Needles and Sharps Exposure: How do We Proceed?

Transcription

1 Needles and Sharps Exposure: How do We Proceed? UMAYYA MUSHARRAFIEH,MD AMERICAN UNIVERSITY OF BEIRUT MEDICAL CENTER JUNE 14, 2013

2 Health care workers who use or may be exposed to needles are at increased risk of needlestick injury Such injuries can lead to serious or fatal infections with bloodborne pathogens such as hepatitis B virus, hepatitis C virus, or human immunodeficiency virus (HIV)

3 Though most organizations believe they are doing what is necessary to prevent injuries, needlestick and sharps injuries continue to occur And, though cost is often cited as a factor for not using safer devices, it is actually a saving when you consider the cost of treating the individual once an injury occurs

4 Background The CDC estimates that each year 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based healthcare personnel; an average of 1,000 sharps injuries per day It is suggested that at an average hospital, workers incur approximately 30 needlestick injuries per 100 beds per year Panlilio AL et al. Atlanta, March 5-9, 2000:61. EPINet 1999

5 What is a needlstick? Needlstick and sharp injuries are accidental penetrating wounds caused by a sharp instrument in a medical setting A break of skin can be from a needle or other Sharp such as scalpel

6 Infections Transmitted via Sharps Injuries during Patient Care (PC) and / or Laboratory / Autopsy (LA)

7 Risk of Seroconversion from a positive source Virus Risk range HBV 6-30%* HCV ~ 2% HIV 0.3% *Risk for HBV applies if not HB vaccinated) Collins CH et al. J Appl Bacteriol 1987;62: Pike AM. Health Lab Sci 1976;13:105-14

8 What is the Risk for HIV Alone? Percutaneous 0.3% Mucous membrane 0.1% Non-intact skin <0.1%

9 Hepatitis B Virus CDC estimated that 12,000 HBV infections occurred in healthcare personnel in Decline in occupational HBV more than 95% is due to widespread immunization of HCW Without post-exposure prophylaxis, there is a 6%-3 0% risk that an exposed, susceptible healthcare worker will become infected with HBV Risk is highest if the source individual is hepatitis B eag positive

10 Occupational HIV Transmission among U.S. Healthcare Personnel, documented cases i.e. of occupational HIV transmission to healthcare personnel 138 possible cases i.e. the source of infection and/or seroconversion could not be definitively determined. the risk for HIV infection was found to be increased with exposure to a larger quantity of blood from the source person (needle in artery or vein, a device visibly contaminated with the patient s blood and deep injury)

11 Burden of Sharp injuries Direct costs initial and follow-up laboratory testing and treatment of exposed healthcare Indirect costs potential side effects of antiretroviral therapies lost time from work emotional cost associated with fear and anxiety societal cost associated with HIV or HCV seroconversion. O Malley, et. Al.ICHE, July 2007, v 28, No. 7.

12 Who is at risk? Occupational Groups of Healthcare Personnel Exposed to Blood/Body Fluids, NaSH June 1995 December 2001 (n=16,922)

13 Work location where Blood/fluid expousre occurred NaSH Where does injury occur?

14 Devices involved in Injuries Six devices are responsible for nearly 80% of all injuries Disposable syringes (32%) Suture needles (19%) Winged steel needles (12%) Scalpel blades (7%) Intravenous (IV) catheter stylets (6%) Phlebotomy needles (3%)

15 Can we prevent Sharp injuries? Non-preventable: 18% Undetermined: 18 % Preventable: 64% Steps that helped in prevention: using needles only when necessary, using devices with engineered safety features, properly using the safety features on these devices, following proper work practices (such as not recapping used needles) properly disposing of needles after use.

