14 needle-stick injuries among health care workers

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Meeqat Hospital, Madina.KSA

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14 needle-stick injuries among health care workers

  1. 1. Needle-stick Injuries Among Health Care Workers 3/4/2014 1
  2. 2. 1. Background of the Topic 2. Needle-stick injuries in Ohud Hospital Dr. Muhammad AL amin Infection Control Coordinator 3/4/2014 2
  3. 3. What are Needle-stick injuries?     Wounds caused by needles. Are hazard for the people. Transmit infectious diseases. Blood born viruses. 3/4/2014 3
  4. 4. Frequency       3/4/2014 Precise national data not available. 600 000 – 800 000 injuries / year occur in USA. ½ of cases are not reported. Injuries begun to decrease in USA. Involve nursing staff, physicians and other health workers. Emotional impact can be sever. 4
  5. 5. Scope of the problem    3/4/2014 ½ of all hepatitis B and C in some parts of Africa and Asia due to contaminated sharps. 2/3 of hepatitis B and C in Eastern Mediterranean due to contaminated sharps. Over 2/3 of hepatitis B in Central and South American due to occupational exposure. 5
  6. 6. Risk of Transmission of Blood born Infection Occupational Exposure Hepatitis B Virus Hepatitis C Virus 2.7-10% HIV 3/4/2014 Risk of Transmission 2-40% 0.3% (1 in 300 chance of infection) 6
  7. 7. Factors which increase risk of infection        3/4/2014 Deep injury. Visible blood on the device. High viral titer. Artery or vein device. Combined factors. Un-immunized against hepatitis B. No post exposure prophylaxis with Zidovidine (prophylaxis decrease risk by 80%). 7
  8. 8. Hazards of Needle stick injuries        3/4/2014 Hepatitis B and C. HIV. Brucellosis. Malaria. S. aureus and S. pyogenes. Toxoplasmosis. Tuberculosis. 8
  9. 9. How common are needle stick injuries?     Needle stick injuries (too common hazard). Surgical instrument wound. Mucus membranes. Skin contact 3/4/2014 9
  10. 10. How do needle stick injuries occur?   Their use, disassembly or disposal. 30 – 50% of injuries occur during clinical procedures: withdrawing a needle from a patient.  Accessing IV line.     3/4/2014 During improper sharp disposal. During clean-up. Recapping: 25 – 30% of all injuries. 10
  11. 11. Conditions of work which increase Needle stick injuries       Staff reductions. Difficult patient care situations. Reduced lighting. New staff or students. Needles are disposed improperly. Emptying disposal containers. 3/4/2014 11
  12. 12. How can needle stick injuries be prevented       3/4/2014 Employee training. Recommended guidelines. Safe recapping procedures. Effective disposal systems. Surveillance programs. Improved equipment design. 12
  13. 13. Devices Involved in Percutaneous Injuries  Hollow bore needle: Hypodermic needle  Winged-steel needle  IV stylet  Phlebotomy needle   Solid sharp: Suture needle.  Scalpel.  3/4/2014 13
  14. 14. Desirable Characteristic of Devices with safety Features     The device is needleless. The device is easy to use and practical. The device is safe and performs reliably. The safety feature is an integral part of the device. 3/4/2014 14
  15. 15. What should the employers of Health care implement.      Analyze needle stick injuries. Proper training. Promote safety awareness. Establish procedures to encourage the reporting. Evaluate the effectiveness of prevention efforts 3/4/2014 15
  16. 16. Health care workers protection       3/4/2014 Use devices with safety features. Avoid recapping needles. Safe handling and disposal of medical waste. Report all needle stick injuries. Follow recommended infection prevention practices. Participate in blood-born pathogen training. 16
  17. 17. Hospitals should implement the followings:     Properly trained health care workers. Encourage the reporting and timely follow up. Promotion of safety awareness. Analyze needle stick injuries to identify hazards. 3/4/2014 17
  18. 18. 3/4/2014 18
  19. 19. 3/4/2014 19
  20. 20. Types of injuries Needle stick injuries Splash to skin and mucus membrane 6 (16%) Blades (Scalpel) 3/4/2014 28 (74%) 4 (10%) 20
  21. 21. Departments ICU Operating Room (OR) 5 (13) Medical Wards 4 (10%) Surgical Wards 4 (10%) Gynecology and Obstetrics Pediatrics and Nursery 3 (8%) Others 3/4/2014 15 (39%) 5 (15%) 2 (5%) 21
  22. 22. State of Vaccination    3/4/2014 31 of 38 (81%) were vaccinated for Hepatitis B. 2 needed booster doses. 5 of 38 (13 %) were not vaccinated. 22
  23. 23. Blood Born Diseases in sera of patients Hepatitis B 9 (24%) Hepatitis C 7 (18%) Not Known 20 (58%) 3/4/2014 23
  24. 24. Time of reporting Same day After 1 day 13 (34%) After 2 days 5 (13%) After 3 days 3 (9%) > 3 days 2 (5%) Not recorded 3/4/2014 11 (29%) 4 (11%) 24
  25. 25. What is the message of this Surveillance?     3/4/2014 Rate of the needle stick injuries is known. Search for factors that cause the injuries. Should receive proper treatment. Identify areas in which the prevention program need improvement. 25
  26. 26. Conclusion   3/4/2014 Ensure that health care workers are properly trained in the safe use and disposable needles. Encourage the reporting and timely follow up of all needle stick injuries. 26
  27. 27. 3/4/2014 27
  28. 28. HIV Post-Exposure Prophylaxis (cont.)  Basic regimen: zidovudine (AZT) 300mg bid + lamivudine (3TC) 150mg bid x 28 days  Expanded regimen: Basic regimen + Kaletra (lopinavir/ritonovir) {or atazanavir (Reyataz) or indinavir (Crixivan) or nelfinavir (Viracept) or efavirenz (Sustiva)} x 28 days
  29. 29. HIV Post-Exposure Prophylaxis  Initiate PEP as soon as possible, preferably within 2 hours of exposure.  Offer pregnancy testing to all women of childbearing age not known to be pregnant.  Seek expert consultation if viral resistance is suspected.  Administer PEP for 4 weeks if tolerated.
  30. 30. Hepatitis C   Perform baseline and follow-up testing for anti-HCV and alanine aminotransferase (ALT) 4 – 6 months after exposure. Perform HCV RNA at 4 – 6 weeks if earlier diagnosis of HCV infection desired.  Confirm repeatedly reactive anti-HCV results with supplemental tests.  Post-exposure prophylaxis (PEP) not recommended.
  31. 31.    Perform follow-up anti-HBs testing in persons who receive hepatitis vaccine. Test for anti-HBs 1 – 2 months after last dose of vaccine. Anti-HBs response to vaccine cannot be ascertained if HBIG was received in the previous 3 – 4 months.
  32. 32. Recommended PEP for exposure to HBV Vaccination and antibody response status of exposed workers Source HBsAg positive Source HBsAg negative Source unknown or unavailable for testing HBIG x 1 and initiate HB vaccine series Initiate HB vaccine series Initiate HB vaccine series No treatment No treatment No treatment -known non-responder HBIG x 1 and initiate revaccination or HBIG x 2 No treatment If known high risk source, treat as if source HBsAg positiive Antibody response unknown Test exposed person. No treatment No treatment if HBsAb positive. If inadequate antibody titer, administer HBIG x1 and vaccine booster Unvaccinated Previously vaccinated - known responder Test exposed person for HBsAb. No treatment if HBsAb positive. If inadequate antibody titer, administer vaccine booster and re-check titer in 1 – 2 month

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