Needle stick injury

1. Needle Stick Injury
Presented by
● Lakhsita Kumawat
● Lalima kaudo
● Lalita rathore
● Loguss Sancheti
● Lupteshwar Kashyap

2. Introduction

3. What is needle stick injury?
A NEEDLE STICK INJURY(NSI) is a percutaneous
piercing wound typically set by a needle point, but
possibly also by other sharp instruments or objects.

4. Needle stick injury as “Occupational injury”
An occupational injury is often loosely termed as needle
stick injury(NSI) though it includes injury through needle
or other sharps and splashes.

5. Exposures causing NSI
An occupational exposure is defined as:
● Percutaneous injury,e.g. needle stick injury or other
sharp injury
● Splash injury:
1.contact with the mucous membrane.
2.contact with non intact skin(abraded skin).
3.contact with the intact skin when the duration is long

6. Devices or Sharps causing NSI
● Hypodermic needles
● Blood collection needles
● Suture needles
● Needles used in IV delivery systems
● Scalpels

7. Specimens causing NSI
Potentially infectious body fluids include blood,genital
secretions (semen, vaginal secretions) and all body fluids
(CSF, synovial fluid, pleural fluid, peritoneal fluid,
pericardial fluid, amniotic fluid)
The following are not considered potentially infectious,
unless visibly contaminated with blood: Feces, nasal
secretions,saliva,sputum, sweat, tears, urine and vomitus.

8. Agents transmitted through NSI
Hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV
are three major blood-borne viruses (BBVs) that are
transmitted through NSI. The risk of transmission is highest
for HBV (30%) followed by HCV (3%) and HIV (0.3%).

9. Who is at risk ?
● Nursing staff
● Emergency care providers
● Labor & delivery room personnel
● Surgeons and operation theatre staff
● Lab technicians
● Dentists
● Health cleaning / mortuary staff / waste handlers

10. Factors that influence the risk of infection by NSI
The risk of infection following exposure depends on the
following factors:
● Type of needle (hollow bore needle has a higher risk than solid
needle)
● Device visibly contaminated with blood
● Depth of injury (higher is the depth, more is the risk)
● Volume of blood involved in the exposure
● Viral load present in the blood at the time of exposure
● Timely performing first aid

11. Prevention of Needlestick Injury

12. Precautions during handling needles
The following measures should be taken during
handling needles to prevent occupational exposures:
● Standard precautions must be followed such as hand
hygiene and appropriate use of personal protective equipment
(PPE) (e.g. gloves, gowns, masks, and goggles) while
handling blood or body fluids.
● Work surfaces must be disinfected with 0.5% sodium
hypochlorite solution.

13. ● HBV vaccination: Health care workers (HCWs) must be
immunized against HBV and protective titer must be
documented
● Spill management: Spillage of blood and other body fluids
must be promptly cleaned and surface disinfected with 0.5%
sodium hypochlorite solution
● Disposable needles should be used. Needles should never
be reused

14. ● Disposal after use: Needles must be disposed into the sharp
box immediately after use. Needles/sharps should not be left
on trolleys and bedside
● Engineering control measures: Various devices are
specially designed with safety features to prevent NSI such as
retractable lancets, safety lock syringe with a protective
sheath and needleless IV systems.
● Never recap needles: If unavoidable, single hand-scoop
technique may be followed, which is shown in the next slide.

15. ● The incorrect way of recapping
● The correct method (single hand scoop technique)

16. Precautions during surgical procedures
Confine and contain approach should be implemented
for every surgical procedure.
● Passing of sharp instruments during surgery must be
acc. to the plan decided by the surgeon and his assistant
nurse. Sharp instruments should always be passed by
non-touch approach, not directly by hands.
● Suturing: Needles must never be picked up with the
fingers while suturing. Forceps or a needle holder is ideal
for holding a needle.

17. Patient known to have BBV infections may require the
following additional precautions for surgical operation:
● The lead surgeon should ensure that all members of the
team know about infection hazards and appropriate
measures should be followed, such as use of double gloves.
● The surgical team must be limited to essential members of
trained staff only.
● It may help theater decontamination if such cases posted
last in the list, but this is not mandatory.

18. Post exposure management

19. Steps of post exposure management
1. First aid
2. Report to designated nodal center
3. Take first dose of PEP for HIV
4. Testing for BBVs
5. Decision on PEP for HIV and HBV
6. Documentation and recording of exposure
7. Informed consent and counseling
8. Follow-up testing of HCWs
9. Precautions during the follow-up period

20. 1. First aid :management of exposed site
● Start first aid as soon as possible
● For splash injuries irrigate the site thoroughly with water
● Don’t place the pricked finger into the mouth reflexively
● Don’t squeeze blood from the wound

21. 2. Reporting to the designated nodal centre
● Every hospital must have a nodal center for the
management of NSI. In most hospitals, HICC office acts
as a nodal center, other hospitals may designate staff
clinic or casualty for the purpose.
● The rest of the steps of post exposure management are
performed by the nodal centre

22. 3. First dose of PEP for HIV
● The first dose of PEP for HIV should be taken as early as
possible as per NACO guidelines. Effect is maximum if
taken <2 hours and effect is nil if taken after 72 hours of
exposure.
● If the HIV negative status of the source is documented in
patient’s case record or in the hospital information system,
then the first dose of PEP is not required.
● If test report is not available, then administer the first
dose regimen immediately without waiting for the
laboratory result.

