NEEDLE STICK AND SHARP INJURIES

DR LEE OI WAHPENGARAH HCM

WHAT ARE NSI ? Are wounds caused by needles that

accidentally puncture the skin. Hazards for people who work with

hypodermic syringes and other needle equipment.

Injuries occur when people use, disassemble or dispose of needles.

Cont.

When not dispose of properly, needles can become concealed in linen or garbage and injure other workers.

Transmit infectious diseases especially blood borne viruses.

Despite published guidelines and training program, NSI remain an on-going problem.

Dr.T.V.Rao MD

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THE PROBLEM CDC 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 blood borne virus

transmission Costly to personnel and healthcare system

Dr.T.V.Rao MD

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Exposures which place health personnel at risk of blood borne

infection –

• A percutaneous injury e.g. Needle stick injury (NSI) or cut with a sharp instrument

• Contact with the mucous membrane of eye or mouth• Contact with non-intact skin (abraded skin or with

dermatitis)• Contact with intact skin when the duration of contact is

prolonged with blood or other potential infected body fluids

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WHO IS AT RISK ? - Nursing Staff Emergency Care

Providers Labor & delivery

room personnel Surgeons and

operation theater staff

Lab Technicians Dentists Health cleaning/

mortuary staff / Waste Handlers

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,

Dr.T.V.Rao MD

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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

Disposal Related:

35%

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Dr.T.V.Rao MD

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Hypodermic needles

Blood collection needles

Suture needles Needles used in

IV delivery systems

Scalpels

WHAT KINDS OF DEVICES USUALLY CAUSE SHARPS INJURIES?

Dr.T.V.Rao MD

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WHAT INFECTIONS CAN BE CAUSED BY SHARP INJURIES?

Sharps injuries can expose workers to a number of blood borne pathogens that can cause serious or fatal infections. The pathogens that pose the most serious health risks are Hepatitis B virus (HBV) Hepatitis C virus (HCV) Human immunodeficiency virus (HIV)

Dr.T.V.Rao MD

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RISKS OF SEROCONVERSION DUE TO SHARPS INJURY

FROM A KNOWN POSITIVE SOURCE

Virus HBVHCVHIV

Risk (Range)6-30%*~ 2%

0.3%

(*Risk for HBV applies if not HB vaccinated)

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Who gets injured? Where do they

happen? When do injuries

occur? What devices are

involved? How can they be

prevented?

HOW DO SHARPS INJURIES HAPPEN?

HOW DO NSI OCCUR ? Equipment Design Nature Of Procedure Condition Of Work Staff Experience Recapping and Disposal (are factors that influences this

occurrence.)

NATURE OF PROCEDURES Critical situations during clinical

procedures include : • Withdrawing needle from a patient, especially staff attends to bleeding patients while disposing of the needle.• Having the device jarred by the patient.• Pulling the needle out of the rubber stopper of a vacuum tube which can jab the hand in a rebound effect.NSI commonly occur when workers try to

do several things at the same time, especially disassembling or disposing of needles.

CONDITION OF WORK Work condition that might contribute

to an increase in the number of NSI include : Staff reductions, where nurses, lab. Personnel and student assume additional duties.

Difficult patient care situations.

Working at night with reduced lighting.

STAFF EXPERIENCE

New staff / student > experience staff.

RECAPPING 25 - 30% of all the NSI. Single most important cause. It is extremely dangerous to hold a

needle in one hand and attempt to cover it with a small cap held in the other hand.

Cont.

Dr.T.V.Rao MD

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WORK PRACTICES WHICH INCREASE THE RISK OF NEEDLE STICK INJURY

Recapping needles (Most important) Performing activities involving needles

and sharps in a hurry Handling and passing needles or sharp

after use Failing to dispose of used needles properly

in puncture-resistant sharps containers Poor healthcare waste management

practices Ignoring Universal Work Precautions

Dr.T.V.Rao MD

A. CATEGORIES OF EXPOSURE

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Category Definition and ExampleMild exposure

Mucous membrane/non-intact skin with small volumes e.g. a superficial wound with a low caliber needle, contact with eyes or mucous membrane, subcutaneous injections with a low caliber needle.

