I have prepared this PPT with Dr bhavika patel (MD microbiologist Surat)

1. Needle stick / Sharps injury and
its Post Exposure Prophylaxis /
Management

2. What are sharp?
 A sharp is an object having an edge or point that is able to cut or
pierce the skin.
 Sharp include needles as well as items such as scalpels , lancet,
razor, blade,scissors,
metal wire, retractor,
clamps,pins,. Staples,cutter
and glass items.

3. CLASSIFICATION OF SHARP INJURIES
SHARP INJURY
Needle Sharp object
stick injury injury

4. SHARP INJURY
 Sharp Injuries are accidental cuts, punctures, nicks
and scratches to the healthcare personnel caused by
used sharp objects.

5. NEEDLE STICK INJURY
Needle stick Injury is defined as a cutaneus cut, scratch or
puncture from a needle that was contaminated with patients blood
or body fluid, whether or not the injury drew blood. It is an
accidental injury caused by used needles.

6. Who are at risk ?
 Any worker handling sharp devices or equipment such as scalpels
, sutures, hypodermic needles, blood collection devices, or
phlebotomy devices is at risk
 Nursing staff are most frequently injured
What can be cause?
 Unsafe work practice( recapping, removal of phlebotomy tube
holder
 Failure to dispose properly
 Disposal system failures (overfull containers, needles sticking out
of container or piercing sides)

7. Risk of seroconversion due to sharps
injury from a known positive source
Virus Risk (Range)
HBV 6-30%
HCV ~2%
HIV 0.3%

8. PREVENTION OF NEEDLE STICK INJURY:
The "One-Hand" technique of recapping
needles. THE RIGHT WAY TO RECAP
Recapping with both hands.
NOTE: THIS IS DANGEROUS
Needles should not be recaped.
Use “ONE HAND” technique

9. Step 1
Place the cap on a flat surface, then
your hand from the cap.
Step 2
With one hand, hold the syringe
and use the needle to "scoop up"
the cap.
Step 3
When the cap covers the needle
completely; use the other hand to secure
the cap on the needle hub. Be careful to
handle the cap at the bottom only (near
the hub).

10. Newer Technologies for Safer Injections
 Auto Disable (AD) and Re Use Prevention (RUP) Syringes
 Prefilled Injection Devices:
 Safety Syringes :
 Vacuum Based Technology
 Safety Needles and Cannulas

11. Needle-based safety injection device
27G Hypo Needle BD Eclipse™ Safety- needle in these syringes is
locked through a luer lock mechanism

12. 2. Never pass a sharp instrument from one
hand to another person’s hand directly: use
hand free technique
Example: Pass instrument in the kidney tray

13. Dealing with Used Needle

14. Disposal of sharp
 Collect sharp items in puncture proof containers.
 Transport securely to disposal place.
 Burn in high temperature incinerator or decontaminate and bury in
safe place.

15. Post-exposure prophylaxis(PEP)
Post-exposure prophylaxis(PEP) is any prophylactic
treatment started immediately after exposure to a
pathogen in blood or body fluids
Post Exposure Prophylaxis Guidelines
 Immediate first aid
 Report incident
 Risk assessment
 Counselling
 Decision regarding use of PEP
 Follow-up

16. Do Don’t
Remove gloves, if appropriate Do not panic
Wash the exposed site thoroughly
with running water
Do not put pricked finger in mouth
Irrigate with water or saline if eyes or
mouth have been exposed
Do not squeeze wound to bleed it
Wash the skin with soap and water Do not use bleach, chlorine,
alcohol, betadine, iodine or any
antiseptic or detergent
Note: Do consult the designated physician immediately as per hospital guidelines
for management of the occupational exposure. Report all needle stick injuries to
unit head / casualty medical officer. Fill the requisite proforma (NSI Form) and
send blood sample to microbiology laboratory for testing of HIV / HBsAg / HCV
after pre-test counseling and consent of both patient and health care worker.

