This document provides guidance on proper sharps handling and needlestick injury prevention. It defines sharps and needlestick injuries, identifies causes and risks. Guidelines are provided for safe sharps use, disposal and handling of occupational exposures, including immediate first aid, evaluation for post-exposure prophylaxis (PEP), and follow up testing. Case scenarios demonstrate appropriate vs inappropriate responses to needlestick injuries. Overall the document aims to educate on preventing needlestick injuries and properly managing incidents to reduce disease transmission risk among healthcare workers.

1. SHARPS HANDLING
Samson Peter Mvandal

2. OBJECTIVES
• At the end of this session learner should be able to;
• Define the term sharp and Needlestick Injuries(NSIs)
• Identify Causes of Needle stick injury
• Identify risk of of Needle stick injuries
• Prevent needle stick injuries(NSIs)
• Identify sharp working guideline
• Demonstrate how to handle sharps( before, during and
after procedures)
• Identify post Exposure protocol
• Post exposure prophylaxis (PEP)

3. DEFINITION OF TERMS
• Sharps are medical devices like needles, scarpels,
scissors and other tools that cut or go through into the
skin.
• Learning how to safely handle sharps is important to
prevent accidental needle sticks and cuts.
• Sharps and needlestick injuries are wounds caused by
needles and other sharp medical instruments (e.g.
Scalpel, blades and scissors) that accidentally puncture
or cut the skin.
• Sharps and needles may only cause small wounds in the
skin, but the effects can be worse.

4. Definition of terms
• Instruments come in contact with blood and other
body fluids and may carry the risk of infections.
• More than 20 dangerous bloodborne pathogens
including HIV and hepatitis may be transmitted
through accidental injuries with contaminated
needles and sharps

5. SHARPS AND NEEDLE STICK INJURY
• Global pooled prevalence of needlestick
injuries(NSIs) among healthcare workers was
44.5% (Bouya et al., 2020)
• Needle stick injuries(NSIs) is the most
occupational hazards among health care workers
(HCWs) globally, More than 6% of occupational
exposures to sharp injuries occur to health
healthcare workers(HCWs) (WHO, 2019)

6. CAUSES OF SHARP INJURIES (NEEDLE STICK INJURY)
• Overuse of injections and unnecessary sharps
• Lack of supplies: disposable syringes, safer needle devices and
sharp disposal container
• Lack of access and failure to use sharps containers
immediately after injection
• Recaping of needle after use

7. Mixing sharps with
other infectious
wastes

8. CAUSES OF SHARP INJURIES (NEEDLE STICK
INJURY)
• Lack of personal protective equipments, safety devices
and sharps disposal containers
• Inadequate or short staffing
• Passing instrument from hand to hands in the operating
suite
• Lack of hazard awareness and lack of training
• Unexpected patient reactions

9. Working environment causing NSIs

10. WHO ARE AT RISK OF NEEDLE STICK INJURIES
• In healthcare, it is not just medical professionals who are at
risk from sharps injuries, but rather anyone who comes
into contact with needles or medical sharps contaminated
with blood or other body fluids.
• Nurses
• Doctors
• Paramedics
• Operating department assistants
• Laboratory workers
• Cleaners

11. PREVENTING INJURIES(NEEDLE STICK INJURIES)
• Before using sharp object, such as scarpel, make sure you
have all the items you need close by.
• Also you need to know where the sharp disposal container is
(Keep it nearby)
• Make sure there is enough room in the container for your
object to fit ( it should not be more than two-thirds full.)
• Some needle have a protective device, such as needle shield,
sheath, or blunting, that you activate after removing the
needle from the person. (this allow to handle the needle
safely, without the risk of exposing yourself to blood or body
fluids
• Before using this kind of needle make sure you know how it

12. Prevention of NSIs Cont….
• Implementing safe systems of work
• Implementing safe procedures for using and
disposing medical sharps
• Banning recapping
• Using personal protective equipment
• Vaccination( hepatitis B)
• Information and training

