Prevention Of Needlestick Injury Among Chinese Nurses


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Prevention Of Needlestick Injury Among Chinese Nurses

  1. 1. Prevention of Needlestick Injuries Zhao X (China)
  2. 2. Introduction <ul><li>Each year more than 1.5 million NSIs happen among Chinese HCWs, an average of 4410 NSIs per day </li></ul><ul><li>Near 80 percent of health workers in China have experience of NSI </li></ul><ul><li>17.9 percent have more than 5 times needlestick injuries </li></ul>Resource from:
  3. 3. Risks of Needlestick Injuries <ul><li>as many as 20 different pathogens are capable of transmission from patients or laboratory specimen to healthcare workers (HCWs) in the event of a NSI. </li></ul><ul><li>Of these 20 pathogens, HIV, HBV, and HCV are the three most common diseases transmitted via NSI. </li></ul><ul><li>A single exposure to HIV, HBV, or HCV in the context of a NSI places a HCW at average risks of infection of 0.3%, 6% to 30%, and 1.8%, respectively (CDC 2004; NIOSH 2000). </li></ul>
  4. 4. Hepatitis B Virus ( H B V ) <ul><li>In America </li></ul><ul><li>12, 000 HBV infections occurred in HCWs in 1985 </li></ul><ul><li>500 HBV infection occurred in HCW in 1997 </li></ul><ul><li>Intervention implemented: </li></ul><ul><li>widespread immunizations of American HCWs for HBV </li></ul><ul><li>But, there is a 6%-30% risk that an exposed, susceptible HCWs will become infected with HBV. </li></ul>
  5. 5. Hepatitis C Virus ( H C V) <ul><li>The precise number of HCWs who acquire HCV occupationally is not known in China. </li></ul><ul><li>In the United States, HCWs exposed to blood in the workplace represent 2% to 4% of the total new HCV infections occurring annually. </li></ul><ul><li>One study in the United States show that HCV transmission occurred only from hollow-bore needles compared with other sharps. </li></ul>
  6. 6. Human Immunodeficiency Virus ( H I V) <ul><li>The first case of HIV transmission from a patient to a healthcare worker was reported in 1986 </li></ul><ul><li>Through December 2001, American Central for Disease Control and Prevention (CDC) had received voluntary reports of 57 documented and 138 possible episodes of HIV transmission to HCW in USA </li></ul><ul><li>The average risk of HIV transmission after a percutaneous exposure is estimated to be approximately 0.3% </li></ul>
  7. 7. Cost of Needlestick Injuries <ul><li>Cost </li></ul><ul><li>Direct costs: </li></ul><ul><li>initial and follow-up treatment of exposed HCWs </li></ul><ul><li>(it is estimated to range from ¥ 4000-2,4000 depending on the treatment </li></ul><ul><li>provided) </li></ul><ul><li>Indirect cost </li></ul><ul><li>Emotional cost (fear, anxiety) </li></ul><ul><li>lost time from work, etc </li></ul>
  8. 8. Host Environment Agent Epidemiologic Homeostasis
  9. 9. Epidemiology of needlestick injury <ul><li>Who? </li></ul><ul><li>Where? </li></ul><ul><li>When? </li></ul><ul><li>How? </li></ul>
  10. 10. Who is at risk of injury?
  11. 11. Where do injuries occur?
  12. 12. How do injuries occur?
  13. 13. What device are involved in percutaneous injuries? <ul><li>Disposal syringes (32%) </li></ul><ul><li>Suture needles (19%) </li></ul><ul><li>Winged steel needles (12%) </li></ul><ul><li>Scalpel blades (7%) </li></ul><ul><li>Intravenous (IV) catheter stylets (6%) </li></ul><ul><li>Phlebotomy needles (3%) </li></ul>
  14. 14. Hollow-bore needles (59%) !!!
  15. 15. Importance of hollow-bore needle injuries <ul><li>NIOSH (2000) point out that the risk of infection for a HCW in the event of a NSI depends on </li></ul><ul><li>his or her immune status at the time of injury </li></ul><ul><li>the pathogen involved </li></ul><ul><li>the severity of the injury (e.g. how much blood was the worker exposed to?) </li></ul><ul><li>whether or not effective treatment is available </li></ul>
  16. 16. <ul><li>Devices requiring manipulation or disassembly after use is associated with a higher rate of injury </li></ul>
  17. 17. Prevention Strategies <ul><li>Hierarchy for prevention of needlestick injury </li></ul><ul><li>First: eliminate and reduce the use of needles where possible . </li></ul><ul><li>Using alternate routes for medication delivery and vaccination when </li></ul><ul><li>available and safe for patient care. </li></ul><ul><li>Second: isolate the hazards. </li></ul><ul><li>Provide a rigid cover that allows the hands to remain behind the needle. </li></ul><ul><li>Ensure that the safety feature is in effect before disassembly and remains in effect after disposal </li></ul><ul><li>Be an integral part of the device </li></ul><ul><li>Be simple and obvious in operation </li></ul>
  18. 18. <ul><li>Handle hypodermic needles and other sharps minimally after use and use extreme care whenever sharps are handled or passed. </li></ul><ul><li>Use the &quot;hands-free&quot; technique (described below) when passing sharps during clinical procedures. </li></ul><ul><li>Do not bend, break, or cut hypodermic needles before disposal. </li></ul><ul><li>Do not recap needles. </li></ul><ul><li>Dispose of hypodermic needles and other sharps properly. </li></ul>How can you prevent needlestick injuries?
