Community needlestick accident data and trends in environmental quality.

New health-based indicators of environmental quality are being sought. In this search a retrospective analysis was undertaken for all persons in England and Wales who, during 1988-91, were given Hepatitis B Immune Globulin (HBIG) in prophylaxis against Hepatitis B infection after accidental percutaneous or permucosal exposure, and for whom a surveillance form was returned to the Public Health Laboratory Service Communicable Disease Surveillance Centre, England and Wales (PHLS CDSC). Although the number of adult HBIG doses issued during 1988-90 increased annually from 1,907 to 2,850, the percentage for which completed forms were returned fell during this time from 55% (1,043/1,907) to 31% (894/2,850). In 1991, 2,049 doses were issued and completed forms returned for 32% (653/2,049). From data on the completed and returned forms for 1988-91, 51% (1,805/3,535) of accidental exposures occurred in the community and 45% (1,604/3,535) in hospitals. Of the community exposures, 958 (53%) were needlestick accidents; 16% of them occurred 'in the street', 12% from 'contact with rubbish', 6% 'in the park', and 4% 'on the beach'. The findings confirm that discarded hypodermic syringe needles in the general environment are causing new public health problems. As the percentage of completed and returned forms has declined, and because HBIG is not recommended for needlestick accidents in the community where the source of the needle is unknown, HBIG surveillance forms are thought not to be a suitable source of data for continued monitoring of environmental quality.