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Needle stick injury Prevention and Management by Dr. Rakesh Prasad Sah

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Needle stick injury Prevention and Management by Dr. Rakesh Prasad Sah

  1. 1. Needle Stick Injury Prevention and Management Dr. Rakesh Prasad Sah Assistant Professor, Microbiology
  2. 2. • A penetrating stab wound from a needle (or other sharp object) that may result in exposure to blood or other body fluids.
  3. 3. • Splash injury: – Contact with mucous membrane (eye or mouth) – Contact with non-intact skin (abraded skin or afflicted with dermatitis) – Contact with the intact skin when the duration is prolonged (e.g. several minutes or more)
  4. 4. Agents transmitted • Hep-B  30% • Hep-C  3% • HIV  0.3% • Blood borne viruses
  5. 5. • Infectious specimens for NSI – Potentially infectious Body fluid  blood, genital secretions (semen, vaginal), CSF, synovial fluid, pleural fluid, peritoneal fluid, pericardial, aminiotic. – Not considered potentially infectious  until visibly contaminated with blood: Faeces, nasal secretions, saliva, sputum, sweat, tears, urine and vomits.
  6. 6. Factors that influence risk of contracting infection following NSI • Type of needle (hollow bore needle has a higher risk than solid needle) • Device visibly contaminated with blood • Depth of injury • Volume of blood involved in the exposure • Timely performing first aid • Timely start of appropriate PEP for HBV and HIV.
  7. 7. Prevention of Needle Stick Injury Precautions during handling Needles • Standard infection control 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 surface  1% sodium hypochlorite • Health care worker (HCW)  immunized with HBV vaccine.
  8. 8. • Spillage of blood & other body fluids  cleaned & disinfected with 10% sodium hypochlorite • Disposable needles should be used. Needles should never be reused. Disposable syringes
  9. 9. • Never recap needles: if unavoidable, single hand scoop technique must be followed • Disposal after use: needles into sharp box immediately after use. Should not be left on trolleys and bed side tables.
  10. 10. • Video
  11. 11. Precaution during surgical procedure • Passing of sharp instruments during surgery • Suturing • Preoperative testing of patient for BBVs is not mandatory; should be performed when clinical indication present
  12. 12. • Patient known to have BBV infections may require the following additional precautions for surgical operation – Lead surgeon  should ensure that all members or the team know about infection hazards and appropriate measures should be followed, such as use of double gloves – Surgical team  must be limited to essential staff only
  13. 13. Post exposure Management • First aid • Report to designated nodal centre • Take first dose of PEP for HIV • Testing for BBVs • Decision on PEP for HIV and HBV • Documentation and recording of exposure • Informed consent and counselling • Follow-up testing of HCWs • Precautions during the follow-up period
  14. 14. First Aid: Management of exposed site  Earlier the first aid, lesser the chances of transmission of BBVs  Do not panic  For splash injury: Irrigate thoroughly the site (e.g. eyes or mouth or other exposed area) vigorously with water at least for 5 min  Do not place the pricked finger into mouth reflexively  Spit fluid out immediately if gone into mouth and rinse the mouth several times  Do not squeeze blood from wound  If wearing contact lenses, leave them in place while irrigating. Once the eye is cleaned, remove the contact lens and clean them in a normal manner  Do not use antiseptics and detergents
  15. 15. Take first dose of PEP for HIV • As early as possible, max effect within 2 hours, nil after 72 hours • NACO  TLE (Tenofovir 300mg + Lamivudine 300mg + Efavirenz 600mg) • HIV status  negative  PEP not required • Test report not available  do not immediately perform as it delays the PEP
  16. 16. Testing of BBVs • Test are done for both source & HCW. • Rapid method and results should be available within 1- 2hrs. – Anti-HIV Ab – HBsAg detection – Anti-HCV Ab – Anti-HBs Ab ( for HCW  previously vaccinated but titer not tested)
  17. 17. Decision on PEP for HIV (NACO) Revised NACO Guidelines for post-exposure prophylaxis (PEP), 2015 Exposure code (EC) HIV source code (SC) PEP Recommendation 1,2 or 3 Negative Nor warranted 1 1 Not warranted 1 2 PEP is recommended Duration of PEP : 28 days Regimen (TLE): Single daily dose of •Tenofovir 300mg •Lamivudine 300mg •Efairenz 600mg 2 1 2 2 3 1 or 2 2 or 3 Unknown (in area with high prevalence)
