NEEDLESTICK INJURIES & POST EXPOSURE PROPHYLAXIS MANAGEMENT

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PATIENT & HEALTHCARE WORKER SAFETY (NUR 2002):

PATIENT & HEALTHCARE WORKER SAFETY (NUR 2002) NEEDLESTICK INJURIES / POST EXPOSURE PROPHYLAXIS MANAGEMENT(PEP ) By Christopher Ekpo

Needlestick and other sharps injuries:

Needlestick and other sharps injuries A Percutaneous piercing wound; typically set by a needle point but possibly also by other sharp instruments or objects.

Needlestick and other sharps injuries:

Needlestick and other sharps injuries An occupational exposure is defined as: a needle stick, sharp puncture wound or a splash to mucous membranes (i.e., mouth or eye) with blood or body fluids while caring for your clients.

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Courtesy: inviromedical.com Breakdown of Needlestick Injuries by Procedure. Courtesy:sehd.scot.nhs.uk

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Courtesy: West Indian med. j. vol.59 no.2 Mona Mar. 2010

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Courtesy: West Indian med. j. vol.59 no.2 Mona Mar. 2010

Needlestick and other sharps injuries:

Needlestick and other sharps injuries High-risk procedures All invasive procedures Blood taking Suturing Giving injections Inappropriate disposal of sharps.

Needlestick and other sharps injuries:

Needlestick and other sharps injuries High-risk procedures Recapping needles (Most important) Transferring a body fluid between containers. Poor healthcare waste management practices

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Risk factors for occupational exposure to body fluids include the following: Failure to adhere to universal precautions Using equipment designed without appropriate safety features Performance of exposure-prone procedures ( Cosens, 2010)

Needlestick and other sharps injuries:

Needlestick and other sharps injuries The most common diseases from needle stick injury are: HIV (Human Immunodeficiency Virus), HBV (Hepatitis B Virus) and HCV (Hepatitis C Virus).

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Health care workers are at the risk of infection when there is : a percutaneous injury (e.g. needle-stick or cut with a sharp instrument), contact with the mucous membranes of the eye or mouth,

Needlestick and other sharps injuries:

Needlestick and other sharps injuries contact with non-intact skin (particularly when the exposed skin is chapped, abraded or afflicted with dermatitis) contact with intact skin when the duration of contact is prolonged (e.g. several minutes or more) With blood or other potentially infectious body fluids

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How do you protect yourself from needlestick or other sharps injuries?

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Prevention Training of health care workers in standard precautions. Application of standard precautions Institution of hierarchy of controls Availability & use of appropriate supplies and equipment. Surveillance of work practices.

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Prevention Avoid the use of needles where safe and effective alternatives are available. Avoid recapping needles. Plan for safe handling and disposal of needles before using them. Promptly dispose of used needles in appropriate sharps disposal containers.

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Prevention Report all needle stick and sharps-related injuries promptly to ensure that you receive appropriate follow-up care. Participate in training related to infection prevention.

Needlestick and other sharps injuries:

Needlestick and other sharps injuries Prevention Help your health facility select and evaluate devices with safety features that reduce the risk of needle stick injury. Use devices with safety features provided by your institution (wherever possible). Record and monitor injuries with an injury register in each location of healthcare setting.

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GIUDELINES FOR PEP

Post exposure prophylaxis :

Post exposure prophylaxis Guidelines The post-exposure guidelines should address: Immediate action Follow-up action Record keeping with standardized codes C onfidentiality

Post exposure prophylaxis :

Post exposure prophylaxis Guidelines Bleed area for 3 – 5 minutes(controversial) Wash site immediately with soap and running water Disinfect area for 3 – 5 minutes with 10% iodized polyvidone (povidone iodine) diluted with 3 volumes of water or with a 0.5% chlorine bleach solution.

Post exposure prophylaxis :

Post exposure prophylaxis Guidelines 1:10 dilution of a 5% chlorine bleach solution or 1:6 dilution of a 3% chlorine bleach solution Take a blood sample for baseline HIV, Hepatitis B surface antigen and Hepatitis C antibody status.

Post exposure prophylaxis :

Post exposure prophylaxis Guidelines Pretest confidential counseling should be offered to the health care worker If health care worker have not had Hepatitis B immunoglobulin vaccination, it should be considered

Post exposure prophylaxis :

Post exposure prophylaxis Guidelines Generally PEP works best the first 3-24 hrs after the accident occurred. It can also be started up to 72 hrs after the accident, but not effective after that.

Post exposure prophylaxis:

Post exposure prophylaxis Guidelines Immediately encourage site bleeding while washing the wound and skin sites exposed to blood or body fluids. Wash with soap and water or other antiseptics

CDC guidelines :

CDC guidelines If the exposure is mucosal or the wound is large enough to irrigate, irrigate with copious amounts of saline or other clean fluid.

