sharp injury

1. OCCUPATIONAL HEALTH
HAZARDS
RENCY SHIBU
ICN

2. What is an Exposure?
CONTACT
WITH
• BLOOD
• PIM * TO NON INTACT SKIN *
PUNCTURE
SKIN WITH
• CONTAMINATED SHARPS WITH PIM
MUCOUS
MEMBRAN
E
• SPLASHES TO
• EYES , NOSE & MOUTH WITH PIM

3. What is not an Exposure?
PUNCTURE WITH
CLEAN/ UNUSED
NEEDLE
SPLASH WITH NON
INFECTIOUS MATERIALS
BLOOD OR BODY
FLUIDS TO INTACT
SKIN

4. Who is at risk?
 Any HCW who comes in contact with
blood/body fluids is at risk, including
nursing staff , laboratory staff , doctors,
anesthesia technicians and EVS staff.
 Common body fluids that may come in
contact with HCW’s ????
 Common situations in which there is a
chance for exposure……

5. What infections can be caused ?
 Hepatitis B Virus(HBV)
 Hepatitis C Virus(HCV)
 Human Immuno Deficiency Virus(HIV)
90% of HCW’s who have HIV or hepatitis
contract the disease from NSI’s
12,000 HCW’s/year get hepatitis, 300
HCW’s die each year
~20 more infections are transmitted
through NSI’s

6. How do needle stick injuries
occur??
 Recapping
 Improper disposal of used needles
 Transferring a body fluid between containers
 Equipment design
 Nature of procedure
 Condition of work
 Staff experience

7. Recapping
 Recapping : can account to 25-
30% for nsg and lab staff
-Injuries can occur in 3 ways :
1. Needle misses the cap
2. Needle pierces the cap
3. Slipping of the cap
 If you recap , use single scoop
method(one handed technique)

8. 0%
5%
10%
15%
20%
25%
30%
35%
0.30%
3%
30%
Hepatitis B Virus Hepatitis C Virus HIV
**Simonsen et al WHO bulletin 77,1999
Estimated Risk of Infection Following a Needle-
stick from an Infected Source-Patient

9. Risk Factors
 The pathogen involved
 Depth of percutaneous injuries
 The amount of blood/body fluid involved
 The amount of virus in the patient’s
blood/body fluid

10. What will you do if Needle stick
Injuries occurs?
 Needle pricks, cuts, bites, scratches
 Do not encourage bleeding by squeezing
 Wash thoroughly with soap and water
 Cover with a water proof dressing
 Splashes to mouth or eyes
 Rinse thoroughly with plenty of running water.
 Do not use any antiseptics
Inform Infection Control dept. immediately for
further follow up

11. W I N
WASH – THOROUGHLY WASH THE AREA
IDENTIFY – NAME AND MEDICAL
RECORD OF THE SOURCE
NOTIFY – SUPERVISORS ,
IC DEPARTMENT

12. How can I protect myself from NSI?
 Follow Standard Precautions.
 Avoid recapping
 If you recap , use single scoop method(one
handed technique)
 Dispose off used needles immediately in
puncture resistant containers
 Make sure sharp containers are accessible
 Take your time

13. Continued…………
 Plan safe handling & disposal before beginning any
procedure using needles
 Participate in training
 Get Hepatitis B vaccination
 Use Sharp Devices with safety features (if available )
 Report all NSI to ensure appropriate follow-up
care

14. Prevention
 Avoid – Sharp Injuries
 Plan – When using sharps
 Report – Blood and Body Fluid Exposure (ASAP)
 Participate – Exposure Prevention

17. Post Exposure Prophylaxis (PEP)
Immunization Chemo prophylaxis
Hepatitis.B Hepatitis B vaccine None
Hepatitis.C None None
HIV None Tenofovir(300),
Lamivudine (300),
Efavirenz(600)

18. Vaccination &
antibody response
status of exposed
workers
Source
HBsAg positive
Source
HBsAg negative
Source
Unknown or not
available for
testing
Unvaccinated HBIG y x 1 &
initiate HB
Vaccine series
(within 7 days)
Initiate Hepatitis B
vaccine series
Initiate Hepatitis B
vaccine series
Previously
vaccinated ,
Responder
No treatment No treatment No treatment
Previously
vaccinated , non
responder
HBIG x 1 and
initiate
revaccination or
HBIG x 2 Ï
No treatment If known high-risk
source, treat as if
source were
HBsAg +ve
Hepatitis B immuno globulin; dose is 0.06 mL /kg intramuscularly.

19. Post-exposure management for HCV
0 week (at injury) Triple
H
3 months (Triple H)
6 months Triple H
PSO – Dr. Suyash
Kulkarni

20. Key Point
“Preventing” needle stick
injuries is the “best” way
to protect yourself from
these infections