Moderate exposure

Mucous membrane/non-intact skin with large volumes or percutaneous superficial exposure with solid needle e.g. a cut or needle stick injury penetrating gloves.

Severe exposure

percutaneous exposure with large volumes e.g. an accident with a high caliber needle visibly contaminated with blood, a deep wound, an accident with material that has been previously been used intravenously or intra-arterially

Management of exposure includes:General wound care and cleaning.Counseling of the exposed worker regarding

bloodborne pathogens.Source patient testing for HBV,HCV and HIV

(consent required).Documentation of the incident and review.Postexposure assessment and prophylaxis

for the health care worker.Baseline and follow up serology of the

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EMERGENCY & EXPOSURE INCIDENT PLAN

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MANAGEMENT OF EXPOSED PERSON

1st step: Management of exposed site - First Aid Skin: Do not squeeze the wound to bleed it, do

not put the pricked finger in mouth. Wash with soap &water, don’t scrub, no antiseptics or skin washes (bleach, chlorine, alcohol, betadine).

Eye: wash with water/ normal saline/ don’t remove contact lens immediately if wearing, no soap or disinfectant.

Mouth: spit fluid immediately, repeatedly rinse the mouth with water and spit / no soap/ disinfectant.

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2ND STEP: ESTABLISH ELIGIBILITY FOR PEP

Evaluation must be made rapidly so as to start treatment as soon as possible-ideally within 2hours but certainly within 72 hours of exposure. However all exposed cases don’t require prophylactic treatment.

Factors determining the requirement of PEP- Nature/Severity of exposure and risk of transmission HIV status of the source of exposure HIV status of the exposed individual

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HBV POSTEXPOSURE MANAGEMENT

IF AND THENSource pt is +ve for HBsAG

Exposed worker not vaccinated

Worker should receive vaccine series should receive single dose of HB immunoglobulin within 7 days.

Exposed worker has been vaccinated

Should be tested for anti-HBs & given 1 dose of vaccine & 1 dose of HBIG if < 10 IU

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IF AND THENSource pt is –ve for HBsAg

Exposed worker not vaccinated

Worker should be encouraged to receive hepatitis B vaccine.

Exposed worker has been vaccinated

No further action is needed.

Source pt refuses testing or not identified

Exposed worker not vaccinated

Should receive HB seriesHBIG should be considered

Exposed worker has been vaccinated

Management should be individualized.

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HIV POSTEXPOSURE MANAGEMNTIF THEN AND

Source pt has AIDS ORSource pt is HIV+ve ORSource Pt refuses to be tested

Exposed worker should be counseled about risk of infection.Should be tested for HIV infection immediatelyShould be asked to seek medical advice for any febrile illness within12 weeksRefrain from blood donation & take appropriate precautions

Exposed worker testing –ve initially should be retested 6 weeks, 12 weeks & 6 months after exposure.

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IF THEN ANDSource pt is tested & found -ve

Baseline testing of the exposed worker with follow up testing 12 weeks later

Source cannot be identified

Serological testing must be done & decisions must be individualized

Incidence of needle sticks injury

All measures according to IPP implemented

First aid for the employee

Reporting to supervisor

Reporting to ICN, Writing Inc. Reporting, JKKP etc

Employee examination in ER, EHC

History taken, complete physical examination

Employee serological tests for HBs AG, Anti HBs, Anti HCV, anti HV

Patient MRP notification, patient examination

Patient serological tests for HBs AG, Anti HBs, Anti HCV, anti HV

JKKP form, Inc reporting form

Employee consent

Patient consent

Negative results of investigation

Continuous monitoring according to IPP

Post exposure prophylaxis

Employee counseling

Management of exposure

Engineering controls are the primary method to reduce exposures to blood from sharp instruments and needles.

Work-practice controls establish practices to protect personnel whose responsibilities include handling, using, or processing sharp devices.

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PRECAUTIONS TO AVOID INJURY EXPOSURE

HOW CAN NSI BE PREVENTED ? “Prevention is better than cure” A comprehensive NSI prevention

program would include : Recommend guidelines NO recapping procedures Effective disposal system Surveillance programs Employee training Improved equipment design

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DO NOT FORGET HEPATITIS B VACCINATION AND UNIVERSAL

PRECAUTIONS ……..

THANK YOU