NEEDLE STICK INJURIES( NSI )

KEJADIAN ‘NEEDLESTICK INJURY’ YANG DILAPORKAN

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NEEDLE STICK INJURIES What are NSI ? What are the hazards of NSI ? How common are NSI ? How do NSI occur ?

How can NSI be prevented ?

•Eqiupment design.•Nature of procedure.•Condition of work.•Staff experience.•Recapping.

WHAT ARE NSI ? Are wounds caused by needles that

accidentally puncture the skin. Hazards for people who work with

hypodermic syringes and other needle equipment.

Injuries occur when people use, disassemble or dispose of needles.

Cont.

When not dispose of properly, needles can become concealed in linen or garbage and injure other workers.

Transmit infectious diseases especially blood borne viruses.

Despite published guidelines and training program, NSI remain an on-going problem.

WHAT ARE THE HAZARDS OF NSI ?

Accidental punctures by contaminated needles can inject hazardous fluids into the body through skin.

Potential for injection of hazardous drugs. Injection of infectious fluids, especially blood

is the greatest concern. Accidental injection of blood-borne viruses is

the major hazard of NSI, especially HIV, Hep B and Hep C.

Cont.

The risk of infection after exposure to infected blood varies by blood-borne pathogen.

• HIV infected blood 0.3%

• Hepatitis B Virus 30%

• Hepatitis C Virus 10%

NSI transmit many other diseases involving viruses, bacteria, fungi, and other microorganism to Health Care Workers, Lab Researchers and Veterinarian staff.

Cont.

The diseases include :Blastomycosis Brucellosis Cryptococcosis Diptheria Cutaneous Gonorrhea

Herpes Malaria Mycobacteriosis

Syphilis Tuberculosis Toxoplasmosis Sporotrichosis Staph Aureus Strep Pyogenes Mycoplasma Cariae Rocky Mountain Spotted Fever

Many transmitted in rare isolated areas.

NSI - serious consequences.

HOW COMMON ARE NSI ? Very common hazard. 1/3 of nursing and laboratory staff

each year. Underreporting of injuries :

•How serious is the problem ?

•How well prevention programs work ?

HOW DO NSI OCCUR ? NSI is the result of an accident with a

needle. Injury at every stage of use, disassembly

or disposal. 30 - 50% of injuries occur during

clinical procedures.

Cont.

How Do NSI Occur ? Equipment Design Nature Of Procedure Condition Of Work Staff Experience Recapping and Disposal are factors that influences

this occurrence.

EQUIPMENT DESIGN

Safer innovative devices using protected needle devices or needle free system with self sealing ports would alleviate many of the injuries.

NATURE OF PROCEDURES Critical situations during clinical procedures

include :

• Withdrawing needle from a patient, especially staff attends to bleeding patients while disposing of the needle.• Having the device jarred by the patient.• Pulling the needle out of the rubber stopper of a vacuum tube which can jab the hand in a rebound effect.

NSI commonly occur when workers try to do several things at the same time, especially disassembling or disposing of needles.

CONDITION OF WORK Work condition that might contribute to an

increase in the number of NSI include :

Staff reductions, where nurses, lab. Personnel and student assume additional duties.

Difficult patient care situations.

Working at night with reduced lighting.

STAFF EXPERIENCE

New staff / student > experience staff.

RECAPPING 25 - 30% of all the NSI. Single most important cause. It is extremely dangerous to hold a needle

in one hand and attempt to cover it with a small cap held in the other hand.

Injuries can occur in 3 other ways :

Cont.

The needle misses the cap and accidentally enters the hand holding it.

The needle pierces the the cap and accidentally enters the hand holding it.

The poorly fitting cap slips off a recapped needle and the needle stabs the hand.

HOW CAN NSI BE PREVENTED ? “Prevention is better than cure” A comprehensive NSI prevention program

would include : Recommend guidelines Safe recapping procedures Effective disposal system Surveillance programs Employee training Improved equipment design

EMPLOYEE TRAINING Workers need to know how to properly

use, assemble, disassemble and dispose of needles :

• Need to understand the risk associated with NSI.

• Know the proper means to prevent them.

Cont.

The program training should address :

• Risk of injury.• Potential hazards.• Recommend precautions for use and disposal of needles.• Procedure for reporting injuries.• The importance of Hepatitis B vaccination where appropriate.