17. Post-HIV exposure management/ prophylaxis
(PEP)
It is necessary to determine the status of the exposure and the
HIV/HBsAg/HCV status of the exposure source before starting post-
exposure prophylaxis(PEP)
Immediate measures:
 • wash with soap and water
 • No added advantage with antiseptic/bleach
Next step:
 • Prompt reporting in accident/incident reporting forms
 • Post-exposure treatment is begin as soon as possible
 • Preferably within two hours
 • Not recommended after seventy -two hours
 • Late PEP? May be yes
 Is PEP needed for all types of exposures? No

18. For HIV: Categories of exposure
Category
(Exposure code)
Definition & examples
Mild exposure
(EC1)
Mucous membrane/non-intact skin with small volumes
Eg: a superficial wound with a plain or low caliber needle,
Or contact with the eyes or mucous membranes, subcutaneous
injections following small-bore needles
Moderate exposure
(EC2)
Mucous membrane/non intact skin with large volumes or
percutaneous Superficial exposure with solid needle
Eg: a cut or needle stick injury penetrating gloves
Severe exposure
(EC3)
Percutaneous with large volume. Eg:
An accident with a high caliber needle (>18G)visibly
contaminated with blood;
A deep wound(haemorrhagic wound and/or very painful);
Transmission of a significant volume of blood;
An accident with material that has previously been used
intravenously or intraarterially.

19. Categories of situations depending on results of the source
Source HIV
Status/Code
Definition of risk in source
HIV negative Source is not HIV infected but consider HBV & HCV
Low risk (SC1) HIV positive & clinically asymptomatic
High risk (SC2) HIV positive & clinically symptomatic
Unknown Status of the patient is unknown & neither the patient
nor his/her blood is available for testing. The risk
assessment will be based only upon the exposure

20. Determine Post-Exposure
Prophylaxis(PEP) Recommendation
EC HIV SC PEP
1 1 Consider basic
1 2 Recommend basic regimen
2 1 Recommended expanded regimen
3 1 OR 2 Recommended expanded regimen
1,2,3 UNKNOWN If exposure setting suggests risks of HIV
Exposure, consider basic regimen
Basic regimen (Two Drug Regimen):
•Zidubudine 300 mg + Lamovudine 300 mg twice daily for 28 days.
•Expanded regimen: (Three drug regimen)
• Basic regimen (+ Indinavir – 800 mg/thrice a day, or any other protease Inhibitor.

21. Testing and Counseling
The health care provider are tested for HIV as per the following
schedule) to monitor seroconversion.
 Base-line HIV test - at time of exposure
 Repeat HIV test - at six weeks following exposure
 2nd repeat HIV test - at twelve weeks following exposure
 3rd repeat HIV test - at 6 months following exposure

22. Pregnancy and PEP:
 Based on limited information, anti-retroviral therapy taken during
2nd and 3rd trimester of pregnancy has not caused serious side
effects in mothers or infants.
 There is very little information on the safety in the 1st trimester. If
the HCW is pregnant at the time of exposure to HIV, the designated
authority/physician must be consulted about the use of the drugs
for PEP.
Side-effects of these drugs:
 Most of the drugs used for PEP have usually been tolerated well
except for nausea, vomiting, tiredness, or headache.

23. Recommended PEP for exposure to Hep B virus

24. Role of vaccine
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

25. Recommended PEP for exposure to Hep C virus
Known Hepatitis C
NO ACTIVE PROPHYLAXIS AVAILABLE
 Check hepatitis C virus RNA testing at 6 and 12 weeks
 Check HCV antibody ( anti HCV ) at 12 and 24 weeks
 Source known not to be infected with hepatitis C following testing at
time of incident
 Check serum if symptoms or signs of liver disease develop
Hepatitis C status of source unknown
 A risk assessment should be done
 High risk – Manage as known infected source
 Low risk – Obtain serum for anti HCV testing at 24 weeks
 HCW found to be acquired hepatitis C infection following occupational
exposure should be referred immediately to a specialist in infectious
disease / physician for treatment.

26. FOLLOW UP SEROLOGY TESTING OF THE
EMPLOYEE TO BE DONE AS PER FOLLOWING
SCHEDULE:
1. HIV - 0,6 WEEKS, 12 WEEKS, 6 MONTHS
2. HbsAg - 0,6 WEEKS, 6 MONTHS
3. ANTI HCV - 0,(4-6) MONTHS


27. Laboratory test on follow up
Recommended follow up laboratory tests
Timing In persons taking
PEP
In persons not taking
PEP
Weeks 2 & 4 Transaminases
Complete blood count
Clinical monitoring for
hepatitis
Week 6 HIV Ab HIV Ab
Month 3 HIV Ab, anti HCV,
HBsAg
Transaminases
HIV Ab, anti HCV,
HbsAg
Month 6 HIV Ab, anti HCV,
HBsAg
Transaminases
HIV Ab, anti HCV,
HbsAg

28. Be Needle Smart
o Do NOT recap
o Do NOT bend
o Do NOT remove
o Do NOT transport
o Do NOT re –use
o Recap only when necessary.
o Report needle stick injury.
o Use puncture proof and leak proof
containers to discard needles.
o Do not fill the container more than 3/4th.
o Do not leave needle protruding from
containers.