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Sharps Injuries in Healthcare

Setting–
Incidence and Prevention

Associate Professor Datin Dr. Yasmin Abu


Hanifah
Dept of Medical Microbiology
Faculty of Medicine
Universiti Malaya
Kuala Lumpur
Blood-borne pathogens

• Bacteria: • Virus:
Bacillus anthracis HAV, HBV, HCV
Leptospira HIV
Strept.
pneumoniae CMV, HSV, EBV
Borrelia recurrentis Measles
Mycobacterium
leprae Parvovirus B19
Listeria
Poliovirus
Brucella
Yellow fever
• Protozoa:
Malaria
Toxoplasma gondii
Sharps injuries

• How do NSI occur?


devices associated with NSI
activities associated with NSI
discarded needles at hospitals, parks, playing
fields, beaches, public toilets, communal
stairways and alleyways
• USA : ~5.6 million HCWs, 800,000 injuries per
year
• Half unreported
• Average hospital : 30 NSI per 100 beds per year.
Transmission of HBC, HCV, HIV
in Healthcare setting
• Patients ↔ HCW
• Direct inoculation of virus into cutaneous
scratches, skin lesions, abrasions, or
burns, and inoculation of virus onto
surfaces of the eyes, nose or mouth
through accidental splashes
• Blood transfusion/donation
• Surgery
• Percutaneous injections
• Disposal of sharps
Universal Precautions
CDC (MMWR 1988:37(24):377-388)

Aim- to prevent parenteral, mucus membrane


and non-intact skin exposures to HCWs to
blood-borne pathogens

Apply to : Not applied to :


• blood • Tears
• semen • Urine
• vaginal secretions • Feces
• pericardial fluid • Nasal secretions
• peritoneal fluid • Sputum
• CSF • Vomitus
• amniotic fluid • Sweat
• synovial fluid • saliva
• pleural fluid
Standard Precautions

• Handwashing
• Gloves
• Gowns/aprons
• Masks/eye shields/goggles/face
shields
• Appropriate handling and disposal of
waste
• Aseptic techniques
Percutaneous injuries during surgery

• 1990 Tokars, 4 US teaching hospitals


• 1382 operations, 99 injuries (7.2%)
• 5 different surgical specialities:
O&G
General
Orthopaedic
Trauma
Cardiac
• 73% related to suturing
• Highest rates – gynaecologic surgeries
• Others- orthopaedic, cardiothoracic
Tokars et al. Percutaneous injuries during surgical procedures. JAMA 1992. June 3,267(21):2899-90
Risk of virus transmission after percutaneous
injury
Ann-Christine Nyquist. Blood-borne Pathogens and Needlestick. Vol XV Number
1, Jan 2000

Virus Transmission risk %

HBV 6 - 30

HCV 3 - 10

HIV 0.3
Average risk of seroconversion following a
percutaneous exposure to an infected source
Lanphear BP. Epidemiol rev. 1994;16(2):437-50

virus Seroconversion
risk %

HBsAg +ve, 5
HBeAg –ve

HBsAg +ve, 19 - 30
HBeAg +ve

Hep C 1-8

HIV 0.31
Hollow-bore needles and other devices associated with
percutaneous injuries in NaSH hospitals, by % total
percutaneous injuries (n=4.951) June 1995-July 1999.
CDC 1999
Causes of percutaneous injuries with hollow-bore
needles in NaSH hospitals, by % total percutaneous
injuries
(n=3,057) June 1995-July 1999. Source : CDC 1999
Incidence of Sharps Injuries in UMMC
2000 - 2005

YEAR INCIDENCE CASE


2000 43
2001 61
2002 106
2003 111
2004 89
2005 100
TOTAL 510
Incidence of Sharps Injuries in UMMC
by Job Category
(January - December 2005)
30

25
25 * Doctor:
Medical officer - 16
20
House officer - 9
20
Total case

15
15

10
9
10 8
7

5
2 2
1 1
0
r

an

t
se

nt
t
se

te
t

er

se
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an
an
en

de

as
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oc

ur

ur

ci
ur

st
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ud

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tu

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N

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le

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si
tte
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af