13. Hands free
Technique
Hand to Hand
technique

15. SHARPS WORKING GUIDELINES
The following are the guidelines when working with
sharps;
• Do not uncover or unwrap
the sharp object until it is
time to use it.
• Keep the object pointed
away from yourself and
other people at all times.
• Never recap or bent sharp
object.
• Keep your fingers away from
the tip of the object
• If object is reusable, put it
• Never hand sharp object to
someone else or put it on tray
for another person to pick up.
• Tell the people you working
with when you plan to set the
object down or pick it up. (Use
non touch technique, keep it
on kidney disk)
• When working with sharps
make sure you have sharp
container nearby.
• Make sure sharp container you

16. Recaping of needle may cause
injury

17. SHARPS DISPOSAL
• Make sure the disposal
container is made for
disposing of sharps
container
• Replace container when
they are two-thirds full.
• Never put your finger into
the sharp container
• Sharp containers should be
at eye level and within your
reach.
• If needle is sticking out of
the container, do not push it
in with your hands ( remove
such container or use tongs
to push the needle back to
the container)
• If you find an uncover sharp
object outside of disposal
container, it is safe to pick
up only by grasping the non-
sharp end.

19. Occupational Exposure Protocol
STEPS FOLLOWING OCCUPATIONAL EXPOSURE
1. Crisis management- Remain CALM
2. Dispose the sharp appropriately
3. First aid- wash and irrigate the site( Do not milk it)
4. Report to the appropriate authority
5. Get evaluated for PEP and baseline testing for HIV, HCV,
HbsAg
6. PEP should be started within 2 Hrs of exposure, and not
later than 72 Hrs.
7. PEP must be taken for 4 weeks(28 days)
8. Follow-up HIV testing (6W, 3M, 6M)
9. Follow up counselling and care.
Inform doctor if pregnant or breast
feeding

20. MANAGEMENT OF EXPOSURE: IMMEDIATE MEASURE
First aid ( depending on area of exposure)
• Wound or skin: Wash with soap
• Mucous membrane: Flush expose membrane with water
• Open wound: Irrigate with sterile saline or antiseptic
solution
• Eyes: Irrigate with clean water, saline or sterile eye
irrigants
• Mouth: Do not swallow! Rinse out several times with cold
water
Remain CALM

21. DO’S AND DON’T AFTER OCCUPATIONAL
EXPOSURE
DO
• Remove gloves , if
appropriate.
• Wash the exposed site
thoroughly with running
water.
• Irrigate with water or saline
if eye or mouth have been
exposed.
• Wash the skin with soap
and water.
DON’T
• Do not panic.
• Do not put the pricked finger
into mouth.
• Do not squeeze the wound.
• Do not use bleach, chlorine,
alcohol, betadine, iodine or
other antiseptics /detergents
on he wound.

22. POST EXPOSURE PROPHYLAXIS (PEP)
PEP
It refers to the use of antiretrovirals
prophylactically to prevent HIV infection
following an occupational exposure.

23. Guideline for PEP
General guideline for PEP
Potential benefit weighed against potential risks and
informed to the staff
Adherence and adverse effects be monitored
Baseline HIV test of staff with counselling
Follow up
• Counselling and HIV testing
• Monitoring for drug toxicity

24. STEPS FOR PEP
1. Asses Nature of Exposure
2. Asses HIV status of source of exposure
3. PEP Evaluation
4. PEP Regimes- Drugs and Dosage for PEP
5. Follow up

25. NATURE OF EXPOSURE
Category of Exposure Definition and example
Mild Exposure Superficial wounds, SQ injection and
small bore needles
Moderate exposure Percutaneous superficial exposure
with solid needle eg. Needle stick
penetrating gloves
Severe exposure Percutaneous with large volume. Eg .
Deep wound

