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Sharp injuries and needle stick post exposure prophylaxis [compatibility mode]

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Infection Control Guidelines for Sharp injuries and needle stick post exposure prophylaxis
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.

Published in: Health & Medicine
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Sharp injuries and needle stick post exposure prophylaxis [compatibility mode]

  1. 1.  ١
  2. 2. OBGECTIVES What the risk of exposure?  How we can prevent the exposure?  If the exposure is already done, what is the exposure management plan?  ٢
  3. 3. What are Bloodborne Pathogens?  Microorganisms that may be present in human blood and other potentially infectious materials (OPIM) that may cause disease in humans. ٣
  4. 4. Diseases Caused by Bloodborne Pathogens HIV / AIDS  Hepatitis B  Hepatitis C   Arboviral infections – La Crosse, St. Louis Brucellosis  Creutzfeldt-Jakob CreutzfeldtDisease     Malaria Syphilis Viral Hemorrhagic Fevers – West Nile ٤
  5. 5. Bloodborne Pathogen Exposures   Puncture from contaminated needles, broken glass, or other sharps Contact between non-intact skin and noninfectious body fluids   cut/abrasion, scratch, acne, sunburn Direct contact between mucous membranes and infectious body fluids  splash in the eyes, nose, or mouth ٥
  6. 6. INJURY TYPES OF EXPOSURE Percutaneous Exposure Mucous Membrane High Risk Exposure Moderate Risk Exposure . Cutaneous Low Risk Exposure ٦
  7. 7. Most Needle Stick Injuries occur during the following activities      Recapping, bending, or breaking needles;52% 52% Inserting a needle into a test tube or specimen container and missing the target;15% 15% Injury from a person carrying unprotected sharps;Sharps that are present in unexpected places, like linens: 13% 13% During complex surgical procedures;Handling or disposing of waste that contains used sharps, 12% 12% Patients moving suddenly during injections:8% ٧
  8. 8. Exposure Prevention  The single most effective measure to control the transmission of Bloodborne Pathogens is: Standard Precautions  Treat all human blood and other potentially infectious materials like they are infectious for Hepatitis B and HIV ٨
  9. 9. Standard Precautions Hand washing and proper use of PPE. Regular cleaning and decontamination of work surfaces with a cleaning agent labeled as effective against HBV/HIV&HCV. Vaccination against Hepatitis-B. HepatitisProper Sharp Waste disposal.     ٩
  10. 10. VACCINATION ١٠
  11. 11. Safer Sharps ١١
  12. 12.   Continuous training and education of Health Care Personnel in all hospital departments on Proper Sharp Disposal. KKHKKH-IFC / Sharp 12
  13. 13.       Avoid rushing when handling needles and sharps. Dispose all needles and other sharps promptly. These items should not be left on food trays or inadvertently deposited in trash containers. DO NOT re-cap needles. rePlace used disposable items in puncture resistant biohazard containers for disposal. In the event recapping is unavoidable, the one-handed onescoop technique or a needle recapping device shall be used. Sharps waste shall be contained in “Sharps “Sharps Containers” Containers” which are rigid and puncture resistant. 13
  14. 14. To safely recap needles use “the oneonehand” hand” technique Step 1  Place the cap on a flat surface, then remove 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). 14
  15. 15.       Sharps containers shall be labeled as “sharps waste” and “sharps biohazardous with international biohazardous symbol. Sharp containers shall be filled up to three quarters and taped closed or tightly lidded. Sharps containers are placed in yellow bags by housekeeping personnel for storage and then processing. Sharps waste is disposed of in sharps containers as close to site of use as possible. InIn-patient rooms shall have wall mounted “Sharps Container system “ which is kept near the patient’s bed and is securely locked. Other direct patient care areas shall have wall mounted “Sharps Container” system and/or rigid puncture resistant containers having the biohazardous symbol printed on. KKHKKH-IFC / Sharp Injuries Prevention / IPP NO: 012 15
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  20. 20. DEVELOP EXPOSURE MANGEMENT PLAN, EDUCATE & TRAIN THE STAFF AND MONITORING THE STAFF COMPLAINCE. ٢٠
  21. 21. IMMEDIATE CARE OF INJURY Risk Reduction PLAN MANGEMENTOF EXPOSED HCWS INCIDENCE DOCUMENTATION RISK ASSESMENT ٢١
