NEEDLESTICK INJURY.pptx

Needle stick Injury ⚫ What is Needle stick injury? ⚫ Who are at the higher risk? ⚫ Risk ⚫ How needle stick injury takes place? ⚫ Management ⚫ Post exposure prophylaxis ⚫ How to prevent needle stick What is needle stick injury? ⚫ Needle stick injury are wounds caused by needles the accid...

Needle stick Injury ⚫ What is Needle stick injury? ⚫ Who are at the higher risk? ⚫ Risk ⚫ How needle stick injury takes place? ⚫ Management ⚫ Post exposure prophylaxis ⚫ How to prevent needle stick What is needle stick injury? ⚫ Needle stick injury are wounds caused by needles the accidentally puncture the skin. or ⚫ It is percutaneous injuries are wounds caused by penetration of the skin accidently by needle CONT… ⚫ These injuries are hazard for people who work with hypodermic syringes and other sharp equipment. Who are at the higher Risk ? ⚫ Nursing staff ⚫ Physicians ⚫ Surgeons ⚫ Emergency care provider ⚫ Dentists ⚫ Dental assistants ⚫ Interns ⚫ Laboratory technicians ⚫ Students ⚫ Others MAINLY: H e p a t i t i s B H e p a t i t i s C H I V others: Ro cky m o untai n fever Myco S yp h i lbi a s c te r i osis Go no r r hea Myco p l asm o s i s to xo p l asm o s i s Tuber culo sis Blast m yco sis Cr ypto co ccus' s Mal ar ia Her pes Br u ce l l o sis 3% 30% 0.03% How does needle stick injury occur? 1. Recapping needles 2. Disposing off needles 3. Administering injection 4. Drawing out blood Recappin ⚫ Most common cause g:- ⚫ 25-30% NSI occur while recapping the needle with two handed method ⚫ Extremely dangerous to hold a needle in one hand and attempt to cover it with a small cap held in the other hand Improper disposal:Forgetfulne ss • Doctor forgets to dispose off the needles. Inconvenient disposal system • When there is lack of puncture proof disposal systems or containers specially for disposing off needles. Lack of motivation Administrating injections and drawing out blood ⚫ Usually while administrating local anesthesia or drawing out blood during any kind of procedure; ⚫ if the patient (mostly children) moves and the doctor is not steady with his work he can accidently prick himself. Handling trash and dirty items ⚫ When the needles are disposed off in garbage bags instead of properly disposing them into puncture proof disposing containers. ⚫ So the people who handle the garbage etc. would eventually end up hurting themselves because the needle would puncture Manageme nt PANIC!! ⚫ DONT ⚫ Terminate procedure ⚫ Remove the gloves ⚫ Encourage the bleeding and wash with running water or soap.(DO NOT SCRUB) ⚫ Use DISINFECTANT or SALINE ⚫ Notify your supervisor immediately ⚫ Seek for medical help ⚫ Should document the incident, with complete details of the incident. The injury source, date and time, whether the needle had blood on it or not etc. Post Exposure Prophylaxis prophylaxis, also known as post-exposure prevention (PEP), is any preventive medical treatment started after exposure to a pathogen in order to prevent the infection from occurring. ⚫ Post-exposure ⚫ We will send blood sample of both the source (patient) and the exposed(health care provider HCP or doctor) for testing. we check for HBsAG in source the ⚫ For Hep C we check for antibody to Virus C viral load and ALT levels. Hep ⚫ For HIV antibodies to HIV ⚫ For Hep B Virus HEPATITIS B VIRUS ⚫ IF; THE SOURCE PT. IS +ve FOR HBsAG AND THE EXPOSED DOCTOR IS NOT VACCINATED: THEN ⚫ The DOCTOR should receive vaccine series ⚫ Should receive single dose of HB immunoglobulin.  IF; THE SOURCE PT. IS +ve FOR HBsAG AND THE EXPOSED DOCTOR IS VACINATED: THEN ⚫ should be tested for antiHBs and if the levels are lower than 10 iu/ml ; if the test is negative, one should get revaccinated by firstly getting HBIG and then restart with vaccine series. ⚫ IF; THE SOURCE PT. IS -ve FOR HBsAG AND THE EXPOSED DOCTOR IS NOT VACCINATED: THEN ⚫ The DOCTOR should get vaccinated. ⚫ IF; THE SOURCE PT. IS -ve FOR HBsAG AND THE EXPOSED DOCTOR IS VACCINATED: THEN ⚫ No further action is needed. ⚫ IF THE SOURCE PT. REFUSES TESTING / THE SOURCE IS UNKNOWN AND THE EXPOSED DOCTOR IS NOT VACCINATED: THEN ⚫ Should receive HB series. ⚫ HBIG should be considered.  IF THE SOURCE PT. REFUSES TESTING / THE SOURCE IS UNKNOWN AND THE EXPOSED DOCTOR IS VACCINATED: Then ⚫ Management should be individualized. Hepatitis C Virus ⚫ As there are no vaccines yet available to prevent hepatitis C, so after getting pricked with the a hepatitis source needle one should Start testing for; Antibody to HCV Viral load (RNA levels in serum) Liver enzyme activity (ALT) Repeat testing 2-8weeks later as well, and if infection is detected, the exposed DOCTOR should consult a specialist. Human immunodeficiency virus ⚫ IF THE SOURCE PT. HAS DS ; AI THEN  exposed doctor should be counselled about the risk of infection.  And if the initial testing is –ve the exposed doctor should be retested 6 weeks, 12 weeks and 6 months ⚫ IF THE SOURCE PT. IS HIV +VE for HIV; THEN  exposed doctor should be tested for HIV infection immediately.  And if the initial test is –ve then the exposed doctor should be retested 6weeks, 12 weeks and 6 months after the exposure. ⚫ IF THE SOURCE PT. REFUSES for TESTING; THEN:  The exposed doctor should be asked to seek medical advice for any febrile illness within 12 weeks.  refrain from blood donation and take appropriate precautions. And if the initial testing is –ve the exposed doctor should be  retested 6weeks, 12 weeks and 6 months after the exposure.  ⚫IF SOURCE IS TEXTED AND FOUND – ve: THEN  baseline testing of the exposed DOCTOR with follow up testing12 weeks later. ⚫ IF SOURCE CANNOT BE IDENTIFIED:  serological testing must be done and decisions must be individualized. Recapping ⚫ In situations when recapping is necessary , the workers should be well aware that they do not move the needle towards unprotected hand. ⚫ ONE HANDED METHOD; (SCOOPING); Recapping can be safe when people lay the cap on a flat surface and scoop it on 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. OTHER PREVENTION GUIDLINES ⚫ NSI usually occur when workers dispose off needles ⚫ Occur when workers use special containers for needle and sharps. ⚫ Wide mouth puncture containers. ⚫ Replace containers before completely filled. Employee training: Employees should be trained and taught the proper protocol of needle and sharp handling along with safety protocol against infected patients of HIV and hepatitis; that is FULL BARRIER TEHINQUIE; ⚫ Double masks. ⚫ Double gloves. ⚫ Correct sterilization protocol. ⚫ Disinfection on surface.