Sharps Management, Needle-Stick Injuries and Exposure to Blood Borne Viruses Procedure ICPr005

Transcription

1 Sharps Management, Needle-Stick Injuries and Exposure to Blood Borne Viruses Procedure ICPr005

2 Version Date Date of Next Reason for Change (eg. full rewrite, No. Ratified/ Implementation Review amendment to reflect new Amended Date legislation, updated flowchart, minor amendments, etc.) 1 01/03/16 01/03/2018 Changed from policy to procedure 2 01/03/18 29/06/ /03/2020 Review of procedure no changes Page 2

3 Table of Contents 1. INTRODUCTION SHARPS MANAGEMENT Good Practice in Sharps Management... 4 Needle and Syringe Management Ensure Safe Use Prevention of Inoculation Injury Risk of Infection from Sharps Injuries Action to be taken following Contaminated Sharps injury Immediate management of sharp injuries (sharps injury or human bite) Management of Significant Exposures Reducing the risk of Hepatitis B Transmission Reducing the risk of Hepatitis C Transmission Reducing the risk of HIV Transmission Exposure Incidents in the Community Follow-Up EQUALITY CONSIDERATIONS REFERENCES AND BIBLIOGRAPHY... 9 APPENDIX 1 SHARPS INJURY AND SPLASH INCIDENTS APPENDIX 2 - SAFER DEVICES Page 3

4 1. INTRODUCTION The risk of transmission of blood borne viruses is greater from patient to healthcare workers than vice versa. Occupational risk of transmission arises from possible exposure to contaminated blood or other body fluids from an infected patient. This procedure aim to make staff aware of the practices which maintain the highest standards of infection prevention and control with regards to blood borne viruses thus preventing the spread of infection to patients, staff and visitors largely without the need to divulge patient information that may be confidential. In addition to the above emphasize awareness of the arrangements for access to advice, assessment and treatment of occupational exposure blood borne viruses. Personal Protective Equipment (PPE) must be worn for invasive procedures, contact with sterile sites and all activities that have been assessed as carrying a risk of exposure to blood/body fluids and when handling sharps or contaminated instruments (Epic2 2011). All sharps/needle-stick injuries must be reported immediately according to the sharps management procedure so that appropriate action may be taken. It is the duty of every employee to report such incidents and document them properly, under the Health and Safety at Work Act. Unfortunately many such exposures result from a failure to follow Standard Infection Control Precautions regarding the safe handling and disposal of sharps dealing with spillages of blood/body fluids plus wearing personal protective equipment. However, even when safe infection control precautions are followed there is a possibility of accidental and malicious acts, which may result in exposure to blood borne viruses. NHFT is committed to the provision of high quality services in environments that are safe for patients, staff and visitors alike. NHFT in conjunction with the Infection Prevention and Control Team have introduced the use of safer devices (appendix 2). This procedure set out the commitment of the organisation and arrangements to minimise the risk from sharps and needle-stick injuries in all areas of its activities and, in particular, those activities involving patient contact. The NHFT Board is committed to providing the resources and support systems for the safe management of risks to staff, patients and others from sharps and needle-stick injuries in order to promote quality health care and provide a safe environment for patients, staff and visitors alike. Through the implementation of this procedure, NHFT will identify, evaluate and control the associated risks. 2. SHARPS MANAGEMENT 2.1 Good Practice in Sharps Management It is the personal responsibility of the individual using a sharp to:- Dispose of it safely Ensure that needles are not bent or broken prior to use or disposal Page 4