26. HIV STATUS & SOURCE OF EXPOSURE
Source of HIV
status
Definition of Risk in source
HIV negative Source is not HIV infected but consider HBV and
HCV
Low risk HIV positive an clinically asymptomatic
High risk HIV positive and clinically symptomatic (see WHO
clinical staging)
Unknown Status of patient I unknown, and neither the
patient nor his/her blood is available for testing(
injury during medical waste management the
source patient might be unknown.)
-The risk assessment will be based only upon
the exposure (HIV Prevalence in the locality can

27. PEP EVALUATION
EXPOSURE Status of Source
HIV+ &
Asymptomatic
HIV+ &
Clinically
symptomatic
HIV status
Unknown
Mild Consider 2 Drug
PEP
Start 2 Drug
PEP
Usually no PEP
OR consider 2
Drug PEP
Moderate Start 2 drug PEP Start 3 Drug
PEP
Same as above
Severe Start 3 drug PEP Same as
above
Same as above

28. DOSAGE OF THE DRUG FOR PEP
Medication 2 Drug Regimen 3 Drug Regimen
Zidovudine(AZT
)
300 mg Twice a day 300 mg twice a day
Lamivudine (3
TC)
150 mg twice a day 150 mg twice a day
Protease Inhibitors 1st choice:
Lopinavir/Ritonavir 400/100 mg
twice a day with meals
2nd choice: Nelfinavir(NLF) 1250mg
twice a day or 750 mg three times
a day with empty stomach
3rd Choice: indinavir(ind) 800mg
every 8 hours and drink 6-8 litres

29. Note: If Protease inhibitor is not available and the
3rd drug is indicated, one can consider using
Efavirenz (EFV 600 mg, once daily). Monitoring
should be instituted for side effects of this drug
e.g. CNS toxicity such as nightmares, insomnia etc.

30. FOLLOW UP
• Follow up for Drug toxicity monitoring : minimally
CBC and LFT at baseline and at 2 weeks
• Repeat HIV testing of exposed staff per protocol
(3weeks-3 months-6months)

31. REQUIREMENT FOR PEP PROGRAMME
• Access to clinicians during all hours
• Easily accessible antiretroviral agents for PEP
• On-site or available within 24 hours
• Availability of trained personel for counselling
• Display PEP protocol around working environment/clinic
• Conduct regular protocol trainings for all employees to
keep then updated

32. KEY POINTS
• Standard precautions must be followed for ALL patients
• Use of standard precautions could reduce the risk of
blood borne and airborne infections
• Nurse’s have a key role in
• Following standard protocols
• Educating other heath care personel
• Preventing occupational exposure
• Protecting self and others from blood borne pathogens
including HIV and Hep B

33. KEY POINTS
• PEP Significantly reduces the risk of HIV transmission from
occupational exposure
• Existing PEP protocol should be followed
• Ideally PEP should be given within 2 hours and not late
than 72 hours after exposure
• Exposured health care providers should be monitored for
side effects and adherence

34. CASE SCENARIO
• While assisting in surgery, Nurse X, working in OT
punctures her finger with contaminated suture needle;
drops of needle holder with suture needle on the sterile
field and asks the nurse Y to remove her gloves
-The wound is not bleeding much, so she “milks” the
punctures finger
-Nurse Y pours Betadine over the finger and helps Nurse X
to re-glove.
-She removes the needle holder from the field and
continues assisting with surgery.

35. CASE SCENARIO; QUESTIONS
1. Is this appropriate management of needle stick injuries?
2. How should the situation have been handled?

36. ANSWERS
1. No.
Nurse should place a contaminated needle into the
sharps container
2. She should remove gloves first;
• Should not squeeze the wound; instead, she should
wash her hands with soap and water;
• Should report the needle stich injury to the
appropriate administrative staff and follow protocols
for post exposure prophylaxis

39. REFERENCES
• WHO medical waste guideline
• Center of disease control (CDC) , sharps handling 2020.
•