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NEEDLE STICK INJURY.ppt
- 1. Preventing & Reporting Needlesticks and Other Sharps Injuries… Everything You Need to Know
- 2. • Part I: Background • Part II: Safer Sharps Devices • Part III: Safe Work Practices • Part IV: Post exposure prophylaxis
- 3. How Do Sharps Injuries Happen? • Who gets injured? • Where do they happen? • When do injuries occur? • What devices are involved? • How can they be prevented?
- 5. Where Do Sharps Injuries Occur? • Patient Room 39% (Inpatient: Medical – ICUs ) • Operating Room 27% • Outpatient 8% • Emergency room 8% • Laboratory 5% • Other 13%
- 6. When Do Sharps Injuries Occur? • During use 41% • After use/before disposal 40% • During and after disposal 15% • Other 4%
- 7. What Devices are Involved in Sharps Injuries? Six Devices Account for 78% of All Injuries • Disposable Syringes 30% • Suture Needles 20% • Winged-Steel Needles 12% • Intravenous Catheter Stylets 5% • Phlebotomy Needles 3% • Scalpels 8%
- 8. How Do Injuries Occur With Hollow-Bore Needles? Disposal Related: 35%
- 9. Based on the Prior CDC Slide Needle Injuries Occur…. • 35% During sharps clean up and disposal • 28% Manipulating needle in patient • 10% Colliding with co-worker • 0.6% Recapping needle Did you notice? 35% happens AFTER the procedure during clean up and disposal
- 10. Preventing Sharps Injuries is Our Goal!
- 11. Sharps Injuries Are Preventable
- 12. 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 - sharp cutter. • Use safer practices to minimize risk for remaining hazards
- 13. Eliminate or Reduce Unnecessary Needle Use First Strategy:
- 14. How Can Needle Use Be Eliminated or Reduced? • Use needle-free IV delivery systems • Use alternate routes for medication delivery. • Streamline specimen collection system.
- 15. Needle-Free IV Delivery Systems IV delivery systems use valved ports and connectors, pre- pierced septa using blunt cannulas, or recessed protected needle connectors
- 16. Use aseptic technique when handling these systems!!! Needle-Free IV Delivery Systems
- 17. Use Devices with Safety Features Engineered to Prevent Sharps Injuries Next Strategy:
- 18. Safer Sharps Devices Engineered to Prevent Sharps Injuries
- 19. Use Devices with Engineered Sharps Injury Protection • Hypodermic Needles • Phlebotomy Needles • IV Catheters • Winged-Steel Needles • IV Delivery Systems • Lancets • Scalpels • Suture Needles • Hemodialysis Needles
- 20. Safety Devices: Key Features • Are integrated into the device • Provide immediate protection after use and throughout disposal – Few devices provide protection during use.
- 21. Sharps Safety Practices • Be Prepared • Be Aware • Dispose with Care www.cdc.gov/sharpssafety
- 22. Be Prepared Before Beginning a Procedure • Wash Hands and Wear Gloves • Organize equipment at point of use • Use needleless systems when appropriate • Use adequate lighting • Keep sharps pointed away from the user • Plan ahead- Have sharps disposal nearby • Assess the patient’s ability to cooperate • Get help if necessary • Ask the patient to avoid sudden movement www.cdc.gov/sharpssafety
- 23. Be Aware During a Procedure • Avoid distractions • Never hand off or leave needles or sharps for others to dispose • Always activate the safety device (cutter) on needles immediately after each use • Be aware of staff nearby • Do not hand-pass exposed sharps from person to person • Alert others when sharps are being passed
- 24. Be Aware During a Procedure continued…. • Activate injury prevention safety feature of device (e.g. retraction) • Observe audible or visual cues that confirm the safety feature is locked in place • Do not bend* or break needles • Do not recap* needles/scalpels
- 25. Clean up and Dispose with Care During Cleanup • Do not disassembled needles from syringes by hand prior to disposal • Use hemostat/forceps to move items when uncovering/checking procedure trays, waste materials, and bedding for exposed sharps • Look for sharps/equipment left behind inadvertently
- 26. Clean Up and Dispose with Care While Disposing of Sharps • Inspect container • Keep hands behind sharps • Never put hands or fingers into sharps container • Do not dispose sharps with attached tubing.
