Needles must be handled with care, as, while a pricked finger may not seem serious, it can lead to a serious, even life-changing, infection with a blood-borne virus, such as Hepatitis B & C or HIV. There is no vaccine or cure for some of these viruses. Show Asides from needles, any sharp object, such as a scalpel, fragment of broken glass, etc. could pose an infection risk. Collectively, these are referred to as 'sharps'. Who is at risk?Although in theory anybody could come across a used needle or other potentially contaminated sharp object, the risk is most common for people in the following occupations:
As well as being used widely in hospital settings, clinics and nursing homes, needles can be found almost anywhere, including derelict buildings and alleyways, due to their use by drug addicts. HIV is particularly common amongst these drug users, necessitating extreme care during clean-up. Should a needle contaminated with blood puncture or scratch the skin, any infections within that blood may be transmitted to the injured person. Known as a needle-stick injury, even the tiniest wound could become infected. All possible care must be taken to avoid these injuries. Needles should only be disposed of by trained persons wearing the right personal protective equipment (PPE). Safety precautions There are several simple yet effective ways to protect against needle-stick injuries:
If you receive a needlestick injuryIn most cases it is unknown whether the needle is infected, therefore it is necessary to act as if it is. Following a needlestick injury, you should: 1. Gently squeeze the area around the puncture, encouraging it to bleed. DO NOT suck the wound To avoid infection with blood-borne diseases more generally, you should:
In situations where employees are likely to be exposed to blood / body fluids or used needles then the employer is responsible for ensuring that employees are provided with the appropriate equipment to protect against needle-stick injuries. This article is for guidance only and should not be used in place of recognised training and procedures. PROTOCOL
POST-HIV EXPOSURE MANAGEMENT / PROPHYLAXIS (PEP) Occupational exposure: Occupational exposure refers to exposure to potential blood-borne infections (HIV, HBV and HCV) that occurs during performance of job duties. “Exposure” which may place an HCP at risk of blood-borne infection is defined as:
What is infectious and what is not?
Protocol: It is necessary to determine the status of the exposure and the HIV status of the exposure source before starting post exposure prophylaxis (PEP). Step 1: Immediate measures For skin — if the skin is broken after a needle-stick or sharp instrument: · Immediately wash the wound and surrounding skin with water and soap, and rinse. Do not scrub. · Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine). After a splash of blood or body fluids on unbroken skin: · Wash the area immediately · Do not use antiseptics For the eye: · Irrigate exposed eye immediately with water or normal saline. Sit in a chair, tilt head back and ask a colleague to gently pour water or normal saline over the eye. · If wearing contact lens, leave them in place while irrigating, as they form a barrier over the eye and will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal manner. This will make them safe to wear again · Do not use soap or disinfectant on the eye. For mouth: · Spit fluid out immediately · Rinse the mouth thoroughly, using water or saline and spit again. Repeat this process several times · Do not use soap or disinfectant in the mouth · Consult the designated physician of the institution for management of the exposure immediately.
Step II: Prompt reporting: a) All needle-stick/sharp injuries should be reported to the immediate supervisor, and then to the Casualty Medical Officer. b) An entry is made in the Needle-Stick Injury Register in the Casualty. Step III: Post exposure treatment: The decision to start PEP is made on the basis of degree of exposure to HIV and the HIV statusof the source from where the exposure/infection has occurred. More so, it should begin as soon as possible preferably within two hours, and is notrecommended after 72 hours. PEP is not needed for all types of exposures:The HIV seroconversion rate of 0.3% after an AEB (accidental exposure to blood) (for percutaneous exposure) is an average rate. The risk of infection transmission is proportional to the amount of HIV transmitted, which depends on the nature of exposure and the status of the source patient. A baseline rapid HIV testing of exposed and source person must be done for PEP. However, initiation of PEP should not be delayed while waiting for the results of HIV testing of the source of exposure. Informed consent should be obtained before testing of the source as per national HIV testing guidelines. First PEP dose within 72 hours A designated person/trained doctor must assess the risk of HIV and HBV transmission following an AEB. This evaluation must be quick so as to start treatment without any delay, ideally within two hours but certainly within 72 hours; PEP is not effective when given more than 72 hours after exposure. The first dose of PEP should be administered within the first 72 hours of exposure. If the risk is insignificant, PEP could be discontinued, if already commenced. Step IV: Counselling for PEP Exposed persons (clients) should receive appropriate information about what PEP is about and the risk and benefits of PEP in order to provide informed consent for taking PEP. It should be clear that PEP is not mandatory. Step V: Psychological support Many people feel anxious after exposure. Every exposed person needs to be informed about the risks, and the measures that can be taken. This will help to relieve part of the anxiety. Some clients may require further specialised psychological support. Step VI: Documentation of exposure IMPORTANT: Seek expert opinion in case of · Delay in reporting exposure (> 72 hours). · Unknown source · Known or suspected pregnancy, but initiate PEP · Breastfeeding mothers, but initiate PEP · Source patient is on ART · Major toxicity of PEP regimen. Step VII: Follow-up of an exposed person Whether or not post-exposure prophylaxis is started, a follow up is needed to monitor for possible infections and to provide psychological support. Clinical follow-up In the weeks following an AEB, the exposed person must be monitored for the eventual appearance of signs indicating an HIV seroconversion: acute fever, generalized lymphadenopathy, cutaneous eruption, pharyngitis, non-specific flu symptoms and ulcers of the mouth or genital area. These symptoms appear in 50%-70% of individuals with an HIV primary (acute) infection and almost always within 3 to 6 weeks after exposure. When a primary (acute) infection is suspected, referral to an ART centre or for expert opinion should be arranged rapidly. An exposed person should be advised to use precautions (e.g., avoid blood or tissue donations, breastfeeding, unprotected sexual relations or pregnancy) to prevent secondary transmission, especially during the first 6–12 weeks following exposure. Condom use is essential.Drug adherence and side effect counselling should be provided and reinforced at every follow-up visit. Psychological support and mental health counselling is often required. Laboratory follow-up Exposed persons should have post-PEP HIV tests. HIV-test at 3 months and again at 6 months is recommended. If the test at 6 months is negative, no further testing is recommended. What happens if you get pricked by a used needle?Needle stick injuries can also happen at home or in the community if needles are not discarded properly. Used needles may have blood or body fluids that carry HIV, the hepatitis B virus (HBV), or the hepatitis C virus (HCV). The virus can spread to a person who gets pricked by a needle used on an infected person.
What should a healthcare provider do immediately after experiencing a needlestick?Workers Please Note. Wash needlesticks and cuts with soap and water.. Flush splashes to the nose, mouth, or skin with water.. Irrigate eyes with clean water, saline, or sterile irrigants.. Report the incident to your supervisor.. Immediately seek medical treatment.. What is the needlestick policy in the hospital?1 The recipient of the Needlestick injury should contact Occupational Health immediately between 8am and 5pm or A&E RVI/EAU FRH outside of these hours for immediate advice and follow up. All incidents occurring outside of 8am and 5pm must be reported to Occupational Health by the recipient as soon as possible.
What is accidental needle stick injury?Needlestick injuries are wounds caused by needles that accidentally puncture the skin. Needlestick injuries are a hazard for people who work with hypodermic syringes and other needle equipment. These injuries can occur at any time when people use, disassemble, or dispose of needles.
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