Medication: Needle Stick Injuries

NEEDLE STICK INJURIES

Introduction

One of the most potentially hazardous procedures that health care personnel face is using and disposing of needles and sharps.

Needle-stick injuries can cause considerable anxiety because of the fear of contracting blood-borne diseases such as HIV, hepatitis B and hepatitis C as well as other diseases such as tetanus.

Between 6 00 000 and I million accidental and sharp injuries occur annually in health care settings (OSHA 2009)

What is needle stick injury?

Needle-stick injuries are wounds caused by needles that accidentally puncture the skin.

What infection can be caused by sharp injuries?

Sharps injuries can expose workers to a number of blood-borne pathogens that can cause serious or fatal infectíons. The pathogens that pose the most serious health risks are

·         Hepatitis B virus (HBV)

·         Hepatitis C virus (HCV)

·         Human immunodeficiency virus (HIV)

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

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 container Poor healthcare waste management practices

·         Ignoring Universal Work Precautions

How Do Injuries Occur With Hollow-Bore Needles?

·         RECAPPNG (very common)

·         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 small cap held in the other hand.

Injuries can occur in 3 other ways:

·         The needles misses the cap and accidentally enters the hand holding it.

·         The needle pierces the cap and accidentally enters the hand holding it.

·         The poorly fitting cap slips off a recapped needle and the needle stabs the hand.

What kinds of devices usually cause sharps injuries?

·         Hypodermic needles

·         Blood collection needles

·         Suture needles

·         Needles used in IV delivery systems Scalpels

Prevention:

Guideline based on Occupational Safety and Health Act (OSHA)

·         Avoid recapping needles:(i.e., has been inserted into a client) except under specified circumstances (e.g., when transporting a syringe to the laboratory for an arterial blood gas or blood culture).

·         Recapping procedure (only when necessary)

·         Whenever possible, dispose of needles immediately without recapping them.

·         In situations where recapping is considered necessary, safe approaches should be developed.

·         Workers should never move an exposed needle tip towards an unprotected hand.

·         Use a one-handed "scoop" method

Steps of the One-Hand Technique:

a)       Placing the needle cap and syringe with needle horizontally on the surface. Remove your hand from the cap.

b)      Inserting the needle into the cap, using one hand.

c)       Then using your other hand to pick up the cap and tighten it to the needle hub. Be careful not to contaminate the needle.

·         Never bend or break needles before disposal.

·         Dispose with care

·         Use appropriate puncture-proof disposal containers to dispose of uncapped needles and sharps.

·         Puncture proof bins are provided in all client areas.

·         Never throw sharps in wastebaskets.

·         Sharps include any items that can cut or puncture skin such as: Needles, Surgical blades, Lancets, Razors etc.

·         Place sharps container at eye-level and at arms reach.

·         Do not fill the container more than 2/4 of its capacity.

·         Seal the container before handing over to biomedical waste disposal staff.

Use of Safety devices in administering medication

This also helps in preventing needle stick injury

SAFETY DEVICES:

Most needle stick injuries can be prevented with the use of safety devices, Which, in conjunction with worker education and training and work practice can reduce injuries by over 90 percent.

There are different types of safety devices and technologies that are available to prevent needle stick and sharps injuries.

SOME OF SAFETY DEVICES:

Syringes and injection equipment

Needleless or jet injection - the medication is injected under the skin without a needle, using the force of the liquid under pressure to pierce the skin.

Retractable needle - The needle (usually fused to the syringe) is spring-loaded and retracts into the banel of the syringe when the plunger is completely the injection is given.

Hypodermic syringes with Retractable Technology" safety feature

Hypodermic syringes with "Self-Sheathing" safety feature:

Protective sheath - after giving an injection, the worker slides a plastic over the needle and locks it in place.

"Add-on" safety feature (Hinged re-cap)

Hinged re-cap

IV Access - Insertion Equipment

Retractable - the spring-loaded needle into the needle bolder upon pressing a button after use or the needle withdraw into the holder when from the patient's arm.

Self-sheathing IV cannula

Blood collection devices

·         Phlebotomy needle with "Self-Blunting" safety feature

·         Phlebotomy device with retractable needle

·         Phlebotomy needle with hinged cap

Use Personal Protective Equipment (PPE) -

Barriers and filters between the worker and the hazard. Examples include eye goggles, gloves, masks, and gowns.

Post Exposure Prophylaxis (PEP)

It refers to the comprehensive management to minimize the risk of infection following potential exposure to blood borne pathogens (HIV, HBV, HCV)

WHAT TO DO IF YOU ARE INJURED?

Wash the wound with soap and water.

Do not apply pressure to the wound; allow it to bleed freely.

Immediately report your injury to your supervisor, do not wait until the end of your shift or the end of the procedure.

Identify the patient involved so that they can be evaluated for an infection.

Get medical assessment.

Follow the direction for any necessary blood test, vaccination, or medications to prevent infection.

Document the incident in forms provided by hospital.

Remember:

Evaluati3on must be made rapidly so as to start treatment as soon as possible ideally within 2 hours but certainly within 72 hours of exposure.

However all exposed cases don't require prophylactic treatment.

Availability of PEP at Healthcare facility

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

- Emergency room, Labor room and ICU.

Drug Stock at the Healthcare facility: Zidovudine(AZT) 300mg + Lamivudine (3TC) 150 mg as a fixed dose combination

Summarize - What are Strategies to Eliminate Sharps Injuries?

·         Eliminate or reduce the use of needles md other sharps

·         Use devices with safety feature to isolate sharps

·         Use safer practice; to minimize risk for remaining hazards

·         Do not forget Hepatitis B vaccination and Universal precautions……

Quick FACT:

HBV vaccination is recommended for all healthcare workers (unless they are immune because of previous exposure). HBV vaccine has proven to be highly effective in preventing infection in workers exposed to HBV. However, no vaccine exists to prevent HCV or HIN infection,