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ss

Te
A

e
al

ic
ta
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ta
A
at
ud

li n
ic

en

en
b.
iv
ed

St

C
D

La
Pr

D
M

er
rt
Po

Job category
Total case

0
2
4
6
8
10
12
Dental Faculty
PTj Trauma & Kecemasan

10 10 10
Operation theater

6
Outpatient clinic

6
Labour ward

5
12U

4
9U

4
8D
5UB 4
4

11U
4

7U
3

7D
3

Laboratory
3

4U
3

Laundry
3

Radiology

Location
2

7E
2

8U
by Locations

13U
2

TSSU
2

10U
1

8E
1

5UA
1

Mortuary
(January - December 2005)

SCN
1

PTj Perubatan Tranfusi


1

Pasca
Incidence of Sharps Injuries in UMMC

Other hospital
1

Disposal Area
Total case

0
10
20
30
40
50
60
54
Hollow bore needle

10
Lancet

7
Stylet

7
Scalpel

7
Suture needle

3
Not known

2
Dental probe
2

Vacuitaner
1

Electro-cautery device

Type of sharps
of Sharp

Liver biopsy needle


1

BMA needle
1

Wire
1

Microtome blade
(January - December 2005)

Skin hook
1

Winged steel needle


Incidence of Sharps Injuries in PPUM by Type
A D
ft u Total case
ri
er n
u g
se us
,B e
ef of
D

0
10
20
30
o

5
15
25
re it
ev em
ic d
e is
p
28

It le Wh os
em ft ile
in a
p a re l
W ro p c
h tr p 17
ile u ro app
p d pr in
B u ed ia g
et tt f te
w in
14

ro
ee g m pl
n i t ac
In
s e m
tr e
p te as
i h
8

re p
p s
nt
o b
D
ar o s ag
at f h
is io m ar
as n p
8

ul
s o ti
- s
em f st b
re in
W b u ep
it lin se
7

pr
h g
d d of ...
S ra
w e r

How it occur?
tu vi eu
in ce sa
g
5

ck
b a o b
y n r l..
e eq .
It
em i te ed u
m ip
4

pi le m
pr fr
er ot o en
t
ce ru m
d d r u
3

si in b
d g be
by How Injuries Occur

e fr r
o o
f m
3

di o
s ...
(January - December 2005)

po
B s al
ef c
o
1

re on
u ...
se
o
1

f
Incidence of Sharps injuries in UMMC

ite
m
1
Staff with exposure to HIV, Hep.B and C

Hepatitis Hepatitis Hepatitis B


Year HIV
B C &C
2000 1 - - -
2001 - - - -
2002 2 2 - -
2003 4 2 - -
2004 - 3 2 -
2005 2 8 2 1
TOTAL 9 15 4 1
Sharps injury management

• Apply first aid


• Report to the supervisor/manager and ICN
• Complete NSI-OSHA form to report
• Take 5 ml blood from source patient and injured
HCW
• Test for HIV, HBV, HCV
• ATT injection and wound dressing
• If source patient was HIV, HBV, HCV positive,
contact ID for counseling, PEP
• Prophylaxis with anti retrovirals started within 2
hours
• Hep B exposure: Ig + vaccine (HBsAb<10mIU/mL)
Help prevent SI –
Be prepared
• Vaccination
• Organise your work area
• Well-lit
• Sharps bins within reach
• Receive training on handling sharps
• Assess any hazards
• Use safety devices to reduce risk
• Consistent evaluation of procedures with intent to
modify to reduce risk
Prevention of sharps injuries –
Be aware

• Keep exposed sharp in view


• Be aware of people and you
• Stop if you feel rushed or distracted
• Focus on your task
• Avoid hand-passing sharps & use verbal
alerts when moving sharps
• Watch for sharps in linen, beds, on the
floor,
or in waste bins (use forceps to handle)
Prevention of sharps injuries -
Dispose sharps with care

• Avoid recapping needles


• Be responsible for the device you use
• Do not remove used needles from disposable
syringes
• Do not bend, break or manipulate used needles
• Activate safety features after use
• Dispose devices in rigid sharps container
• Do not overfill
• Keep fingers away from the opening of the sharps
containers
Conclusion

• Culture of safety.
• Organisation makes SI prevention a
prominent priority
• Management and staff have a shared
commitment to prevent SI
• Staff is encouraged to report SI
promptly
• Appropriate management of
occupational exposure