- 27. Clean Up and Dispose with Care After Disposing of Sharps •Visually inspect sharps container for overfilling •Replace containers when no more than ¾ full SCPMC.MCW- IP.063 www.cdc.gov/sharpssafety
- 28. Clean Up and Dispose with Care If you Find improperly Disposed Sharps in Work Environment • Handle Carefully • Keep hands behind sharps at all times • Use mechanical device (e.g. tong/hemostat) if you cannot safety pick up sharps by hand www.cdc.gov/sharpssafety
- 29. Your Part in Prevention • Tell your employer about any sharps hazards you observe • Participate in training related to infection prevention • Get a Hepatitis B vaccination • Wear gloves • Wash Hands Sharps fall under OSHA’s Bloodborne Pathogen Standard, 29 CFR 1910.1030.
- 31. What to do when a Needlestick WASH QUICKLY!! The area of the needle- stick should immediately be washed with soap and water.
- 32. Report! Report! Report! ■ It is crucial that the exposure is reported immediately. ■ Some post exposure prophylaxis medications need to be started within hours to be most effective.
- 33. How to Report an exposure ■ There should be a person within the office who handles employee injuries report the exposure to this person.
- 34. Reporting an exposure ■ Your exposure coordinator may ask you exactly how the incident occurred. They will evaluate the exposure and tell you how to proceed. You may be asked for the source patients name and medical record number, so have them handy.
- 35. What to expect ■ In the case of a true exposure Hep B surface antigen, Hepatitis C antibody, and a Rapid HIV will be drawn on the blood of the source patient. These must be ordered by a physician and charged to the office. These charges should never be charged to the source patient. If this can not be done, the employee who was injured must proceed to Occupational Health and Medicine at MCHC.
- 36. Negative results ■ If all three tests come back negative on the source patient, there is no need for further follow up. ■ The results are communicated to the employee by the office exposure coordinator. ■ The incident is logged into the needle stick injury form.
- 37. Positive results ■ If the results are positive The physicians will work together to ensure that everything possible is done for your employee. ■ Post exposure medications will be started as soon as the results are known.
- 38. What Infections Can Be Caused by Sharps Injuries? • The pathogens that pose the most serious health risks are: -Hepatitis B virus (HBV) – -Hepatitis C virus (HCV) – -Human immunodeficiency virus (HIV)
- 39. Risk of transmission ■ Hepatitis B is 22%-31% ■ Hepatitis C is 1.8% ■ HIV is 0.3% ■ Transmission of Hepatitis B can be prevented with a vaccine.
- 40. Employee testing ■ This is done when results are positive on the source patient or when the source patient is unknown or they are not available for testing. ■ HIV, Hepatitis C antibody, Hepatitis B surface antigen, the latter need only be drawn if the employee has not had Hepatitis B Vaccine with documentation of lab confirmed immunity.
- 41. Vaccinations ■ Getting the Hepatitis B vaccine is the one thing that you can do to prevent transmission of a blood borne pathogen. It is recommended for all Health care workers who are at risk of coming into contact with blood and body fluids in their daily routines.
- 42. What is an exposure ■ A percutaneous injury or contact with non-intact skin or mucus membrane with blood, tissue, or other body fluid that are potentially infectious. These include semen, vaginal fluids, cerebral spinal fluid, synovial, pleural, pericardial, and amniotic fluids.
- 43. What is not an exposure ■ Feces, nasal secretions, saliva, sputum, sweat, tears, urine, and vomitus are not considered potentially infectious unless they contain visible blood. HIV, Hepatitis B, and Hepatitis C are not easily transmitted in these fluids.
- 44. Exposures by human bite ■ For human bites the evaluation must include the possibility that both the person bitten and the person who inflicted the bite were exposed to bloodborne pathogens. Only rarely have HIV or Hepatitis B been transmitted this way.
- 45. It is important to… ■ Prevent exposures, report exposures and get vaccinated!