  22. 22.    The employee concerned should immediately wash away the contaminating fluid. If blood or body fluids get in the mouth, spit out and then rinse mouth with water several times. If there is a puncture wound, wash with soap and water and disinfected by Alcohol or Betadine. If the eyes are contaminated (may be more dangerous than an NSI) rinse well with tap water or saline. ٢٢
  23. 23.    Should be in detail with completion of the appropriate form. Report should include details of the incident ,date & time of incident , people involved ,any witnesses to the incident. All occupational exposures must be fully documented to meet relevant legal requirement. ٢٣
  24. 24. The injury The source The exposed HCWs ٢٤
  25. 25. INJURY Percutaneous Exposure to Blood Highest Risk Increased Risk No Increased Risk BOTH Large vol. of bl. EITHER Large vol. of bl. NEITHER Large vol. of bl. + OR NOR High titre of HBV,HCV,HIV High titre of HBV,HCV,HIV High titre of HBV,HCV,HIV ٢٥
  26. 26. The source HBsAg HCV-Ab HIV-Ab ٢٦
  27. 27. The exposed HCWs HBsAg And Anti-HBsAb HCV-Ab HIV-Ab ٢٧
  28. 28.  SOURCE is –ve for HBV,HCV, HIV.  SOURCE of unknown infectious or unable to be tested. tested.  SOURCE is +ve or likel to be +ve. ٢٨
  29. 29.  Source is –ve for HBV,HCV,HIV Anti-HBs Ab Titre > 10 IU /ML IMMUNE < 10 IU /ML NON IMMUNE POST-EXPORUE PROPHYLAXIS ٢٩
  30. 30. Source of unknown infectious status or unable to be tested   If after every effort has been made to ascertain the HBV ,HCV ,HIV status of the source ,the status is uncertain then the relative risk of the source being + ve , must be inferred when giving recommendations concerning prophylactic measures. If concern exists that there is a high risk of the source being infected with HBV,HCV,HIV the HCWs should be manged as in case of source is +ve or likely to be +ve. +ve +ve. ٣٠
  31. 31.  Source is +ve or likely to be +ve forHBV forHBV Anti-HBs Ab Anti-HBc Ab +Ve IMMUNE - Ve NON IMMUNE POST EXPOSURE PROPHYLAXIS ٣١
  32. 32. Postexposure Prophylaxis Immunogluline Vaccination Follow up ٣٢
  33. 33. Clinical or serological Evidence of acute hepatitis Seek for clinical advise Repeat HBs Ag at 1 & 6 months No plasma,bl,body tissue donation. Protect sexual partner. Highest risk ٣٣ percuteneous exporure,modify WP.
  34. 34. Source is +ve or likely to be +ve for HCV Screening HCV-IgG -Ve -No infection -Early infection -False -ve +Ve -Current infection -past infection -False +ve Confirmatory HCV-RNA by real-time PCR +ve Confirms active HCV replication -ve Does not confirm absence of ٣٤ HCV replication
  35. 35. Clinical or serological evidence of acute hepatitis Seek for clinical advise HCV-RNA by PCR repeated After 2 months HCV-IgG repeated after 6 to 9 months No plasma,bl,body tissue donation Protect the sexual partner . Hihgest risk percutaneous exposure,modify WP. ٣٥
  36. 36. Source +ve or likely to be +ve for HIV +ve +ve The risk of transmission of infection     The average risk estimated for all types of percutaneous exposure is 0.5%. The overall risk estimate from m.m. exposure is m.m. 0.08%. 08%. No evidence of HIV transmission via intact skin exposure. Although HIV is present in a number of bodliy fluids, the incidence of transmission from secretions not containing visible blood is low. ٣٦
  37. 37. Source is +ve or likely to be +ve for HIV     Postexporue Prophylactic treatment is indicated. It must be commenced as soon as possible .preferably within hours rather than days . It should be administrated for 4 weeks. If PEP is offered & taken &the source is later determined to be HIV -ve ,PEP should be discontinued. ٣٧
  38. 38. Repeated HIV screening at 1 & 3 & 6 months Until screening for seroconversion is completed ٣٨
  39. 39.    All staff should be aware of the need to comply with Infection Control Policy. All staff should be aware of whom to contact for advice concerning occupational exposure. All HCWs should be aware of immediate care of injuries &their rights & responsibilities following an occupational exposure. ٣٩
  40. 40.     Standard precautions must be employed when handling blood or bodily substances All bodily fluids such as semen, vaginal secretions, CSF, synovial ,pleural ,peritoneal ,pericardial should be consider potentially infectious. The use of needless or self sheathing devices must be encourage. Overstuffing sharps containers & recapping of needles must not be allowed . ٤٠
  41. 41.    The operating room & emergency room are particularly areas of high risk to HCWs. Gowns, gloves ,eye protection are recommended when procedures involving blood or bodily fluids are likely to take place. A hands free technique ,where the same sharp item is never touched by more than one person at the same time ,should be implemented in the operating room. ٤١
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