5 Ensure that handling is at a minimum. Do not pass sharps directly from hand to hand or person to person Discard directly into an approved sharps disposal box Ensure a range of sharps box sizes are available. Ensure that sharps boxes are kept in a location that prevents injury to patients, staff and visitors. They must not be stored on the floor Take a sharps box whenever possible to the point of use so that any sharps can be disposed of immediately Ensure sharps boxes are correctly assembled and the identification label on the box is signed by the person assembling it Do not overfill sharps boxes, the box should be changed when at three quarter full (see fill line) Ensure that the lid is closed in the correct manner for that container and the identification record on the box is completed Never re-sheath a needle Needle and Syringe Management NHFT has adopted the use of safety devices following the EU Directive; Do not re-sheath needles Dispose of needle and syringes as one unit into a specified sharps container If it is necessary to detach the needle, great care must be taken preferably using the device on the sharps container Request assistance when using sharps with reluctant or confused patients Do not carry sharps in the hand; always use a tray or receiver Do not pass sharps from hand to hand Always carry sharps containers away from the body 2.2 Ensure Safe Use Wherever sharps are being used, an appropriate disposal system must be available e.g. sharps box The size of sharps boxes should be determined according to requirement In cases of low usage, boxes should not be in use for longer than three month (NICE, 2012) Sharps needles and syringes should be placed into the disposable container by the person(s) using them. Do not leave sharps for someone else to dispose of Sharps containers should comply with the British Standard BS7320 Always assemble containers correctly with lid securely fastened to base At no time should a sharps box be placed on the floor Sharps containers should be taken to point of use An injection tray with an integral sharps box should be used when a healthcare worker has to walk some distance to the point of use Sharps boxes should be situated in a safe and secure place and not accessible to other patients or visitors In rooms or areas where boxes do not need to be moved, they should be wallmounted Page 5

6 Never press down the contents to make more room or attempt to retrieve an item from the sharps box Sharps boxes must be disposed of when no more than ¾ full After each use, the aperture should be moved into the closed position All apertures must be locked prior to disposal All sharps boxes must be disposed of by incineration Sharps boxes must not be placed inside waste bags prior to disposal Sharps boxes must be labeled with date and signature, when assembled, locked and disposed of. They must be labeled with their source prior to disposal 2.3 Prevention of Inoculation Injury A sharps injury is an injury where the skin or mucous membrane is breached. It becomes an inoculation incident where the sharp has already been used on a patient. Other inoculation incidents include:- Contact of diseased or non-intact skin with blood or blood stained body fluids Splashes to the eye, mouth or nose of blood or blood stained body fluids A human bite which breaks the skin of the bitten person Many accidental exposures to blood and body fluids are, therefore, not classed as inoculation incidents, such as:- Splashes on to intact skin. In these circumstances, washing the contaminated area thoroughly with soap and water Exposure to vomit, faeces and urine (unless visibly blood stained) and to sterile sharps are also not considered as inoculation injuries Compliance with the above guidance on sharps management should reduce the risk of contaminated sharps injury. In addition:- Inexperienced staff should not performing invasive procedures which might result in a needle-stick injury until a competency assessment has been completed All staff should protect their skin, as the skin is an effective barrier to microorganisms. Skin should be intact before using sharp instruments If cuts/abrasions are present these should be covered with impermeable dressings, however, staff with weeping eczema should not be working refer to the Occupational Health Department for management. The use of gloves provides additional protection as long as dexterity is not impeded. Venipuncturist should use gloves Gloves must be worn for invasive procedures and where there is a risk of exposure to contaminated sharps Protection of the mucous membranes (eyes, mouth and nose) must be provided where there is a risk of blood splashing Always:- Use Standard Precautions Page 6

