Sharp injuries

8/13/2019 Sharp injuries

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Dr. Ashish Jawarkar

NEEDLE STICKS AND

SHARPS INJURIESFACTS, LEGAL CONCERNS, AND CARE

Dr. Ashish V. Jawarkar 1


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THE PROBLEM ~385,000 sharps injuries annually among hospital-

based healthcare personnel (>1,000 injuries/day)

Many more in other healthcare settings (e.g., emergencyservices, home care, nursing homes)

Increased risk for blood borne virus transmission

Costly to personnel and healthcare system

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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 membraneof 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

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WHO GETS INJURED?

Nurse

43%

Technician

15%

Student

4%

Dental

1%

Housekeeping/

Maintenance

3%

Clerical /

Admin

1%

Other

5%

Physician

28%

Occupational

Groups ofHealthcare

Personnel Exposed

to Blood/Body

Fluids,

NaSH June 1995

December 2003

(n=23,197)

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HOW DO INJURIES OCCUR WITH HOLLOW-BORE

NEEDLES?

During Sharps

Disposal

13%

During Clean Up

9%

In Transit to

Disposal

4%

Handle/Pass

Equipment

6%

Improper

Disposal

9%

Access IV Line5%

Transfer/Process

Specimens

5%

Recap Needle

6%

Collision

W/Worker or

Sharp

10%Manipulate

Needle in Patient

28%

Other

5%

Circumstances Associated with Hollow-Bore Needle Injuries NaSH June

1995December 2003 (n=10,239)

Disposal

Related:

35%

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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

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Hypodermicneedles

Blood collection

needles

Suture needles

Needles used in IV

delivery systems

Scalpels

WHAT KINDS OF DEVICES USUALLYCAUSE SHARPS INJURIES?

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WHAT INFECTIONS CAN BE CAUSEDBY SHARP INJURIES?

Sharps injuries can expose workers to anumber of blood borne pathogens that cancause serious or fatal infections. Thepathogens that pose the most serious healthrisks are

Hepatitis B virus (HBV)

Hepatitis C virus (HCV)

Human immunodeficiency virus (HIV)

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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)

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WHAT IS THE RISK FOR HIV ALONE?

Percutaneous 0.3%

Mucous membrane 0.1%

Non-intact skin


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Who gets injured?

Where do they happen?

When do injuriesoccur?

What devices areinvolved?

How can they beprevented?

HOW DO SHARPS INJURIES HAPPEN?

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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

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RISK FACTORS FOR HIV

SEROCONVERSION IN HCWS

Risk Factor Adjusted Odds Ratio*

Deep Injury 15.0

Visible Blood on Device 6.2

Terminal Illness in Source Patient 5.6

Needle in Source Vein/Artery 4.3

From: NEJM 1997;337:1485-90.

*All Risk Factors were significant (P < 0.01)

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Report all needle stickand sharps-relatedinjuries promptly toensure that you receiveappropriate follow-upcare.

Tell your employer aboutany sharps hazards youobserve.

Participate in trainingrelated to infectionprevention.

Get a Hepatitis Bvaccination.

PROTECTING YOURSELF

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POST EXPOSURE PROPHYLAXIS (PEP)

It refers to the comprehensive management to minimize therisk of infection following potential exposure to blood bornepathogens (HIV, HBV, HCV ).It includes

First Aid Risk Assessment

Counseling

PEP drugs (4Weeks) depending upon risk assessment

Relevant Lab Investigation on informed consent of the

source and exposed person

Follow up and support


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MANAGEMENT OF EXPOSED PERSON

1ststep: 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,dont scrub, no antiseptics or skin washes (bleach,

chlorine, alcohol, betadine).

Eye: wash with water/ normal saline/ dont removecontact lens immediately if wearing, no soap ordisinfectant.

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


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2NDSTEP: 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 dontrequire 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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3 rd step : administer PEP

Status of index case PEP Follow up

HIV Positive HAART (zido+lami) within

1-2 days, continue for 28

days

Check HIV antibody levls

at 6 weeks, 3 months and

6 months

Negative Counselling only Do

HBV [psotove Counselling

HBIG prophylaxis

Not required

Negative Counselling Not required

HCV Positive No prophylaxis available

Treatment if disease

occurs

Check anti HCV at 3 and

6 month


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QUICK FACT:HBV VACCINATION IS RECOMMENDED FOR ALL

HEALTHCARE WORKERS (UNLESS THEY AREIMMUNE BECAUSE OF PREVIOUS EXPOSURE).

HBV VACCINE HAS PROVEN TO BE HIGHLY

EFFECTIVE IN PREVENTING INFECTION INWORKERS EXPOSED TO HBV. HOWEVER, NOVACCINE EXISTS TO PREVENT HCV OR HIV

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SUPREME COURT DIRECTIVE TO ENSURE PEP

DRUGS IN ALL GOVERNMENT HOSPITALS IN INDIA

1. Universal Work Precautions (UWP) and PEP guidelines should be followed byHCPs to prevent occupational transmission of HIV, Hepatitis B and hepatitisC.

2. This will develop confidence in HCPs while working with patients some ofwhom might be infected with HIV/HBV/HCV.

3. PEP drugs should be available in all Govt Hospitals toenable protection of HCPs dealing with potentially infectedpatients to make sure that no patients suffering from HIVbe denied treatment/surgery/ procedures etc

4. Availability of UWP and PEP can minimize the stigma and discriminationagainst PLHIVs in Health Care facilities.

5. Above regulations to be practiced in Private hospitals and Establishments

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RESPONSIBILITY OF HEAD OF THE INSTITUTION

To ensure that the hospital has a written protocol tohandle exposure and the same is displayed atprominent locations within the hospital for information ofstaff.

Sensitization of Doctors, Nurses, Paramedics & wastehandlers

To ensure that Universal precautions are followed. Availability of Personal protective equipment. Dissemination of procedure to be followed in case of

accidental exposure to Blood and Body fluids

Availability of Rapid HIV test kits. Availability of other preventive measures including

vaccinations.


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AVAILABILITY OF PEP AT HEALTHCARE FACILITY

It is recommended that PEP drugs be kept available round-the-clock in any of the three locations - Emergency room,

Labor room and ICU.

Drug Stock at the Healthcare facility

PEP kit comprises of 2 drug regimen:

Zidovudine(AZT) 300mg + Lamivudine (3TC)

150 mg as a fixed dose combination


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WHAT ARE STRATEGIES TO ELIMINATE SHARPS INJURIES?

Eliminate or reduce the use of needles

and other sharps

Use devices with safety features to

isolate sharps

Use safer practices to minimize risk for

remaining hazards

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DO NOT FORGET HEPATITIS B VACCINATION AND

UNIVERSAL PRECAUTIONS ..

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THANK YOU

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Sharp injuries