  19. 19. <ul><li>Many accidental needlestick injuries occur when staff are recapping needles. </li></ul><ul><li>Recapping is a dangerous practice: If at all possible, dispose of needles immediately without recapping them. </li></ul><ul><li>If it does become necessary for you to recap a needle (for example, to avoid carrying an unprotected sharp when immediate disposal is not possible), do not bend or break the needle and do not remove a hypodermic needle from the syringe by hand. </li></ul>Recapping?
  20. 20. Recapping: The &quot;one-hand&quot; 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 &quot;scoop up&quot; the cap. Step 3 When the cap covers the needle completely, use the other
  21. 21. Handling sharps <ul><li>During a clinical procedure </li></ul><ul><li>When passing sharps, especially when there is sudden motion by staff members carrying unprotected sharps </li></ul><ul><li>when clients move suddenly during injections </li></ul><ul><li>when sharps are left lying in areas where they are unexpected (such as on surgical drapes). </li></ul><ul><li>Giving verbal announcements when passing sharps </li></ul><ul><li>Avoiding hand-to-hand passage of sharp instruments by using a basin or neutral zone </li></ul><ul><li>Ensuring cooperation from patients </li></ul><ul><li>Dispose a contaminated needle immediately after use </li></ul>
  22. 22. Safe passing of sharp instruments <ul><li>Uncapped or otherwise unprotected sharps should never be passed directly from one person to another. </li></ul><ul><li>In the operating theater or procedure room, pass sharp instruments in such a way that the surgeon and assistant are never touching the item at the same time. </li></ul><ul><li>This way of passing sharps is known as the &quot;hands-free&quot; technique: </li></ul>
  23. 23. &quot;hands-free&quot; technique: First step: The assistant places the instrument in a sterile kidney basin or in a designated &quot;safe zone&quot; in the sterile field. Second step: The assistant tells the service provider that the instrument is in the kidney basin or safe zone. Third step: The service provider picks up the instrument, uses it, and returns it to the basin or safe zone.
  24. 24. When giving injections……… <ul><li>Unexpected client motion at the time of injection can lead to accidental needlestick injuries. Therefore, always warn clients when you are about to give them an injection. </li></ul><ul><li>To protect clients, always use proper client preparation when giving an injection, and be sure that you handle IV fluids and multidose vials correctly. </li></ul>
  25. 25. If you are a head nurse in the unit, what you can do to prevent NSI? <ul><li>Educating your staff </li></ul><ul><li>A reduction in the use of invasive procedures </li></ul><ul><li>(as much as possible) </li></ul><ul><li>A secure work environment </li></ul><ul><li>An adequate staff-to-patient ratio </li></ul>
  26. 26. <ul><li>Risk-taking personality profile </li></ul><ul><li>Perceived poor safety climate in the workplace </li></ul><ul><li>Perceived conflict of interest between providing optimal patient care and protecting staff themselves </li></ul><ul><li>HCWs most readily change their risk behaviors when they thinks </li></ul><ul><li>They are at risk </li></ul><ul><li>The risk is significant </li></ul><ul><li>Behavior change will make a difference </li></ul><ul><li>The change is worth the effort </li></ul>If you are a head nurse in the unit, what you can do to prevent NSI?
  27. 27. Introduction of safety devices <ul><li>Vanish point syringe </li></ul><ul><li>Work principle </li></ul><ul><li>How to use it appropriately </li></ul><ul><li>Cost </li></ul>
  28. 28. Introduction of safety devices <ul><li>Sharps Container </li></ul><ul><li>Work principle </li></ul><ul><li>How to use it appropriately </li></ul><ul><li>Cost </li></ul>
  29. 29. Post-exposure Treatment <ul><li>Source patient details </li></ul><ul><li>Risk assessment </li></ul><ul><li>Action plan </li></ul><ul><li>Introduction of Nottingham Report Form Following Contamination from Blood or Body Fluids </li></ul>
  30. 30. Post-exposure treatment <ul><li>Available data from animal studies (Ferreiro & Sepkowitz 2001) indicated that </li></ul><ul><li>systemic infection after a NSI does not occur immediately if antiviral therapy is delivered expeditiously, establishment of infection may be prevented. </li></ul><ul><li>Therefore, </li></ul><ul><li>If you are injured by contaminated needle, ensure effective treatment to be available as soon as possible </li></ul>
  31. 31. Useful information after exposure <ul><li>Disease Control and Prevention Center of Yannan Province </li></ul><ul><li>Telephone number: 0871-3611773 </li></ul><ul><li>(available: 8am-11am, 2:30pm-5:30pm) </li></ul><ul><li>Health Education Institution of Yannan Province </li></ul><ul><li>Telephone number: 0871-5377136 </li></ul><ul><li>(available: 24hours) </li></ul><ul><li>Disease Control and Prevention Center of Kunming </li></ul><ul><li>Telephone number: 0871-4108357 </li></ul><ul><li>(available: 8am-11am, 2:30pm-5:30pm) </li></ul>
  32. 32. Useful websites <ul><li>Disease Control and Prevention Center of the People’s Republic of China </li></ul><ul><ul><li> </li></ul></ul><ul><li>American Disease Control and Prevention Center (CDC) </li></ul><ul><ul><li> </li></ul></ul><ul><li>American Occupational Safety & Health Administration (OSHA) </li></ul><ul><ul><li> </li></ul></ul>
  33. 33. DISCUSSION <ul><li>Share your experience of needlestick injuries </li></ul><ul><li>Your experience might help others! </li></ul>
  34. 34. <ul><li>Thank you </li></ul><ul><li>for listening! </li></ul>