Presentation title Needlestick Injury Prevention Program Presenter name [Facility Name]
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
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
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
Outcome • Upon completion of this presentation the learner will have a theoretical knowledge of strategies to prevent hollow-bore needlestick injuries
Part I Occupational Exposures and Sharps Management
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
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
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
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
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%)
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
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
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
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
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.
Sharps Management -General Principles • Needles should not be recapped, bent or broken by hand, removed from disposable syringes or otherwise manipulated by hand.
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
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 >10 mIU/mL
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.
You have now completed Part I of this module Please proceed to Part II