16 Risk of Infection after a needlestick After a needlestick exposure to an infected Patient a HCW s risk of infection depends pathogen involved immune status of the worker the severity of the needlestick injury availability and use of appropriate postexposure prophylaxis

17 Activities Associated with Needlestick Injuries Whenever a needle or other sharp device is exposed, injuries can occur. 38% of percutaneous injuries occur during use 42% occur after use and before disposal. The circumstances leading to a needle-stick injury depend partly type and design of the device used recapping transferring a body fluid between containers failing to properly dispose of used needles in punctureresistant sharps containers.

18 OSHA guidelines A written exposure control plan designed to eliminate or minimize worker exposure to BBP Compliance with universal precautions Engineering controls and work practices to eliminate or minimize worker exposure Personal protective equipment Prohibition of bending, recapping, or removing contaminated needles

19 OSHA guidelines Prohibition of shearing or breaking contaminated needles Free hepatitis B vaccinations offered to workers with occupational exposure to BBP pathogens Worker training in appropriate engineering controls and work practices Post-exposure evaluation and follow-up, including post-exposure prophylaxis when appropriate

20 Strategies to eliminate sharp injuries Eliminate or reduce the use of needles and other sharps Use devices with safety features to isolate sharps Use safe practices to minimize risk for hazards

21 Eliminate or reduce the use of needles and other sharps

22 Needle-Free IV Delivery Systems Delivery Systems IV delivery systems use valved ports and connectors, prepierced septa using blunt cannulas, or recessed protected needle connectors

23 How can we reduce the use of needles? Use an alternate route for medication delivery and specimen collection when available and safe for patient care Streamline specimen collection systems to identify opportunities to consolidate and eliminate unnecessary punctures.

24 Use devices with safety features to isolate sharps

25 Hypodermic syringes with Self-Sheathing safety feature

26 Hypodermic syringes with Retractable Technology safety feature

27 Add-on safety feature

28 Disposable scalpels with safety features Retracted position Protracted position Protracted position

29 Use safer practices to minimize risk for remaining hazards

30 A cross sectional study on 1301 nurses to determine nurse reported risk management and perceptions of risk associated with sharps-related injuries 73% participants reported following organizational policies However, Recapping One-third had recently attended prevention training. Nurses perceptions of risk were variable. Ashley K Risk management SIN injury nurses

31 Needlesticks occur anytime during the use or after the disposal of a sharp 40% of sharp injuries occur during use 40% occur after use and before disposal and 15% are disposal related Recapping needles, a practice that is prohibited, still accounts for 5% of all sharp injuries

32 How to protect from NSI Lack of safety devices Inconveniently placed or overfilled sharps disposal containers Busy congested environments, work pressure and rushing Frequent and distracting interruptions

33 Prevention strategies Be prepared Do not hand-pass exposed sharps from one person to another Give verbal announcement when passing sharps Use predetermined neutral zone for placing/retrieving sharps Limit interruption during procedure Explain procedure to patient to gain their cooperation Ask for assistance when patient s are not cooperative Dispose with care Never re-cap Dispose in sharp designated containers Transport reusable sharps in a closed container Secure the container to prevent spillage Avoid overfilling sharp disposal Care for yourself Report all NSI Get vaccinated ( at no cost)

34 Sharp containers Should be at eye level and within arms reach Should be emptied before they are full Ensure that containers are closable, punctureresistant, and leak-proof Ensure that containers are clearly and correctly labelled

35 What do I do if you are injured with a sharp?

36 General algorithm of management of occupational exposure to HBV, HCV and HIV

37 Postexposure prophylaxis against HBV infection

38 Management of accidental exposure to hepatitis C

39 Recommended post exposure prophylaxis for percutanous injuries

40 Recommendations for HCW Avoid the use of needles where safe alternatives are available Use devices with safety features Avoid recapping needles. Plan safe handling and disposal before beginning any procedure using needles. Dispose of used needle devices promptly in appropriate disposal containers. Report all needlestick and other sharps-related injuries promptly to ensure that adequate followup care. Participate in blood-borne pathogen training and follow recommended infection prevention practices, including hepatitis B vaccination.

41 Thank you