Editor's Notes
- [Note to presenter– this presentation is divided into three parts. Part I discusses background on the nature of sharps injuries, the risks of exposure to bloodborne pathogens, and how and where injuries tend to occur. Part II describes the types of engineered sharps injury prevention devices that are available. Part III presents safe work practices to prevent sharps injuries.] [Feel free to discard slides or information to tailor this slide set to your particular organization’s needs.] [Opportunities for discussion or to personalize the slide set will be indicated in bold.]
- To prevent sharps injuries, we first need to understand how they occur. Who gets injured? Where do they happen? What devices are involved? When and how do injuries occur? And, how can they be prevented? [Note to Presenter: The following slides may be augmented or replaced using local data. Use the questions above as a guide.]
- Data from NaSH show that nurses sustain the highest percentage of percutaneous injuries. However other patient-care providers (such as physicians and specialized technicians), laboratory staff and support personnel (such as housekeeping and maintenance staff) are also at risk. [ NOTE to presenter: Depending on audience, the collective data can be used to elicit discussion on issues that contribute to this distribution: devices, training, staffing, disposal problems, etc. Ask audience members how they think injuries to housekeeping and maintenance staff occur. If the targeted group is primarily laboratory staff, you may want to include other bloodborne pathogens important to lab workers (See Workbook, Overview—Risks and Prevention of Sharps Injuries in Healthcare Personnel, Table 1).]
- Although sharps can cause injuries anywhere within the healthcare environment, NaSH data show that a large share (39%) of injuries occur on inpatient units (particularly medical floors and ICUs) and in operating rooms (27%). [NOTE to presenter: Focus discussion according to targeted audience. Ask why they think there are differences and what may be involved (e.g., devices, work practices, or both).]
- Injuries with needles and other sharp devices can happen at any time during use. NaSH data show that the majority of injuries occur during or immediately after use; 15% occur during or after disposal. During use injuries often occur when the device is being inserted or withdrawn and/or the patient moves. After use injuries occur during cleanup or in transit to another location. Injuries during disposal often involve Placing used sharps into the container or Disposing of a sharps devise inappropriately; that is, when a device is placed in the trash or left at the bedside or other location. In the next few moments, we will look in greater detail at how these injuries occur.
- Think about all the needles and other sharp devices that are used to provide healthcare. While many different devices that can cause sharps injuries, six types account for nearly 80% of injuries in NaSH hospitals. Hollow-bore needles alone account for 56% of all sharps injuries. Hollow-bore needle injuries, especially from devices used for blood collection or for IV catheter insertion, are of particular concern, since they are likely to contain residual blood and are associated with an increased risk for bloodborne virus transmission. Of the 57 documented cases of occupational HIV transmission to healthcare personnel reported to CDC from June 1995 to December 2002, 50 (88%) involve percutaneous exposure. Of these, 45 (90%) were caused by hollow-bore needles and half of these needles were used in a vein or an artery. Although two scalpel injuries (both in an autopsy setting) caused HIV seroconversions, solid sharps such as suture needles or scalpels, generally deliver a smaller blood inoculum, especially if they first penetrate gloves or another barrier. Therefore these devices theoretically pose a lower risk for HIV transmission. Similar descriptive data are not available for type of devices or exposures involved in transmission of HBV or HCV.
- You may also know that there are many possible mechanisms for injuries. In NaSH hospitals, 26% of hollow-bore needle injuries occur while the needle is being inserted, manipulated or withdrawn from the patient, and the patient moves or jars the device. Some needle injuries occur when accessing intravenous lines, such as giving an IV flush. With needle-free IV systems now available, these injuries should not be occurring. The same applies to recapping injuries. Why do you think people recap needles when it is so dangerous? [NOTE to presenter: Encourage discussion of this subject if time permits] You can see that many injuries in NaSH hospitals occur after use on the patient, such as during clean up, in transit to disposal, and during disposal. An additional 9% of injuries are due to improper disposal or result from leaving a sharp device on a table, stuck in a mattress, on the floor, or some other location. Another 10% of injuries occur when healthcare personnel collide with each other during a procedure. [NOTE to presenter: Encourage discussion of the different injury mechanisms, including some not mentioned here.]
