2. WHAT ARE NSI ?
Are wounds caused by needles that
accidentally puncture the skin.
Hazards for people who work with
hypodermic syringes and other needle
equipment.
Injuries occur when people use, disassemble
or dispose of needles.
Cont.
3. When not dispose of properly, needles can
become concealed in linen or garbage and
injure other workers.
Transmit infectious diseases especially blood
borne viruses.
Despite published guidelines and training
program, NSI remain an on-going problem.
4. Dr.T.V.Rao MD
THE PROBLEM
CDC estimates ~385,000 sharps injuries
annually among hospital-based healthcare
personnel (>1,000 injuries/day)
Many more in other healthcare settings (e.g.,
emergency services, home care, nursing homes)
Increased risk for blood borne virus
transmission
Costly to personnel and healthcare system
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5. Dr.T.V.Rao MD
Exposures which place health
personnel at risk of blood borne
infection –
• A percutaneous injury e.g. Needle stick injury (NSI) or
cut with a sharp instrument
• Contact with the mucous membrane of eye or mouth
• Contact with non-intact skin (abraded skin or with
dermatitis)
• Contact with intact skin when the duration of contact is
prolonged with blood or other potential infected body
fluids
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5
6. Dr.T.V.Rao MD
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
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7. Dr.T.V.Rao MD
WHO GETS INJURED?
Clerical /
Housekeeping/ Admin
Maintenance 1% Dental
Occupational 3% 1%
Other
Groups of Student 5%
Healthcare 4%
Personnel
Exposed to Technician
Blood/Body 15%
Nurse
Fluids, 43%
Physician
28%
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8. Dr.T.V.Rao MD
HOW DO INJURIES OCCUR WITH HOLLOW-BORE
NEEDLES?
Transfer/Process Other
Specimens 5% During Sharps
5% Disposal
Access IV Line 13%
5%
Handle/Pass Improper
Equipment Disposal
6% 9%
During Clean Up
Recap Needle
9%
Disposal
6% Related:
In Transit to
Disposal
35%
Collision
4%
W/Worker or
Sharp
Manipulate
10%
Needle in Patient
28%
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Circumstances Associated with Hollow-Bore Needle
9. Dr.T.V.Rao MD
WHAT KINDS OF DEVICES USUALLY CAUSE
SHARPS INJURIES?
Hypodermic needles
Blood collection
needles
Suture needles
Needles used in IV
delivery systems
Scalpels
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10. Dr.T.V.Rao MD
WHAT INFECTIONS CAN BE CAUSED BY
SHARP INJURIES?
Sharps injuries can expose workers to a
number of blood borne pathogens that can
cause serious or fatal infections. The pathogens
that pose the most serious health risks are
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Human immunodeficiency virus (HIV)
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11. Dr.T.V.Rao MD
RISKS OF SEROCONVERSION DUE TO SHARPS
INJURY
FROM A KNOWN POSITIVE SOURCE
Virus Risk (Range)
HBV 6-30%*
HCV ~ 2%
HIV 0.3%
(*Risk for HBV applies if not HB vaccinated)
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12. Dr.T.V.Rao MD
HOW DO SHARPS INJURIES HAPPEN?
Who gets injured?
Where do they
happen?
When do injuries
occur?
What devices are
involved?
How can they be
prevented?
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13. HOW DO NSI OCCUR ?
Equipment Design
Nature Of Procedure
Condition Of Work
Staff Experience
Recapping and
Disposal
(are factors that influences this
occurrence.)
14.
15. NATURE OF PROCEDURES
Critical situations during clinical procedures
include :
• Withdrawing needle from a patient, especially staff
attends
to bleeding patients while disposing of the needle.
• Having the device jarred by the patient.
• Pulling the needle out of the rubber stopper of a vacuum
tube which can jab the hand in a rebound effect.
NSI commonly occur when workers try to do
several things at the same time, especially
disassembling or disposing of needles.
16. CONDITION OF WORK
Work condition that might contribute to an
increase in the number of NSI include :
Staff reductions, where nurses, lab. Personnel
and student assume additional duties.
Difficult patient care situations.
Working at night with reduced lighting.
18. RECAPPING
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 a small
cap held in the other hand.
Cont.
19. Dr.T.V.Rao MD
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 containers
Poor healthcare waste management practices
Ignoring Universal Work Precautions
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20. Dr.T.V.Rao MD
A. CATEGORIES OF EXPOSURE
Category Definition and Example
Mild Mucous membrane/non-intact skin with small volumes
exposure e.g. a superficial wound with a low caliber needle,
contact with eyes or mucous membrane, subcutaneous
injections with a low caliber needle.
