Needlestick Injury Prevention Program Part 1

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Presentation title
Needlestick Injury Prevention Program
Presenter name
Facility Name
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About this presentation

• This presentation is designed to assist with the
  training of staff on sharps management including
  safety devices
• The information relates to prevention of
  hollow-bore needlestick injuries (NSI) and should
  be used in combination with other training
  material
• The presentation should be read in conjunction
  with the Recommended Practices For Preventing
  Hollow-Bore Needlestick Injuries

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About this presentation

• The training module is presented in three parts
• Part I outlines general information in relation
  to occupational exposures and sharps management
• Part II describes the various safety devices
  which will be utilised in the facility
• Part III highlights generic principles regarding
  occupational exposure management

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About this presentation

• The presentation is designed to be customised by
  an individual facility
• In Part II of this presentation, only include
  slides of safety devices that will be used in
  your facility

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Outcome

• Upon completion of this presentation the learner
  will have a theoretical knowledge of strategies
  to prevent hollow-bore needlestick injuries

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Part I

• Occupational Exposures and Sharps Management

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Sharps Management

• What is an occupational exposure?
• A blood or body fluid exposure that occurs as a
  consequence of a work-related activity
• There are two types of blood and body fluid
  exposure
• Percutaneous exposure (penetrates the skin) e.g.
  needlestick injury (NSI) or cut with a sharp
  object such as a scalpel blade
• Non-percutaneous or mucocutaneous exposure
  (contact of mucous membrane or non-intact skin
  with blood or body fluids) e.g. blood splash to
  the eye

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Sharps Management

• What about human bites and scratches that break
  the skin?
• For human bites, clinical evaluation must include
  the possibility that both the person bitten and
  the person who inflicted the bite were exposed to
  blood borne pathogens
• Transmission of HIV infection by this route has
  been reported rarely, but not after an
  occupational exposure.
• The risk of transmission of a blood borne virus
  via a scratch is highly unlikely

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Sharps Management

• Why do I need to be concerned if I have an
  occupational exposure?
• An occupational exposure potentially exposes
  healthcare workers to blood and other body fluids
  (except sweat), that may contain blood borne
  viruses
• Human Immunodeficiency Virus (HIV)
• Hepatitis B Virus (HBV)
• Hepatitis C Virus (HCV)
• Contaminated sharps pose the greatest risk to
  healthcare workers of occupational exposure to
  blood borne viruses

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Sharps Management

• How does transmission of a blood borne virus
  occur from a contaminated sharp?
• Transmission requires transfer of
  blood-containing material by injection or via
  sharp instruments through unbroken skin
• The risk of transmission is influenced by
• Organism
• Volume of blood
• Status of source
• Status of staff member

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Sharps Management

• What is the risk of transmission following a NSI
  to a positive source?
• HIV
• 0.3
• HBV
• If healthcare worker susceptible (i.e.
  non-immune)
• 1 - 6 if the source is hepatitis B surface
  antigen (HBsAg)-positive
• 22 - 31 if the source is HBsAg- and
  HBeAg-positive
• HCV
• 1.8 (range 0 - 7)

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Sharps Management

• Who is at risk of an occupational exposure?
• All healthcare workers who have the potential for
  exposure to infectious materials (e.g. blood,
  tissue, and specific body fluids, as well as
  medical supplies, equipment or environmental
  surfaces contaminated with these substances) e.g
• Nurses
• Doctors
• Laboratory staff
• Technicians
• Therapists
• Support personnel e.g. housekeeping, maintenance
• Dental staff
• Contractual staff
• Students

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Sharps Management

• Where, when and how do NSI occur?
• Where?
• Inpatient units
• Operating rooms
• Emergency Department
• Procedure Room
• When and How?
• During use
• After use and before disposal (including
  recapping)
• During or after disposal
• After appropriate disposal
• After inappropriate disposal

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Sharps Management

• What types of devices are involved in NSI?
• Analysis of the results of a 10-year study at a
  large Queensland tertiary referral hospital
  revealed that two hollow-bore devices were
  implicated in over 90 of NSI1
• Disposable needle/syringes
• Steel-winged (butterfly) needles
• Other types of hollow-bore needles include
• Intravenous (IV) catheter stylets
• Multi-sample blood collection (vacutainer)
  needles
• Arterial blood collection syringe needles
• Aspiration needles
• Injector pen needles

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Sharps Management -General Principles

• Policies and procedures including NSI management
• Standard Precautions including personal
  protective equipment (PPE)
• Hepatitis B vaccination
• Education programs
• Modifications to work practices including
  alternatives to using needles
• Safe handling of sharps
• Sharps disposal systems i.e. puncture-resistant
  containers
• Injury prevention features/safety devices
• Active
• Passive

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Sharps Management -General Principles

• The person who has used the sharp is responsible
  for its immediate safe disposal following use,
  preferably at the point of use.

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Sharps Management -General Principles

• Needles should not be recapped, bent or broken by
  hand, removed from disposable syringes or
  otherwise manipulated by hand.

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Sharps Management -General Principles

• In the case of inappropriately disposed sharps, a
  sharps container should be taken to the location,
  the sharp handled and disposed of in a manner to
  avoid injury, and hands washed following
  disposal.
• Report inappropriate disposal

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Sharps Management -General Principles

• Hepatitis B Vaccination
• A primary course of hepatitis B vaccinations over
  six months
• Mandatory for all staff in contact with patients
  and patient-contaminated material
• Titre level (HBsAb) four to six weeks after last
  dose
• Booster doses not required if titre level
  gt10 mIU/mL

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References

• Queensland Health. Infection Control Guidelines.
  Appendix P3 Management of Blood and Body Fluid
  Exposure (updated 2006). Brisbane Queensland
  Government.
• Centers for Disease Control and Prevention.
  Workbook for Designing, Implementing and
  Evaluating a Sharp Injury Prevention Program.
  2004. Atlanta US Department of Health and Human
  Services.
• Whitby R, McLaws M. Hollow bore needlestick
  injuries in a tertiary teaching hospital
  epidemiology, education and engineering. Med J
  Aust 2002 177(8) 418-422.
• Centers for Disease Control and Prevention.
  Updated U.S. Public Health Service Guidelines for
  the Management of Occupational Exposures to HBV,
  HCV, and HIV and Recommendations for Postexposure
  Prophylaxis. MMWR 2001 50(No. RR-11) 1-7.

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• You have now completed Part I of this module
• Please click here to proceed to Part II