Preventing Needlesticks and Other Sharps

Injuries…

Everything You Need to Know

The ProblemCDC estimates ~385,000 sharps injuries

annually among hospital-based healthcare personnel (>1,000 injuries/day)Many more in other healthcare settings (e.g., emergency

services, home care, nursing homes)

Increased risk for bloodborne virus transmission

Costly to personnel and healthcare system

Risks of Seroconversion due to Sharps Injury from a known positive source

Virus

HBV HCV HIV

Risk (Range)

6-30%* ~ 2% 0.3%

(*Risk for HBV applies if not HB vaccinated)

What is the Risk for HIV Alone?

Percutaneous 0.3%

Mucous membrane 0.1%

Non-intact skin <0.1%

Costs of Sharps InjuriesBaseline and follow-up laboratory testingTreatment of exposed personnel

$71-~$5,000 depending on treatment providedLost productivityTime to complete paperworkLoss of income / loss of careerEmotional costsSocietal costs

O’Malley, et. al. Costs of Management of Occupational Exposure to Blood and Body Fluids.

ICHE, July 2007, v 28, No. 7.

Who Gets Injured?

Nurse43%

Technician15%

Student4%

Dental1%

Housekeeping/Maintenance

3%

Clerical / Admin

1%

Other5%

Physician28%

Occupational Groups of Healthcare Personnel Exposed to

Blood/Body Fluids,

NaSH June 1995—December 2003

(n=23,197)

When Do Sharps Injuries Occur?

During use 41%

After use/before disposal 40%

During and after disposal 15%

Other 4%

Source: NaSH, June 1995—December 2003

What Devices are Involved in Sharps Injuries?

Six Devices Account for 78% of All Injuries

Disposable Syringes 30%

Suture Needles 20%

Winged-Steel Needles 12%

Intravenous Catheter Stylets 5%

Phlebotomy Needles 3%

Scalpels 8%Source: NaSH, June 1995—December 2003

How Do Injuries Occur With Hollow-Bore Needles?

During Sharps Disposal

13%

During Clean Up9%

In Transit to Disposal

4%

Handle/Pass Equipment

6%

Improper Disposal

9%

Access IV Line5%

Transfer/Process Specimens

5%

Recap Needle6%

Collision W/Worker or

Sharp10%

Manipulate Needle in Patient

28%

Other5%

Circumstances Associated with Hollow-Bore Needle Injuries NaSH June 1995—December 2003

(n=10,239)

Disposal

Related: 35%

Sharps Injuries Are Preventable

Preventable64%Nonpreventabl

e18%

Undetermined18%

Preventability of Needlesticks in 78 NaSH Hospitals, June 1995--December 2004 (n=11,625)

First Strategy:

How Can Needle Use Be Eliminated or Reduced?

Use needle-free IV delivery systems

Use alternate routes for medication delivery and specimen collection when available and safe for patient care

Streamline specimen collection systems

Needle-Free IV Delivery Systems

IV delivery systems use valved ports and connectors, pre-pierced septa using blunt cannulas, or recessed protected needle connectors

Use aseptic technique when handling these systems!!!

Needle-Free IV Delivery Systems

Next Strategy:

Safer Sharps Devices Engineered to Prevent Sharps Injuries

Injuries Related to Work Practices

Injuries occur because of the following:

Passing or transferring equipment

Recapping contaminated needles

Colliding with coworkers

Decontaminating/processing used equipment

Injuries occur from sharps left in unusual places:

Laundry

Mattresses

Tables, trays, or other surfaces

The Sharps Safety Continuum

Prepare to use the device the moment the sharps are first exposed

Take precautions while using sharps

Take precautions during cleanup

Take precautions during disposal

Sharps Safety Practices

Be preparedBe awareDispose with care

Before Beginning a Procedure

Be Prepared

Organise equipment at the point of use

Make sure workspace have adequate lighting

Assess the patient’s ability to cooperate and - Get help if necessary

Ask the patient to avoid sudden movement

Obtain assistance from other staff or a family member to assist in calming or restraining a patient as necessary.

Proper placement of sharps

container

If using a fixed sharps container it should not be fitted higher than 1.4 meter

Before the beginning of a procedure that involves the use of a needle or other sharp device:Identify the location of

the sharps disposal container; if moveable, place it as near the point-of-use as appropriate for immediate disposal of the sharp.

If the sharp is reusable, determine in advance where it will be placed for safe handling after use.

Before the beginning of a procedure that involves the use of a needle or other sharp device:

If multiple sharps will be used during a procedure, organize the work area (e.g. procedure tray) so that the sharp is always pointed away from the operator.

During a Procedure That Involves the Use of Needles or Other Sharp Devices:Maintain visual

contact with the procedure site and location of the sharp device.

During a Procedure That Involves the Use of Needles or Other Sharp Devices:When handling an

exposed sharp, be aware of other staff in the immediate environment and take steps to control the location of the sharp to avoid injury to oneself and other staff.

During a Procedure That Involves the Use of Needles or Other Sharp Devices:

During a Procedure That Involves the Use of Needles or Other Sharp Devices:If the procedure necessitates reusing a needle

multiple times on the same patient (e.g., giving local anesthesia), recap the needle between steps using a one-handed technique or a fixed device that enables one-handed recapping.

One handed recapping

Locking the cap of the needle

Using a one-handed technique recapping

Manipulate or remove sharps using a mechanical device

Activate the safety feature as the procedure is being completed, observing for audio or visual cues that the feature is locked in place.

Safety syringes

During Clean-up following a Procedure:

During Clean-up Following a Procedure:

Do not use bare hands to sort procedure tray

Use a mechanical device to pick up the sharp if it cannot be performed safely by hand.

After Disposal:

Visually inspect sharps containers for evidence of overfilling before removal.

Use a mechanical device to remove sharps from overfilled boxIf a sharps container

is overfilled, obtain a new container and use forceps or tongs to remove protruding devices and place them in the new container.

During Disposal:

If a sharps container is overfilled, obtain a new container

Improperly Disposed Sharps:

If an improperly disposed sharp is encountered in the work environment, handle the device carefully, keeping the hands behind the sharp at all times.

During disposalNo recapping

During a procedureDo not carry sharps without a tray .

Wrong disposal can harm others

Do not dispose sharps into regular garbage

Improper Disposal

Assemble container correctly

Do not use sharps box without cover

FLOW SHEET FOR NEEDLE STICK/SHARPS INJURYNEEDLE STICK/SHARPS INJURYWASH THE INJURY UNDER RUNNING

WATER (DO NOT SUCK/SQUEEZE FROM THE

INJURED SITE)COVER INJURY WITH AN

IMPERMEABLE DRESSINGNOTIFY SUPERVISOR IF INJURY IS SERIOUS GO TO ER FOR

APPROPRIATE TREATMENT

FLOW SHEET NEEDLESTICK/SHARPS INJURY

COMPLETE AN OVA FORM (INCLUDE PATIENT/SOURCE MEDICAL NO.)

GO TO EHS WORKING HOURS/AFTER WORKINH HOURS GO TO ER)

GO TO GP LAB FOR BLOOD WORKSIF POSSIBLE DO BLOOD WORKS FROM

SOURCE PATIENT AFTER CONSENT FROM TREATING PATIENT

GO BACK TO EHS AT THE SPECIFIED FOLLOW-UP DATES GIVEN TO YOU FOR BLOOD WORKS

THANK YOU !!!