Moderate Mucous membrane/non-intact skin with large volumes or
exposure percutaneous superficial exposure with solid needle e.g.
a cut or needle stick injury penetrating gloves.
Severe percutaneous exposure with large volumes e.g. an accident
exposure with a high caliber needle visibly contaminated with blood, a
deep wound, an accident with material that has been
previously been used intravenously or intra-arterially
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21. EMERGENCY & EXPOSURE INCIDENT
PLAN
Management of exposure includes:
General wound care and cleaning.
Counseling of the exposed worker regarding
bloodborne pathogens.
Source patient testing for HBV,HCV and HIV
(consent required).
Documentation of the incident and review.
Postexposure assessment and prophylaxis for the
health care worker.
Baseline and follow up serology of the worker.
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22. Dr.T.V.Rao MD
MANAGEMENT OF EXPOSED PERSON
1st step: Management of exposed site - First Aid
Skin: Do not squeeze the wound to bleed it, do
not put the pricked finger in mouth. Wash with
soap &water, don’t scrub, no antiseptics or skin
washes (bleach, chlorine, alcohol, betadine).
Eye: wash with water/ normal saline/ don’t
remove contact lens immediately if wearing, no
soap or disinfectant.
Mouth: spit fluid immediately, repeatedly rinse the
mouth with water and spit / no soap/ disinfectant.
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23. Dr.T.V.Rao MD
2ND STEP: ESTABLISH ELIGIBILITY FOR PEP
Evaluation must be made rapidly so as to start
treatment as soon as possible-ideally within 2hours
but certainly within 72 hours of exposure. However all
exposed cases don’t require prophylactic treatment.
Factors determining the requirement of PEP-
Nature/Severity of exposure and risk of
transmission
HIV status of the source of exposure
HIV status of the exposed individual
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24. HBV POSTEXPOSURE MANAGEMENT
IF AND THEN
Source pt Exposed worker Worker should receive
is +ve for not vaccinated vaccine series
HBsAG should receive single
dose of HB
immunoglobulin within 7
days.
Exposed worker Should be tested for anti-
has been HBs & given 1 dose of
vaccinated vaccine & 1 dose of HBIG
if < 10 IU
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25. IF AND THEN
Source Exposed worker Worker should be
pt is –ve not vaccinated encouraged to receive
for hepatitis B vaccine.
HBsAg Exposed worker No further action is needed.
has been
vaccinated
Source Exposed worker Shouldreceive HB series
pt not vaccinated HBIG should be considered
refuses
testing
or not Exposed worker Management should be
identifie has been individualized.
d vaccinated
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26. HIV POSTEXPOSURE MANAGEMNT
IF THEN AND
Source pt has Exposed worker should Exposed
AIDS be counseled about risk worker testing
of infection. –ve initially
OR should be
Should be tested for
Source pt is retested 6
HIV+ve HIV infection
immediately weeks, 12
OR weeks & 6
Should be asked to
Source Pt months after
seek medical advice for
refuses to be exposure.
any febrile illness
tested within12 weeks
Refrain from blood
donation & take
appropriate precautions 26
27. IF THEN AND
Source pt is tested Baseline
& found -ve testing of the
exposed
worker with
follow up
testing 12
weeks later
Source cannot be Serological
identified testing must
be done &
decisions must
be
individualized
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28. Incidence of needle sticks injury
Reporting to supervisor
First aid for the employee
Reporting to ICN, Writing Inc. JKKP form, Inc
Reporting, JKKP etc reporting form
Employee examination in ER, EHC
Negative results of investigation History taken, complete
physical examination
Management of Post exposure Employee serological tests for HBs Employee
exposure prophylaxis AG, Anti HBs, Anti HCV, anti HV consent
Continuous monitoring Patient MRP notification,
Employee counseling
according to IPP patient examination
Patient serological tests for HBs Patient
AG, Anti HBs, Anti HCV, anti HV consent
All measures according to
IPP implemented
29. PRECAUTIONS TO AVOID INJURY
EXPOSURE
Engineering controls are the primary method to
reduce exposures to blood from sharp instruments
and needles.
Work-practice controls establish practices to protect
personnel whose responsibilities include handling,
using, or processing sharp devices.
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30. HOW CAN NSI BE PREVENTED ?
“Prevention is better than cure”
A comprehensive NSI prevention
program would include :
Recommend guidelines
NO recapping procedures
Effective disposal system
Surveillance programs
Employee training
Improved equipment design
31. Dr.T.V.Rao MD
DO NOT FORGET HEPATITIS B VACCINATION AND
UNIVERSAL PRECAUTIONS ……..
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