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NEEDLE STICK AND SHARP INJURIESDR 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 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 4
Dr.T.V.Rao MD 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 5 5
Dr.T.V.Rao MD 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 6
Dr.T.V.Rao MD WHO GETS INJURED? Clerical / Housekeeping/ Admin Maintenance 1% DentalOccupational 3% 1% Other Groups of Student 5% Healthcare 4% Personnel Exposed to TechnicianBlood/Body 15% Nurse Fluids, 43% Physician 28% 7
Dr.T.V.Rao MDHOW DO INJURIES OCCUR WITH HOLLOW-BORE NEEDLES? Transfer/Process Other Specimens 5% During Sharps 5% Disposal Access IV Line 13% 5% Handle/Pass Improper Equipment Disposal 6% 9% During Clean Up Recap Needle 9% Disposal 6% Related: In Transit to Disposal 35% Collision 4% W/Worker or Sharp Manipulate 10% Needle in Patient 28% 8 Circumstances Associated with Hollow-Bore Needle
Dr.T.V.Rao MDWHAT KINDS OF DEVICES USUALLY CAUSE SHARPS INJURIES? Hypodermic needles Blood collection needles Suture needles Needles used in IV delivery systems Scalpels 9
Dr.T.V.Rao MD WHAT INFECTIONS CAN BE CAUSED BY SHARP INJURIES?Sharps injuries can expose workers to anumber of blood borne pathogens that cancause serious or fatal infections. The pathogensthat pose the most serious health risks are Hepatitis B virus (HBV) Hepatitis C virus (HCV) Human immunodeficiency virus (HIV) 10
Dr.T.V.Rao MDRISKS OF SEROCONVERSION DUE TO SHARPS INJURY FROM A KNOWN POSITIVE SOURCE Virus Risk (Range) HBV 6-30%* HCV ~ 2% HIV 0.3% (*Risk for HBV applies if not HB vaccinated) 11
Dr.T.V.Rao MD HOW DO SHARPS INJURIES HAPPEN? Who gets injured? Where do they happen? When do injuries occur? What devices are involved? How can they be prevented? 12
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 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 19 19
Dr.T.V.Rao MD A. CATEGORIES OF EXPOSURECategory Definition and ExampleMild Mucous membrane/non-intact skin with small volumesexposure e.g. a superficial wound with a low caliber needle, contact with eyes or mucous membrane, subcutaneous injections with a low caliber needle.Moderate Mucous membrane/non-intact skin with large volumes orexposure percutaneous superficial exposure with solid needle e.g. a cut or needle stick injury penetrating gloves.Severe percutaneous exposure with large volumes e.g. an accidentexposure 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 20
EMERGENCY & EXPOSURE INCIDENT PLANManagement 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 worker. 21
Dr.T.V.Rao MDMANAGEMENT OF EXPOSED PERSON1st 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. 22
Dr.T.V.Rao MD 2ND STEP: ESTABLISH ELIGIBILITY FOR PEPEvaluation must be made rapidly so as to starttreatment as soon as possible-ideally within 2hoursbut certainly within 72 hours of exposure. However allexposed cases don’t require prophylactic treatment.Factors determining the requirement of PEP- Nature/Severity of exposure and risk oftransmission HIV status of the source of exposure HIV status of the exposed individual 23
HBV POSTEXPOSURE MANAGEMENT IF AND THENSource pt Exposed worker Worker should receiveis +ve for not vaccinated vaccine seriesHBsAG should receive single dose of HB immunoglobulin within 7 days. Exposed worker Should be tested for anti- has been HBs & given 1 dose of vaccinated vaccine & 1 dose of HBIG if < 10 IU 24
IF AND THENSource Exposed worker Worker should bept is –ve not vaccinated encouraged to receivefor hepatitis B vaccine.HBsAg Exposed worker No further action is needed. has been vaccinatedSource Exposed worker Shouldreceive HB seriespt not vaccinated HBIG should be consideredrefusestestingor not Exposed worker Management should beidentifie has been individualized.d vaccinated 25
HIV POSTEXPOSURE MANAGEMNT IF THEN ANDSource pt has Exposed worker should ExposedAIDS be counseled about risk worker testing of infection. –ve initially OR should be Should be tested forSource pt is retested 6HIV+ve HIV infection immediately weeks, 12 OR weeks & 6 Should be asked toSource Pt months after seek medical advice forrefuses to be exposure. any febrile illnesstested within12 weeks Refrain from blood donation & take appropriate precautions 26
IF THEN ANDSource pt is tested Baseline& found -ve testing of the exposed worker with follow up testing 12 weeks laterSource cannot be Serologicalidentified testing must be done & decisions must be individualized 27
Incidence of needle sticks injury Reporting to supervisor First aid for the employee Reporting to ICN, Writing Inc. JKKP form, Inc Reporting, JKKP etc reporting form Employee examination in ER, EHC Negative results of investigation History taken, complete physical examination Management of Post exposure Employee serological tests for HBs Employee exposure prophylaxis AG, Anti HBs, Anti HCV, anti HV consent Continuous monitoring Patient MRP notification,Employee counseling according to IPP patient examination Patient serological tests for HBs Patient AG, Anti HBs, Anti HCV, anti HV consent All measures according to IPP implemented
PRECAUTIONS TO AVOID INJURY 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. 29
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
Dr.T.V.Rao MDDO NOT FORGET HEPATITIS B VACCINATION AND UNIVERSAL PRECAUTIONS …….. 31