NEEDLE STICK INJURY & PROPHYLAXIS

Needle Stick Injury WHAT ?

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.
When not disposed properly needles can become
concealed in linen or garbage and can injure other
workers.
It can transmit infectious diseases specially blood borne
viruses.

What kinds of devices usually cause sharp

injuries?
Hypodermic needles
Blood collection needles
Suture needles
Needles used in IV delivery systems
scalpels

Oral & maxillofacial Surgery

Local Anesthesia
Exposed ends of dental wires (IMF)
Irrigation
Suturing

What infections can be caused by

needlestick injuries?
Needlestick injuries can expose workers to a number of
bloodborne pathogens that can cause serious or fatal
infections. The pathogens that pose the most serious
health risks are
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
Human immunodeficiency virus (HIV)the virus that
causes AIDS

RISKS OF SEROCONVERSION DUE TO SHARP

INJURIES
VIRUS

RISK

HBV

6-30%

HCV

0.4 - 2%

HIV

0.3%

How common are needlestick injuries among

health care workers?
Estimates indicate that 600,000 to 800,000 needlestick
injures occur each year.
Unfortunately, about half of these injuries are not
reported.
Always report needlestick injuries to your employer to
ensure that you receive appropriate follow up care.

Violations In Dental Office

improper disposal of biohazardous waste
improper biological monitoring of sterilizer
improper disposal of sharps
improper hand hygiene
improper storage of dental instruments
improper flushing of dental water lines
improper disinfection of surfaces
improper instrument debridement
lack of PPE
lack of written exposure control plan

 failure to sterilize handpieces

lack of written protocol for instrument processing & sterilization
lack of verification of employee hepatitis B vaccination inability
to verify instrument sterilization
repeated use of single use disposables
cross contamination of surfaces
failure to use surgical gloves when providing surgical services
failure to use utility gloves when handling contaminated items in
sterilization area
failure to separate contaminated areas from non-contaminated
areas in the sterilization area

Who are at RISK ?

Any worker who may come in contact with needles is at risk.
Nursing staf
Emergency care providers
Surgeons & O.T. Staf
Lab workers
Doctors
Housekeeper/ waste handlers

Sharps Injuries: What to Do Following a Sharps

Injury
Immediate First Aid
Encourage puncture site to bleed by applying pressure (do not suck).
Wash injury site liberally with soap and running water for several minutes.
Do not scrub as this may inoculate virus into the tissues. Cover with a
waterproof plaster.
Wash exposed eyes thoroughly with running water or eye wash solution.
Remove contact lenses prior to washing eyes.
Splash of oral mucous membranes. Rinse vigorously with water and spit
out.
Report incident immediately to the practice infection control lead or
Registered Provider.

 Recheck medical history of patient and ask about risk behaviors

for BBV:
Promptly contacttheir Occupational Health service for an urgent
risk assessment of the incident and whether they will require post
exposure prophylaxis.
If advised to do so, arrange for blood sample to be taken from the
source patient for testing for HIV, HBV, and HCV.

HBV Post exposure prophylaxis

Need for HBIG administration and HBV vaccination depends on
the exposure, and HBV status of the source and the exposed.

 Give PEP as soon as possible, preferably within 24 hours.

PEP can be given to pregnant women.
Follow Up

-Perform follow-up anti-HBs testing in persons who

receive hepatitis B vaccine.
-Test for anti-HBs 12 months after last dose of vaccine.
-Anti-HBs response to vaccine cannot be ascertained if
HBIG wreceived in the previous 34 months.

HCV- PEP
No efective vaccine or chemo prophylactic agent for preventing
HCV infection after accidental occupational exposure.
For the source, perform testing for anti-HCV.
For the person exposed to an HCV-positive source
perform baseline testing for anti-HCV and ALT activity.
Follow Up
- Perform baseline and follow-up testing for anti-HCV and alanine
aminotransferase (ALT) 46 months after exposures.
- Perform HCV RNA at 46 weeks if earlier diagnosis of HCV
infection desired.
- Confirm repeatedly reactive anti-HCV enzyme immunoassays
(EIAs) with supplemental tests.
Data indicate that antiviral therapy might be beneficial when

HIV - PEP
HIV should be evaluated within hours (rather than days) after their
exposure and should be tested for HIV at baseline (i.e., to establish
infection status at the time of exposure).
If the source person is seronegative for HIV, baseline testing or further
follow-up of the exposed person normally is not necessary.
For HIV PEP, the evaluation also should include information about
medications the exposed person might be taking and any current or
underlying medical conditions or circumstances (i.e., pregnancy, breast
feeding, or renal or hepatic disease) that might influence drug selection.
Most occupational HIV exposures do not result in the transmission of
HIV, potential toxicity must be carefully considered when prescribing
PEP.

 If indicated, start PEP as soon as possible after an exposure.

Reevaluation of the exposed person should be considered within
72 hours postexposure, especially as additional information about
the exposure or source person becomes available.
Administer PEP for 4 weeks, if tolerated.
If a source person is determined to be HIV-negative, PEP should
be discontinued.

Follow Up
Perform HIV-antibody testing for at least 6 months
postexposure (e.g., at baseline, 6 weeks, 3 months, and 6
months).
Perform HIV antibody testing if illness compatible with
an acute retroviral syndrome occurs.
Advise exposed persons to use precautions to prevent
secondary transmission during the follow-up period.
Evaluate exposed persons taking PEP within 72 hours
after exposure and monitor for drug toxicity for at least 2
weeks

 BASIC REGIMEN
Zidovudine (RETROVIR; ZDV; AZT) + Lamivudine (EPIVIR;
3TC); available as COMBIVIR
ZDV: 600 mg per day, in two or three divided doses.
3TC: 150 mg twice daily.

Guidelines: Sharps disposal

containers
Must be puncture-resistant
Sides and the bottom must be leakproof.
Must be labeled or color-coded red to warn that the contents are
hazardous
Must be closable
Must be kept upright to keep the sharps & any liquids from
spilling out
Must be replaced routinely & not overfilled
Disposal containers that are reusable must not be opened,
emptied, or cleaned manually or in any other manner that would
expose workers to the risk of injury
Contaminated sharps must never be sheared or broken.

 Recapping , bending or removing needles is permissible only if

there is no feasible alternative or if such actions are required for
a specific medical or dental procedure
- If recapping, bending, or removal is necessary, employers must
ensure that workers use either a mechanical device or a onehanded technique; the cap must not be held in one hand while
guiding the sharp into it or placing it over the sharp
One-handed "scoop" technique
uses the needle itself to pick up the cap, and then the cap is
pushed against a hard surface to ensure a tight fit onto the device;
the cap may be held with instrument and placed over the needle

THANK YOU!