2. WHAT IS NEEDLE STICK INJURY
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A needle stick injury is a percutaneous piercing wound
typically set by a needle point, but possibly also by
other sharp instruments or objects.
Commonly encountered by people handling needles in
the medical setting, such injuries are an occupational
hazard in the medical community.
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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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4. 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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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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Potentially infectious body fluids -
Exposure to body fluids
considered at risk
Exposure to body fluids
considered not at risk unless they
contain visible blood
Blood, Semen, Vaginal
secretions, CSF, Synovial,
Pleural and Pericardial fluid,
Amniotic fluid & other body
fluids contaminated with
visible blood
Tears, Sweat, Urine and
faeces, Saliva, Sputum and
vomitus
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8. • Hypodermic
needles
• Blood collection
needles
• Suture needles
• Needles used in IV
delivery systems
• Scalpels
WHAT KINDS OF DEVICES USUALLY
CAUSE SHARPS INJURIES?
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9. 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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10. RISKS OF SEROCONVERSION DUE TO SHARPS
INJURY
FROM A KNOWN POSITIVE SOURCE
Virus
HBV
HCV
HIV
Risk (Range)
6-30%*
~ 2%
0.3%
(*Risk for HBV applies if not HB vaccinated)
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11. WHAT IS THE RISK FOR HIV ALONE?
• Percutaneous 0.3%
• Mucous membrane 0.1%
• Non-intact skin <0.1%
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12. • Who gets injured?
• Where do they happen?
• When do injuries
occur?
• What devices are
involved?
• How can they be
prevented?
HOW DO SHARPS INJURIES HAPPEN?
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13. • Report all needle stick
and sharps-related
injuries promptly to
ensure that you receive
appropriate follow-up
care.
• Tell your employer about
any sharps hazards you
observe.
• Participate in training
related to infection
prevention.
• Get a Hepatitis B
vaccination.
PROTECTING YOURSELF …
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14. A. CATEGORIES OF EXPOSURE
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Category Definition and Example
Mild
exposure
Mucous membrane/non-intact skin with small volumes
e.g. a superficial wound with a low caliber needle,
contact with eyes or mucous membrane, subcutaneous
injections with a low caliber needle.
Moderate
exposure
Mucous membrane/non-intact skin with large volumes or
percutaneous superficial exposure with solid needle e.g.
a cut or needle stick injury penetrating gloves.
Severe
exposure
percutaneous exposure with large volumes e.g. an accident
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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POST EXPOSURE PROPHYLAXIS (PEP)
It refers to the comprehensive management to minimize the
risk of infection following potential exposure to blood borne
pathogens (HIV, HBV, HCV ).It includes –
First Aid
Risk Assessment
Counseling
PEP drugs (4Weeks) depending upon risk assessment
Relevant Lab Investigation on informed consent of the
source and exposed person
Follow up and support
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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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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
18. QUICK FACT:
HBV VACCINATION IS RECOMMENDED FOR ALL
HEALTHCARE WORKERS (UNLESS THEY ARE
IMMUNE BECAUSE OF PREVIOUS EXPOSURE).
HBV VACCINE HAS PROVEN TO BE HIGHLY
EFFECTIVE IN PREVENTING INFECTION IN
WORKERS EXPOSED TO HBV. HOWEVER, NO
VACCINE EXISTS TO PREVENT HCV OR HIV
INFECTION.
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19. SUPREME COURT DIRECTIVE TO ENSURE PEP
DRUGS IN ALL GOVERNMENT HOSPITALS IN INDIA
1. Universal Work Precautions (UWP) and PEP guidelines should be followed by
HCPs to prevent occupational transmission of HIV, Hepatitis B and hepatitis
C.
2. This will develop confidence in HCPs while working with patients some of
whom might be infected with HIV/HBV/HCV.
3. PEP drugs should be available in all Govt Hospitals to
enable protection of HCPs dealing with potentially infected
patients to make sure that no patients suffering from HIV
be denied treatment/surgery/ procedures etc
4. Availability of UWP and PEP can minimize the stigma and discrimination
against PLHIVs in Health Care facilities.
5. Above regulations to be practiced in Private hospitals and Establishments
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RESPONSIBILITY OF HEAD OF THE INSTITUTION
• To ensure that the hospital has a written protocol to
handle exposure and the same is displayed at
prominent locations within the hospital for information of
staff.
• Sensitization of Doctors, Nurses, Paramedics & waste
handlers
• To ensure that Universal precautions are followed.
• Availability of Personal protective equipment.
• Dissemination of procedure to be followed in case of
accidental exposure to Blood and Body fluids
• Availability of Rapid HIV test kits.
• Availability of other preventive measures including
vaccinations.
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AVAILABILITY OF PEP AT HEALTHCARE FACILITY
It is recommended that PEP drugs be kept available round-
the-clock in any of the three locations - Emergency room,
Labor room and ICU.
Drug Stock at the Healthcare facility
PEP kit comprises of 2 drug regimen:
Tinofovir disoproxil fumarate + emtricitibine
+raltegravir in dose combination
22. WHAT ARE STRATEGIES TO ELIMINATE SHARPS INJURIES?
• Eliminate or reduce the use of needles
and other sharps
• Use devices with safety features to
isolate sharps
• Use safer practices to minimize risk for
remaining hazards
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23. DO NOT FORGET HEPATITIS B VACCINATION AND
UNIVERSAL PRECAUTIONS ……..
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