Management of blood exposure and needle stick injuries

Dr. Moustapha A. Ramadan

Fellow of Community Medicine Department

Faculty of Medicine

Alexandria University

Means pathogenic microorganisms that are present in human blood and can cause disease in humans.

These pathogens include, but are not limited to, HIV (Human Immune-deficiency Virus), HBV (Hepatitis B virus), and HCV (Hepatitis C Virus).

Means specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact

with blood or other potentially infectious materials

that result from procedures or activities done in health-care settings.

3 million exposures per year in healthcare workers

37% of Hepatitis B

39% of Hepatitis C

4.4% of HIV

are due to needlestick injuries (50% of hospitalized patients in sub-Saharan Africa are HIV +)

Virus Chance of HCW Infection

HBV 6 – 30 out of 100 people

HCV 3 – 10 out of 100 people

HIV 1 out of 300 people

Most exposures do not result in infection.

The risk of infection vary with :

The pathogen involved

The type of exposure

The amount of blood involved in the exposure

The amount of virus in the patient's blood at the time of exposure

1% of hospital healthcare personnel have evidence of HCV infection

CDC had received reports of 57 documented cases and 138 possible cases of occupationally acquired HIV infection among healthcare personnel in the United States since reporting began in 1985 till 2001

Of the CDC documented cases of occupational transmission of HIV, 90% were from contaminated hollow- bore needles that pierced the skin

OSHA mandates HBV vaccination

17,000

800

This regulation had the greatest impact in eliminating HBV

transmission among healthcare workers

Elimination or substitution of sharps:eliminate unnecessary injections, needleless IV systems

Engineering ControlsA-D syringes, safer needle devices

Administrative and Work Practice Controls

Universal Precautions, no recapping, provision & placement & removal of sharps containers

Personal Protective Equipmentgloves, masks, gowns,

LeastEffective

MostEffective

Does not harm the recipient,

Does not expose the provider to any avoidable risk,

Does not result in any waste that is dangerous for other people

Have sharp disposal container available

Do not recap needles

Do not manually remove the used needle from the syringe

Do not walk around the immunization area carrying syringes

Do not set needle/syringe down

Do not manually sort medical waste

Leak-proof

Puncture-proof

Clearly labeled with warning (easy for the

community to understand)

Do not overfill (only 3/4 is safe)

Do not transfer contents to other container

UnsafeSafe

If an exposure occurs,

What should I do?

• Wash injuries and cuts with soap and water

• Flush splashes to the nose, mouth, or skin with water

• Irrigate eyes with clean water or saline

• Remove contaminated clothing ( if necessary)

No scientific evidence shows that squeezing the wound will reduce the risk of transmission of a blood borne pathogen.

Prompt reporting of the exposure incident to the In-charge person or supervisor

The incident report should include:

1. Time and date of incident

2. Location/ department

3. Source patient

4. Description of the incident

Fear of being punished or fired

Lack of awareness of risk of infection

Lack of assurance of confidentiality

Emphasis on patient care (unable to leave patient care area for follow-up)

No employee training on reporting procedures

No post-exposure treatment/prophylaxis available

Mechanism of injury

Site of injury

Amount and type of blood/body fluid

Infectious status of source patient

Susceptibility of exposed person

Immediate action taken

Hepatitis B Virus

Employee Status HBsAg Positive HBsAg Negative Unknown

Unvaccinated HB Ig and initiate vaccine

Initiate vaccine Initiate vaccine

Previously vaccinated

No PEP No PEP No PEP

Know non responder

HB Ig and re vaccinate or HB Ig 2 doses

No PEP If know high risk, treat as HBs Ag positive

Antibody response unknown

Test for anti HBsIf adequate no PEPIf inadequate HB ig and vaccine booster

No PEP Test for anti HBsIf adequate no PEPIf inadequate Administer vaccine booster and recheck titre in 1-2 months

HB IG should be administered as soon as possible ( within 24 hours of exposure)

If vaccine is indicated, it should be administered as soon as possible ( within 24 hours of exposure)

HB IG and vaccine can be administered simultaneously but at a separate sites.

Hepatitis C Virus:

IG and antiviral agents are not recommended for PEP after exposure to HCV positive blood.

Perform a baseline testing for anti HCV and ALT activity

Perform a follow up testing (4-6 months).

HIV:

If testing the source patient is delayed PEP should start while awaiting the result.

Serological testing for HIV at baseline, 6 week, 3 month, 6 month following exposure to identify seroconversion

Risk assessment:

No

Yes

No

Yes

No

Yes

Yes

High Risk Incident

High Risk Body Fluid

High Risk Source

Prescribe PEPRefer to ID physicianEvaluate drug toxicity

PEP not indicatedReassure

Medications:

Start within hours after exposure

Combination therapy of 2 drug Truvada and Isentress is recommended

Counseling:

Refrain from blood/tissue donation

Sexual intercourse should be protected

Pregnant women should be advised against breast feeding

Razors and toothbrushes should not be shared

Prompt reporting is essential because, in some cases, post exposure treatment may be recommended and it should be started as soon as possible.

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