Protection from Needlestick Injuries

Protection from Needlestick Injuries

• Avoid using needles when safer alternatives are available.
• Never recap needles.
• Plan for safe handling and disposal of needles before using them.
• Use safety devices provided by employers.
• Help employers select devices that minimize needlestick risks.
• Dispose of used needles in designated sharps containers.
• Inform supervisors about any needlestick hazards in the work environment.
• Familiarize yourself with your workplace's infection control protocols.
• Ensure you are immunized against Hepatitis B.
• Report all needlestick and sharps-related injuries promptly for follow-up care.

Sharps: Handling and Disposal

• Sharps are the most hazardous element of clinical waste.
• Examples of sharps:
  • Needles (injections, sutures, IV cannulae, etc.)
  • Blades (scalpels, razors, lancets)
  • Broken glass (ampoules, vials, bottles)
  • Any other sharp object

Non-Disposable Sharps

• Handle non-disposable sharps with care during all stages:
  • Using
  • Cleaning
  • Disinfecting
  • Storing

Objectives for Sharps Management

• Reduce the risk of Needlestick Injuries (NSI).
• Utilize appropriate sharps receptacles, protocols, and training.
• Every staff member and student is responsible for preventing injury and infection risk.

Preparing for Procedures

• Understand the procedure before attempting it.
• Prepare equipment.
• Familiarize yourself with instruments and devices before usage.
• Develop safe habits.
• Ensure all necessary items are within reach.
• Maintain awareness of sharps throughout the procedure.
• Keep the sharps disposal container within reach and correctly placed.
• Explain the procedure to the patient and their role in it.
• Support the limb against an immovable surface.
• Take extra precautions with patients who need assistance supporting limbs, require restraint (violent or uncooperative), or are children.

Precautions During Procedures

• Avoid excessive force.
• Position yourself correctly.
• Keep your fingers behind the sharp.
• Do not recap needles.
• Be aware of the sharp tip of vacutainer needles, which is covered by the gray rubber.
• Do not bend or break needles
• Dispose of Butterfly needles as a complete set.

Vacutainer System Disposal

• Use Venoject and keyhole aperture methods when disposing of the Vacutainer system
• Do not leave sharps lying around on drapes, poked into mattresses, or on beds.
• Use a designated sharps disposal container.

Syringe and Needle Disposal

• Dispose of syringes and needles as a unit.
• Syringes with exposed needles (mainly during emergencies) must be carried in a receiver.
• Never resheath needles.
• Drop sharps directly into the container (do not push).
• Close the container when it's ¾ full.

Precautions After Procedures

• Avoid sudden movements if you have a sharp object in your hand.
• Keep sharps visible to those around you.
• Avoid carrying sharps around by keeping a sharps container close at hand.
• Maintain awareness of the sharp until it is safely disposed of.
• Never attempt to retrieve anything from a sharps container.
• If the sharps container is full, obtain a new one.
• Never leave sharps lying around.

Post-Exposure Prophylaxis (PEP)

• PEP refers to medications taken after a possible exposure to HIV to reduce the risk of infection.
• Drug Regimens:
  • NRTI Dual Regimen:
    • Tenofovir 300 mg + emtricitabine 200 mg 1 tab daily
    • Tenofovir 300 mg 1 tab daily PLUS lamivudine 300 mg 1 tab daily
    • Lamivudine 150 mg + zidovudine 300 mg 1 tab 12 hourly
  • PI Combination or INSTIs:
    • Atazanavir 300 mg PLUS ritonavir 100 mg daily
    • Aluvia® (lopinavir/ritonavir 200/50 mg) 2 tabs 12 hourly
    • Dolutegravir 50 mg daily
    • Raltegravir 400 mg 12 hourly
• Drug Considerations:
  • Tenofovir is generally better tolerated than zidovudine.
  • Fixed-dose combinations are preferred.
  • Atazanavir + ritonavir is once-daily and often better tolerated than Aluvia®.
  • Always check for drug-drug interactions.
  • Atazanavir is contraindicated with rifampicin and proton-pump inhibitors (e.g., omeprazole, lansoprazole). Antacids should not be used with raltegravir.
  • Dolutegravir should be avoided in women of childbearing age not on reliable contraception or during the first 8 weeks of pregnancy.
  • If the source patient is on a third-line regimen, salvage therapy, or failing second-line treatment, other ARVs might be necessary.
  • Consult an Infectious Disease Specialist or the Hotline for recommendations in those cases.
  • Avoid nevirapine and abacavir in PEP.