  18. 18. • Source material : Blood, body fluids or other potentially infectious material (CSF, synovial, pleural, pericardial and amniotic fluid and pus) or an instrument contaminated with any of these substances.
  19. 19. • Exposure code: – EC-1 (Mild exposure): Mucous mem/non stick skin exposure with small vol or less duration – EC-2 (Moderate exposure): • Mucous membrane/non-stick skin with large vol/splashes for several minutes or more duration OR • Percutaneous superficial exposure with solid needle or superficial scratch – EC-3 • Large volume transfer • By hollow needle, wide bore needle or deep puncture • Visible needle in patient’s artery or vein
  20. 20. • Source HIV Status code (SC) – SC-1: HIV positive, asymptomatic or low viral load (<400 copies/ml) – SC-2: HIV positive, symptomatic (advanced AIDS or primary HIV infection), high viral load – SC Unknown: Status of the patient is unknown and neither the patient nor his/her blood is available for testing – HIV negative: Tested negative according to NACO strategy • The first dose of PEP – Should be started within 2 hrs (for greater impact) and definitely within 72 hrs. No need to provide PEP if exposure occurred >72 hrs.
  21. 21. PEP not required in the following situations • > 72hrs • Exposed person is HIV positive • Skin is intact • Source is HIV negative • Exposure with low risk specimens like tear, saliva, urine, stool, vomits, nasal secretion, sweat etc. • For exposures with EC-1 and SC-1 • Source unknown if HIV prevalence is low.
  22. 22. Side effects and compliance to PEP • At the beginning: Nausea, diarrhoea, muscular pain, headache or fatigue • Later during the course: Anemia, leukopenia or thrombocytopenia • Compliance of > 95% to the PEP schedule is required to maximize the efficacy of PEP. Hence, the person should be counselled to continue the PEP and to take medication to minimize the side effects of PEP
  23. 23. Post-exposure prophylaxis (PEP) for Hep-B HCW Status If source is positive or unknown for HBsAg If source is negative for HBsAg If the exposed person is vaccinated and the Ab titer is protective (≥10mIU/mL) No further treatment is required: • Regardless of the HBV status of the source •Regardless if the titer falls down later If the exposed person is vaccinated and the Ab titer is not protective (≤10mIU/mL) HBIG-1 dose should be started immidiately, given maximum within 7 days Vaccine: Statr the the 2nd series (3 dose) Vaccine: Start the second series (3 doses) If the exposed person is not vaccinated or partially vaccinated HBIG-1 dose should be started immediately max upto 7 days Vaccine: Complete the vaccine series from the last dose given (do not restart) Vaccine: Complete the series of 3 doses from the last dose given (do not restart) Nonresponders HBIG-2 doses at 1 month apart (0.06mL/kg or 10-12 IU/kg) Nothing is required
  24. 24. • Informed consent and counseling – Almost every person feels anxious after exposure. – They should be counselled and provided with psychological support – Informed about the risks and benefits of PEP medications – PEP is not mandatory. Exposed person should however be made to understand the risk of acquiring transmission if PEP is not taken.
  25. 25. • Documentation and recording of exposure – Structured Performa • Date, time, place of exposure • Type of procedure done • Duration of exposure • Source status and volume and type of specimen – Consent form • For prophylactic treatment
  26. 26. • Follow-up testing – HCW for BBVs should be done if the source status is positive/unknown • HIV testing  6 weeks, 3 months and 6 months after exposure • HBV and HCV  6 months after exposure
  27. 27. Spill management for Blood and Body Fluids • Bring the spill kit to the site of spillage – wear PPE (gloves, gown)  put ‘no entry’ sign board near the spill area. • Small volume (<10ml) – Wipe up spill immediately with absorbent material and discard into appropriate bin – Wipe the area with 10% sodium hypochlorite and allow it to dry – Remove PPE and perform hand hygiene
  28. 28. • Large volume (>10ml) – Place disposable paper towels over spills to absorb the spillage and then pour 10% sodium hypochlorite on the top of absorbent paper towels and leave for 15mins – Remove the absorbent papers; put fresh disposable paper towels to clean the area and then discard these into appropriate waste bin Spill management for Blood and Body Fluids

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