If someone is taken to a healthcare facility for treatment of a needle stick, take both the product insert and the container.
Employees should know the location of sharps disposal containers, and such containers should be easy to use. Sharps containers can be purchased – or use laundry detergent jugs made of heavy plastic. Make sure the lid is secured each time the jug is used and store the jug in a safe location until disposal. Consult the farm veterinarian regarding proper disposal of sharps containers.
by Sally Colby
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