23. NACO recommendation for PEP
The first dose regimen comprises of a fixed-dose
combination of five tablets; given on the first day of
exposure
● Tenofovir 300 mg + Lamivudine 300 mg, one tablet
once daily and
● Lopinavir (200 mg) + Ritonavir (50 mg) two tablets
twice daily.

24. 4. Testing for blood borne viruses (BBVs)
The following tests are done for both source and HCW. The
test format should be a rapid method
(immunochromatographic test or flow through assay) and
result should be available within 1–2 hours.
● Anti-HIV antibody detection
● HBsAg detection
● Anti-HCV antibody detection
● Anti-HBs antibody (done for HCW if previously vaccinated
for HBV and titer not tested).

25. 5. Decision on post exposure prophylaxis
Decision on post-exposure prophylaxis (PEP) for HIV and
HBV is taken based on standard guidelines (NACO for HIV
and CDC for HBV) as described in subsequent slides .
NACO- National AIDS control organisation
CDC- centre for disease control and prevention

26. EXPOSURE SEVERITY HIV STATUS OF SOURCE PEP RECOMMENDATION
Mild,moderate or severe
exposure
Negative Not warranted
Mild exposure HIV positive, asymptomatic Not warranted
Mild exposure HIV positive, symptomatic PEP recommended
Moderate exposure HIV positive, asymptomatic PEP recommend
Moderate exposure HIV positive, symptomatic PEP recommend
Severe exposure HIV positive whether
symptomatic or
asymptomatic
PEP recommend
Moderate or severe
exposure
Unknown PEP recommend
Revised NACO guidelines for PEP, 2021

27. HCW status Source positive for
HBsAg
Source negative for
HBsAg
Unvaccinated ● HBIg dose should be
started immediately
● Complete the vaccine
series from the last dose
given
● Complete the vaccine
series from the last dose
given
Vaccinated
Antibody titer >10 mU/ml
No further treatment is
required
No further treatment is
required
Vaccinated
Antibody titer <10 mU/ml
● HBIg dose should be
started
● Start the second series
of vaccines
● Start the second series
of vaccines
CDC guidelines for PEP of hepatitis B, 2013

28. 6. Informed consent and counselling
Almost Every Person feels anxious after exposure. They
should be counseled and provided with psychological support
● They should be informed about the risks and benefits of
PEP medications
● PEP is not mandatory. If the exposed person refuses to
take the PEP, it should be documented. However, he
should be made to understand about the risk of acquiring
infection if PEP is not taken.

29. 7. Documentation and recording of exposure
● A structured proforma should be used to collect the detail
information related to exposure such as date, time, and
place of exposure, type of procedure done, type of
exposure, duration of exposure, source status, volume
and type of specimen involved.
● Consent form: For prophylactic treatment, the exposed
person must sign a consent form. If the individual refuses
to initiate PEP, it should be documented.

30. 8. Follow up testing of HCWs
Follow-up testing of HCWs for BBVs should be done if the
source status is positive/unknown
● HIV testing follow-up is done: At 6 weeks, 3 months
and 6 months after exposure
● HBV and HCV follow-up testing is done: at 6 months
after exposure.

31. 9. Precautions during the follow up period
Precautions during the follow-up period: If the source status is
positive/unknown, then the following precautions should be adopted by
the HCW during the follow-up period, especially the first 6–12 weeks
● Refraining from blood, semen, organ donation
● Abstinence from sexual intercourse or use of latex condom till both
baseline and 3 months HIV tests are found negative
● Women should not breastfeed their infants
● The exposed person is advised to seek medical evaluation for any
febrile illness that occurs within 12 weeks of exposure.

32. Why is awareness regarding NSIs necessary?
● CDC estimates ~385,000 sharps injuries among hospital based
healthcare personnel (>1,000 injuries/day), the number may go even
higher if we consider other healthcare settings.
● As we have already seen in previous slides it increases risk for blood
borne virus transmission which puts HCWs at greater risk and
increases chances of further transmission to related population
● Considering it’s frequency and risks supreme court of India has
issued directives to ensure PEP guidelines are followed and there is
availability of PEP drugs in all government & private hospitals in India

33. Thank you