- Because of the high burden of sharps injuries, our goal is to prevent – and ideally eliminate – sharps injuries.
- Data from the NaSH system show that most sharps injuries from hollow-bore needles are preventable. A majority (64%) of all hollow-bore needle-related injuries can be prevented by using needles only when necessary, using devices with engineered safety features, properly using the safety features on these devices, following proper work practices (such as not recapping used needles), and properly disposing of needles after use.
- The prevention of sharps injuries is a priority at __________ [your facility name]. In the hierarchy of priorities to prevent sharps injuries, the first priority is to eliminate and reduce the use of needles and other sharps wherever possible. For example, use alternate routes for medication delivery and vaccination when available and safe for patient care. The next priority is to isolate the hazards and thereby protect otherwise exposed sharps, through the use of engineering controls. The emphasis on engineering controls has led to the development of many types of devices with engineered sharps injury prevention features. When these strategies are not available or do not provide total protection, the focus shifts to work-practice controls and the use of personal protective equipment. In the operating room, for example, instruments, rather than fingers, can be used to grasp needles, retract tissues, and load and unload scalpels; verbal announcements should be given when passing sharps; and hand-to-hand passage of sharps instruments can be avoided by using a basin or neutral zone.
- As stated earlier, the first strategy in the hierarchy of sharps injury prevention is to reduce, if not eliminate, the unnecessary use of needles or other sharps objects when appropriate.
- There are several ways that needle use can be eliminated or reduced. One way is the implementation of needle-free IV delivery systems that do not require, and in some instances, do not permit needle access. The majority (approximately 85%) of US hospitals have eliminated unnecessary use of needles through implementation of these devices. This strategy has largely removed needles attached to IV tubing, such as those for intermittent (piggy-back) infusion and other needles used to connect and access the part of the IV delivery system. Such systems have demonstrated considerable success in reducing IV-related sharps injures.
- Here are two examples of needle-free IV delivery systems. As you can see all connections are made without the use of needles. Some systems use blunt cannulae (lower right) that enter the system through pre-pierced ports. Still other systems have recessed needles for system connections. [Note to Presenter: Discuss the safer IV delivery system that is used in your facility. When available, include a picture or have samples of the system on display.]
- Some needle-free systems have been associated with bloodstream infections in patients. Therefore it is important to understand the infection control measures that should be adhered to, particularly the need for aseptic technique, when handling these systems.
- The needs of patient care suggest that it will never be possible to eliminate the use of all needles and other sharps devices. Therefore, devices with engineered, or built-in sharps injury protection features aim to reduce the hazard to healthcare personnel.
- This slide displays a variety of safer sharps devices engineered to prevent sharps injuries. On the left you see a variety of devices with the needle exposed in the before-use position. On the right you see that sharps are protected after use. The safety features include hinged caps [Note to presenter: point to devices #2 and # 7 from the top], sliding sheaths [Note to presenter: point to devices #3, 4, and 6 from the top], and retracting needles [Note to presenter: point to devices #1, 5, and 8 from the top]. Another type of safety feature, not shown here, is a bluntable phlebotomy or butterfly type needle. Additional strategies for needle protection are likely to evolve. [Note to Presenter: Identify whether any of these devices are currently in use or being evaluated by your facility. If other products are available, provide samples of them. Alternatively, create a slide with pictures of the devices used in your facility.] [Disclaimer: The devices pictured in this slide are meant to serve as examples of devices that are currently available. This is not an exhaustive list, nor is it meant to favor one device over another. CDC and OSHA do not approve, endorse, register, or certify any medical devices.]
- Today there are devices with engineered sharps injury protection for all of the major device categories, including those listed on this slide.
- One of the key features of these devices is that the safety features are part of the device itself. Furthermore, safety devices have the ability to provide immediate protection at the point of use and throughout the disposal process. Keep in mind, few devices provide protection during use of the device on the patient. Another safety feature is that the user’s hands can remain behind the exposed sharp when activating the safety feature, thus reducing the opportunity for injury.
- Blood exposures to intact skin are not considered exposures unless there is a large amount of blood involved. Typically a blood exposure is defined as blood or one of the above fluids inside the mouth, nose or eyes or an open cut.