Hepatitis B

• Hepatitis B Post-Exposure Prophylaxis (PEP) Table:
  • Source patient: HBsAg positive, HBsAg negative, or unknown.
  • Vaccination status and antibody response of healthcare worker:
    • Unvaccinated or vaccination incomplete: HepB vaccine (3 doses at monthly intervals) PLUS HBIG, IM, 500 units.*
    • Vaccinated AND known to have HBsAb titre ≥ 10 units/mL#: No treatment.
    • Vaccinated AND HBsAb ≤ 10 units/mL OR unknown: HepB vaccine (3 doses at monthly intervals) PLUS HBIG, IM, 500 units.*
• HBIG:
  • Refer to secondary level of care for HBIG, IM.
  • Administer HBIG as soon as possible, preferably within 24-72 hours after exposure (or within 7 days).
• HBsAb Titres:
  • If obtaining HBsAb titre takes longer than 24 hours, initiate treatment as if vaccinated with HBsAb ≤ 10 units/mL.
  • Repeat HBsAb 1-2 months after the last vaccine dose to ensure an adequate immune response (HBsAb > 10 units/mL).

PEP Follow Up

• Continue counseling.
• Monitor toxicity with blood tests:
  • FBC/LFT/Amylase/Lipid profile: 2 weeks, 4 weeks
  • HIV: 6 weeks, 3 months, 6 months
  • HBV Ag: 6, 9, 12 months

PEP Counseling

• Emphasize adherence to medication for 4 weeks.
• Promote prevention of transmission:
  • Condom use
  • Stop breastfeeding

Possible Side Effects of Antiretroviral Treatment

• Atazanavir/ritonavir: Generally well tolerated. Jaundice with unconjugated hyperbilirubinaemia occurs commonly but is benign; hepatitis.
• Dolutegravir: Usually well tolerated. Avoid during the first 8 weeks of pregnancy and in women of childbearing age not on a contraceptive.
• Emtricitabine/Lamivudine: Generally well tolerated.
• Lopinavir/ritonavir: Diarrhoea, nausea, vomiting, hepatitis.
• Raltegravir: Generally well tolerated. Nausea, fatigue, Stevens-Johnson syndrome.
• Tenofovir: Generally well tolerated. Nausea, diarrhoea, vomiting, nephrotoxicity.
• Zidovudine: Nausea, vomiting, headache, fatigue, anaemia, neutropenia.

Rapid HIV Test

• Rapid HIV tests are used for screening and qualitative detection of antibodies to HIV.
• Examples of rapid HIV tests: SD Bioline, SENSA Tri-line, SmartCheck HIV.
• Sensitivity: 99.9%
• Specificity: 99.9%

ELISA (Enzyme-Linked Immunosorbent Assay)

• ELISA detects the presence of HIV antibodies.
• A blood sample is added to a cassette containing HIV antigens.
• If HIV antibodies are present, they bind to the antigens, causing a color change in the cassette.
• ELISA is a highly sensitive test and was the first one widely used for HIV detection.

This quiz covers essential practices for preventing needlestick injuries and managing sharps in clinical settings. It includes guidelines on safe handling, disposal of needles, and the importance of reporting injuries. Familiarity with workplace protocols and safety devices is also emphasized.