7 Dispose of single use items after one use Dispose of single patient use items after treatment Decontaminate re-usable items according to local policy and manufacturer s instructions Store sterile equipment in a clean, dry environment, off the floor and away from potential damage Dispose of waste as per local policy 2.4 Risk of Infection from Sharps Injuries Specific infection exposure risk will vary depending on the nature of the pathogens in the patient s blood, the type of sharp injury and the amount of virus in the patient s blood or body fluid at the time of exposure. Surveillance studies indicate that the risk of seroconversion following exposure to blood from HIV infected patients is about 1 in 300 for needle-stick injury and 1 in 1000 for mucous membrane exposure. The risk of acquiring Hepatitis B virus from a Hepatitis B e antigen positive source is in the order of 1 in 3, for an unvaccinated individual. Vaccination is protective. The risk of acquiring Hepatitis C virus from a Hepatitis C positive source is 1 in Action to be taken following Contaminated Sharps injury Following a sharp injury, the post exposure procedure must be followed immediately as indicated below and in appendix Immediate management of sharp injuries (sharps injury or human bite) The injured area or damaged skin should be washed thoroughly, but without scrubbing, and covered with a dressing Blood or body fluid splashes to mucous membranes or conjunctivae should be irrigated copiously with water If there has been a puncture wound, free bleeding should be encouraged, but the wound should not be sucked Staff subject to inoculation injuries in the course of their work should report the incident to their manager as soon as possible and complete the on-line incident form (Datix). Advice should be sought from the Occupational Health Department or out of hours from the Accident and Emergency (A&E) Department as indicated in appendix 1. Where A&E advice has been sought, a communication should be given to the relevant occupation health department to ensure that they are able to: a) Follow up and give any ongoing support, b) Complete the organisational reporting procedure in line with the trust policy 2.6 Management of Significant Exposures A risk assessment should be made based on the significance of the exposure, the recipient s prior immunity to Hepatitis B and the known or likely status of the patient Page 7

8 for blood born viruses. This should be carried out by Occupational Health Department and/accident and Emergency. Where the risk is high the recipient should be offered prophylaxis medication as soon as possible; preferably within an hour of the incident. If the source patient is known, every attempt should be made to obtain a blood specimen for testing for blood borne viruses. To avoid discrimination, it is standard practice for all source patients to be offered tests for the three main blood born viruses, Hepatitis B, Hepatitis C and HIV. Appropriate pre-test, counseling and informed consent is a prerequisite of testing the source; this should be arranged by the manager. Bloods from the recipient will also be required for serum save. The taking of blood specimens and the approach to the source for permission to test should be managed by a third party, i.e. somebody other than the recipient of the injury. 2.7 Reducing the risk of Hepatitis B Transmission Hepatitis B vaccination is effective in preventing Hepatitis B transmission. HBV vaccine must be offered as part of employer s contractual responsibilities to staff in at risk occupations. All staff likely to be in contact with sharps or inoculation risks should be aware of their immunisation status regarding Hepatitis B Optimal management of healthcare workers can only be achieved if their vaccination status is known Depending on the circumstances of the exposure and the immune status of the recipient, the recipient may be advised to have immediate additional vaccine doses or to receive Hepatitis B immunoglobulin Seeking early advice is the key to successful intervention to prevent transmission 2.8 Reducing the risk of Hepatitis C Transmission No specific post exposure prophylactic measures are advised beyond basic first aid. In the event of a source proving to be Hepatitis C positive, specific advice on subsequent testing and management will be provided through the Occupational Health Department, including advice on preventing onward transmission. 2.9 Reducing the risk of HIV Transmission In the case of a significant exposure to a known or suspected HIV infected source, or if there is evidence of AIDS related illness, then HIV post exposure prophylaxis (PEP) should be offered. HIV post exposure prophylaxis should ideally be started within one hour of exposure, but can still be offered up to 2 weeks later. Advice must be sought from the Occupational Health Department or the Accident and Emergency Department during out of hours, who will perform a risk assessment, advise the recipient, and can initiate therapy Exposure Incidents in the Community Occasionally, members of the public will present to General Practitioners following a community exposure, typically an injury with a discarded syringe. In this instance, where the source is unknown, an accelerated course of Hepatitis B vaccine is recommended. Community prevalence of HIV and Hepatitis C remain low and no specific action in respect of these viruses is indicated. The incident should be reported to Public Health England (PHE). If the source is known, a risk assessment is required Page 8