RECOMMENDED GUIDELINES Needles, scalpel blades and other sharp instruments --

workers should consider these as potentially infectious and handle them with care to prevent accidental injuries.

Disposable needles and syringes, scalpel blades and other sharp items -- workers should place this in puncture resistant container located near the area of use, avoid overfilling.

Recapping -- workers should not recap needles by hand or purposely bend, break or remove them from disposable syringes or otherwise manipulate them by hand.

Cont.

Reasons for recapping despite knowing about the potential hazards :

• To protect themselves when disassembling a non disposable needle device with an exposed contaminated needle.• To protect themselves from exposed needles when several items were carried to a disposal box in a single trip.• To store a syringe safely between uses if its content were to be administered in 2 or more doses at different times. • To protect other people from crowded conditions on the way to the disposal bin.

Guidelines from CDC recommends that workers do not recap ( or bend or cut ) needles but dispose of them directly into approved, puncture proof containers.

SAFE RECAPPING PROCEDURES

In situations where recapping is considered necessary, safe approaches should be developed.

Workers should never move an exposed needle tip towards an unprotected hand.

Cont.

1.0 SINGLE HANDED SCOOPING Recapping can be safe when people lay the

cap on a flat surface and scoop it onto the tip of the syringe held in one hand.

They must keep the free hand away from the sheath and well behind the exposed needle.

2.0 RECAPPING DEVICES

?

DISPOSAL NSI commonly occur when workers

dispose of needles. Occur when workers use special containers

for needles and sharps. Occur when needles are disposed of

improperly in regular garbage or is lost in the workplace.

Cont.

DISPOSAL Wide mouth puncture proof containers. Readily accessible to reduce recapping. Replace containers before completely filled. Sealed, collected and dispose off safely as for

biomedical waste.

All staff should report every incident in which they find needles left at the bedside or thrown into theregular garbage.

SPECIAL CONTAINERS Up to 30% NSI occur when workers attempt to

dispose of needles using sharp containers. Accident occur at every step : • While carrying the needle to the disposal container, especially when the needle is uncapped and mixed with other trash.• While placing the needle into the disposal container, especially if the container is overfilled.• While emptying the disposal container instead of sealing them for disposal.

IMPROPER DISPOSAL

Forgetfulness ?

Lack of motivation ?

Inconvenient disposal system ?

Clinical Waste Management Procedures Safe handling requires proper segregation

at source into the appropriate groups. Staff are responsible for segregation of

clinical waste into appropriate approved receptacles.

Guidelines on Disposal

Clinical Waste Group

Containment Waste Type

Group A & E Yellow Bag Soft wastes, human parts etc.

Group B & D Sharp Container Sharp instruments, expired drugs

Group C Blue Bag Infectious wastes

 

Group B Sharp instruments and objects

Syringes Needles Cartridges Scalpel blades

Group D Pharmaceutical wastes

Expired drugsSeraVaccines

Using Sharp Containers Assemble sharps container correctly prior to use,

ensure that the top of the unit is pressed firmly into place and is secure prior to use.

The sharps container is normally exchanged on a one for one basis and only placed into the designated locations (lab or workbench).

Do not fill the container more than ¾ of its capacity.

Ensure that the lid aperture is sealed when ¾ full. The authorized personnel shall sign and date the

label provided by FMS. Tag the sharps container with the labels. Deposit the containers into FMS approved

wheeled bin, carry the sealed containers only by the handle on the unit and at arms length away from the body. It is recommended that the sharps container is not placed into a yellow bag.

SURVEILLANCE Still a serious lack of information about the

various factors that cause accident with needles.

In depth analysis of needle stick accidents is an important tool for obtaining this information.

Cont.

The goals of these programs should include :

• Determining the rate of NSI.• Investigating the factors that cause the injuries.• Ensuring that injured workers receive proper treatment.• Identifying areas in which the prevention program needs improvement.• Eventually providing practical strategies for dealing with the problem.

CONTINUED INNOVATION There is a need for further investigation and

innovation to develop means for preventing NSI.

These investigations should aim :

Cont.

To identify the type and designs of needle instruments that are potentially capable of causing NSI.

To understand better how needle devices are normally handled in the workplace and how they cause injuries ( Job Hazard Analysis ).

To find methods that eliminate the need to move hands towards the tip of contaminated needles or to manually disassemble contaminated needle equipment.

END

THANK YOU FOR YOUR ATTENTION