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Needle-stick Injuries Among Health Care Workers

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1. Background of the Topic 2. Needle-stick injuries in Ohud Hospital

Dr. Muhammad AL amin

Infection Control Coordinator

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What are Needle-stick injuries?

Wounds caused by needles. Are hazard for the people. Transmit infectious diseases. Blood born viruses.

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Frequency 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.

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Scope of the problem

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.

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Risk of Transmission of Blood born Infection

Occupational Exposure

Risk of Transmission

Hepatitis B Virus 2-40%

Hepatitis C Virus 2.7-10%

HIV 0.3% (1 in 300 chance of infection)

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Factors which increase risk of infection 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%).

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Hazards of Needle stick injuries

Hepatitis B and C. HIV. Brucellosis. Malaria. S. aureus and S. pyogenes. Toxoplasmosis. Tuberculosis.

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How common are needle stick injuries?

Needle stick injuries (too common hazard). Surgical instrument wound. Mucus membranes. Skin contact

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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.

During improper sharp disposal. During clean-up. Recapping: 25 – 30% of all injuries.

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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.

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How can needle stick injuries be prevented Employee training. Recommended guidelines. Safe recapping procedures. Effective disposal systems. Surveillance programs. Improved equipment design.

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Devices Involved in Percutaneous Injuries

Hollow bore needle: Hypodermic needle Winged-steel needle IV stylet Phlebotomy needle

Solid sharp: Suture needle. Scalpel.

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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.

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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

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Health care workers protection

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.

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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.

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Types of injuriesNeedle stick injuries 28 (74%)

Splash to skin and mucus membrane

6 (16%)

Blades (Scalpel) 4 (10%)

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Departments

ICU 15 (39%)

Operating Room (OR)

5 (13)

Medical Wards 4 (10%)

Surgical Wards 4 (10%)

Gynecology and Obstetrics

3 (8%)

Pediatrics and Nursery

2 (5%)

Others 5 (15%)

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State of Vaccination

31 of 38 (81%) were vaccinated for Hepatitis B.

2 needed booster doses. 5 of 38 (13 %) were not

vaccinated.

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Blood Born Diseases in sera of patients

Hepatitis B 9 (24%)

Hepatitis C 7 (18%)

Not Known 20 (58%)

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Time of reporting

Same day 11 (29%)

After 1 day 13 (34%)

After 2 days 5 (13%)

After 3 days 3 (9%)

> 3 days 2 (5%)

Not recorded 4 (11%)

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What is the message of this Surveillance?

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.

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Conclusion 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.

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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

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.

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.

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.

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

Unvaccinated HBIG x 1 and initiate

HB vaccine seriesInitiate HB vaccine series

Initiate HB vaccine series

Previously vaccinated - known responder

-known non-responder

No treatment

HBIG x 1 and initiate revaccination or HBIG x 2

No treatment

No treatment

No treatment

If known high risk source, treat as if source HBsAg positiive

Antibody response unknown

Test exposed person. No treatment if HBsAb positive.If inadequate antibody titer, administer HBIG x1 and vaccine booster

No treatment 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