9 and further intervention may be advised. GPs should discuss these cases with PHE or the local consultant microbiologist. Persons subject to penetrating human bites should also be offered a course of Hepatitis B vaccination and should have their wound medically assessed because of the risk of bacterial infection Follow-Up Occupational Health Department will support the recipient (NHFT Staff) throughout the procedures and during the recovery period as necessary and where necessary referral to other supporting agencies. Refer to the Supporting Staff Policy. 3. EQUALITY CONSIDERATIONS The author has considered the needs of the protected characteristics in relation to the operation of this policy and protocol to align with the outcomes with IP&C Assurance Framework. We have identified that ensuring that communication reaches all vulnerable groups. The service has been designed to ensure communication relevant to any outbreaks or other healthcare associated infections reaches all sections of the community. This includes taking into consideration communication barriers relating to language or specific needs to reach the whole population. IP&C work closely with multi agency groups and community partners where appropriate we will undertake engagement and outreach activity. We targeted action to relevant groups follow public health England s communication framework. Some groups are particularly vulnerable in relation to their protected characteristics, e.g. age, ethnic minority communities and disability and where we identify that, the expectation is that staff will meet the needs appropriately. 4. REFERENCES AND BIBLIOGRAPHY Public Health England (2014) Eye of the Needle United Kingdom Surveillance of Significant Occupational Exposures to Bloodborne Viruses in Healthcare Workers Department of Health (2015) The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance code-ofpractice-on-the-prevention-and-control-of-infections-and-relatedguidance Department of Health (2013) Health Technical Memorandum 07-01: Safe management of healthcare waste Department of Health (2008) HIV Post Exposure Prophylaxis. Guidance from the UK Chief Medical Officers Expert Advisory Group on AIDS HIV postexposure prophylaxis.pdf Page 9

10 Department of Health (2006) The Green Book Immunisation against infectious diseases latest updated versions can be accessed at [Last updated17/12/13] Health and Safety Executive (2013) The Health and Safety (Sharp Instruments in Healthcare) Regulations Health and Safety Executive (2013) Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 (the Sharps Regulations). HSE Information sheet Loveday HP et al (2014) Epic 3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospital in England National_EvidenceBased_Guidelines_for_Preventing_HCAI_in_NHSE.pdf National Institute for Health and Clinical Excellence (2014) NICE clinical guideline 139, Infection; Prevention and control of healthcare-associated infections in primary and community care. March 2012 (reviewed September 2014) Page 10

11 APPENDIX 1 SHARPS INJURY AND SPLASH INCIDENTS Following the event, follow the procedure below immediately. Sharps injury and cuts Encourage bleeding by gentle massage (Do Not Suck) Wash wound under running water, cover with a waterproof dressing If body fluids splash into eyes irrigate with cold water If splash into mouth, do not swallow; rinse out mouth with water several times Report incident to senior person on duty Fill in Incident Form If injury from clean unused needle or instrument it is likely that no further action is necessary. However you should still report the incident to Occupational Health on the needle stick hotline. Number: If injury from used needle or instrument, seek advice from Occupational Health: During out of office hours or during the weekend, Bank Holidays contact A&E. However you should still report the incident to Occupational Health on the next working day or leave a message on the hotline number: During office hours - Occupational Health Department can be contacted via St Mary s Hospital switchboard: or direct: Outside of office hours, weekend or bank holidays contact nearest A&E department: as follows: - 1- Northampton General Hospital: Kettering General Hospital: Page 11

12 APPENDIX 2 - SAFER DEVICES BD Vacutainer Safety-Lok, Blood collection set Sol-Care Safety Hypodermic Needle Description KFK253 Green 21 G (7inch tubing) FTR 1968 Green 1 inch 21 G KFK056 Green 21G (12 inch tubing) FTR1970 Green 1.5 inch 21G NHS Codes KFK254 Light Blue 23G (7inch tubing) FTR1974 Blue 1 inch 23G KFK058 Light Blue 23G (12 inch tubing) FTR1975 Blue 1.5 inch 23G KFK336 Dark Blue 25G (7inch tubing) FTR1978 Orange 1 inch 25G BD Blunt Fill Needle with Filter FTR G BD Saf-T- Intima Venflon (for Sub cutaneous or syringe driver use only). Safety Insulin Pen Needle FSP3559 Yellow FSW1151 Safety Insulin Pen Needle 30G x 5mm Page 12