CDC guidelines :

CDC guidelines The need for tetanus and/or hepatitis B prophylaxis is based on medical history. Health care workers should have been immunized against hepatitis B. Hepatitis A prophylaxis may (rarely) need to be considered depending on the source-patient situation.

CDC guidelines :

CDC guidelines The need for HIV or chemoprophylaxis (antiretrovirals) is based on an assessment of the risk by using the 3-step process developed by the Centers for Disease Control and Prevention (CDC)

CDC guidelines :

CDC guidelines Step 1 : Determine exposure code . Is the source material blood, bloody fluid, other potentially infectious material, or an instrument contaminated with one of these substances? If not, there is no risk of HIV transmission? If yes, what type of exposure occurred? If the exposure was to intact skin only, there is no risk of HIV transmission.

CDC guidelines :

CDC guidelines Step 1 : Determine exposure code . If the exposure was to mucous membrane or integrity-compromised skin, was the volume of fluid small (few drops, short duration) or large (several drops or major splash, long duration)? If small, the category is exposure code 1. If large, the category is exposure code 2.

CDC guidelines :

CDC guidelines Step 1 : Determine exposure code If the exposure was percutaneous, was it a solid needle or a superficial scratch (ie, less severe)? If yes, the category is exposure code 2.

CDC guidelines :

CDC guidelines Step 1 : Determine exposure code Was it from a large-bore hollow needle, a device with visible blood, or a needle used in a source patient's artery or vein (ie, more severe)? If yes, the category is exposure code 3.

CDC guidelines :

CDC guidelines Step 2 : Determine HIV status code . What is the HIV status of the exposure source? If HIV negative, no post exposure prophylaxis is needed. If HIV positive, was the exposure low titer or high titer?

CDC guidelines :

CDC guidelines Step 2 : Determine HIV status code . Low-titer exposures are asymptomatic patients with high CD4 counts These are HIV status code 1.

CDC guidelines :

CDC guidelines Step 2 : Determine HIV status code . High-titer exposures are patients with primary HIV infection, high or increasing viral load or low CD4 counts, or Advanced Acquired Immunodeficiency Syndrome (AIDS)

CDC guidelines :

CDC guidelines Step 2 : Determine HIV status code These are HIV status code 2. If HIV status is unknown or the source is unknown, the HIV status code is unknown.

CDC guidelines :

CDC guidelines Step 3 : Match exposure code with HIV status code To determine if any post exposure prophylaxis is indicated. Post exposure prophylaxis recommendation are as follows:

CDC guidelines :

CDC guidelines Exposure code 1 and HIV status code 1 : Post exposure prophylaxis may not be warranted. Exposure type does not pose a known risk. The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of post exposure prophylaxis

CDC guidelines :

CDC guidelines Exposure code 1 and HIV status code 2 : Consider the basic regimen. Exposure type poses a negligible risk for HIV transmission. A high HIV titer in the source may justify consideration of post exposure prophylaxis.

CDC guidelines :

CDC guidelines Exposure code 1 and HIV status code 2 The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of post exposure prophylaxis.

CDC guidelines :

CDC guidelines Exposure code 2 and HIV status code 1 : Recommend the basic regimen. Most HIV exposures are in this category. No increased risk for HIV transmission has been observed, But use of post exposure prophylaxis is appropriate.

CDC guidelines :

CDC guidelines Exposure code 2 and HIV status code 2 : Recommend expanded regimen. Exposure type represents an increased HIV transmission risk.

CDC guidelines :

CDC guidelines Exposure code 3 and HIV status code 1 or 2 : Recommend expanded regimen. Exposure type represents an increased HIV transmission risk.

CDC guidelines :

CDC guidelines HIV status code unknown : If the source or, in the case of an unknown source, the setting where the exposure occurred suggests possible risk for HIV exposure and the exposure code is 2 or 3, Consider the post exposure prophylaxis basic regimen.

CDC guidelines :

CDC guidelines Basic regimen 4 weeks of: Zidovudine (600 mg/d in 2-3 divided doses) and Lamivudine (150 mg twice daily)

CDC guidelines :

CDC guidelines Expanded regimen : Basic regimen plus either Indinavir (800 mg q8h) or Nelfinavir (750 mg 3 times/d).

References :

References Cosens, B. ( 2010). Needle-stick Guideline http://emedicine.medscape.com/article/784812

References :

References Safe Injection Global Network ( 1998). Strategies for Safe Injection. Retrieved from http://www.injectionsafety.org

References :

References WHO ( 1998). Strategies for Safe Injection. Retrieved from http:// www.who.int/bulletin/archives/77(12 ). pdf

References :

References WHO ( 2010). Best practices for injections and related procedures toolkit. Retrieved from http://www.whqlibdoc.who.int/publications / 2010/9789241599252 eng.pdf

References :

References WHO (2010). Revised Injection Safety Assessment Tool. Retrieved from http://www.who.int/injection_safety/injectionsafety_final-web.pdf

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