Needle Stick Injury

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<p>NEEDLE STICK INJURYDr.G.Ashok M.D.,</p> <p>Needle Stick Injury (NSI) By definition, Puncturing of the skin by a needle or similar sharp object - Serious concern for health care professionals</p> <p>Needle stick Injuries come under a category of sharp injuries. Sharps are devices that are intentionally sharp to puncture or cut skin (needles, scalpels, etc.), or become sharp due to accident, such as broken glass tubes.Hypodermic needles Scalpels IV devices Capillary tubes Glass containers Pipettes Others</p> <p>Magnitude of needle stick injury The exact number of needle stick injury occuring annually is difficult to calculate-</p> <p>Lack of data from non hospital settings is a major obstacle In hospital settings the rate is India it is largely underestimated</p> <p>-</p> <p>The WHO estimates about 3 million of the 35 million health care workers worldwide are exposed to blood-borne pathogens each year</p> <p>Who are at risk?? Any worker who may come in contact with contaminated needles is at risk -doctors -nursing staff, -lab workers, -housekeepers. Predominantly HEALTH CARE WORKERS</p> <p>Risk Involved Significant Injuries expose health care workers to diseases caused by bloodborne pathogens. The risk after exposure to infected blood has been estimated as: Hepatitis B (risk ~30%) Hepatitis C (risk ~10%) HIV (risk ~0.3%) Emotional distress</p> <p>RISK OF INFECTON FOLLOWING A Needle Stick Injury DEPENDS ON, the pathogen involved, the immune status of the worker, the severity of the needlestick injury appropriate postexposure prophylaxis.</p> <p>Hepatitis B Virus The risk of transmisson of virus is highest in HBV following a NSI The incidence of HBV following NSI has shown a rapid decline from 1980 s to 2000 The decline is due to widespread vaccination done for health care workers Following an acute Hep B infection, 30 50 % of people develop jaundice, nausea and vomiting Most resolve, 10 15 % develop chronic infection In chronicity, 20 % develop cirrhosis in their lifetime 6 % has a lifetime risk of hepatocellular carcinoma.</p> <p>HIV INFECTION Percutaneous needle stick injury has an infectivity rate of 0.3 % The risk may appear trivial, however, it is a major concern for health care workers The chances of transmission of HIV were found to be higher If blood is visible in device If needle is used in piercing artery or vein A deeper injury</p> <p>HCV infection The incidence in health care workers is equal to general population However, it is a major occupational hazard Following HCV infection, Acute infection is rare 70 % develop chronic HCV infection 10 20 % of active liver disease develop cirrhosis 1- 2% develop liver cell carcinoma</p> <p>Methods of prevention of NSI1. 2. 3. 4. 5. 6. 7.</p> <p>Report ALL needle stick injury Switch to safer alternatives if available DO NOT RECAP NEEDLES. Safe handling and disposal of needles Training and awareness programmes for needle stick injury Hepatitis B vaccination to be made mandatory not only for doctors but also lab technicians and housekeepers If injury occurs follow a good Post Exposure Prophylaxis routine</p> <p>Safe needle devices Ideal safe device should have following characteristics </p> <p>The device is needleless. The safety feature is an integral part of the device. The safety feature cannot be deactivated and remains protective through disposal. The device performs reliably. The device is easy to use and practical. The device is safe and effective for patient care.</p> <p>BLUNT TIPPED NEEDLE</p> <p>"Add on" Safety Feature</p> <p>Retracting Finger Prick Lancets</p> <p>SAFETY ENGINEERED NEEDLE TIPS</p> <p>NEEDLE FREE IV ACCESS</p> <p>SAFE NEEDLE CLIPPER</p> <p>POST EXPOSURE PROPHYLAXIS By definition, Post exposure prophylaxis (PEP) refers to the comprehensive management given to minimize the risk of infection following potential exposure to blood-borne pathogens (HIV, HBV, HCV). This includes - counselling, - risk assessment, - relevant laboratory investigations based on informed consent of the source and exposed person, - first aid and - depending on the risk assessment, the provision of short term (4 weeks) of antiretroviral drugs, with follow up and support.</p> <p>Exposure which may place an health care professional at risk of bloodborne infection is defined as:-</p> <p>a percutaneous injury (e.g. needle-stick or cut with a sharp instrument), contact with the mucous membranes of the eye or mouth, contact with non-intact skin (particularly when the exposed skin is chapped, abraided, or afflicted with dermatitis),</p> <p>-</p> <p>-</p> <p>- contact with intact skin when the duration of contact is prolonged (e.g. several minutes or more) with blood or other potentially infectious body fluids.</p> <p>Priniciples of providing PEP</p> <p>1. 2. 3.</p> <p>Non discriminatory Confidentiality Detailed informed consent</p> <p>Institutions should follow Universal Precautions strictly to reduce incidence of NSI Universal precautions are intended to prevent the exposure of health-care workers and patients to bloodborne pathogens. These must be practised in regard to the blood and body fluids of all patients, regardless of their infection status.</p> <p>Universal precautions include: 1. Hand-washing before and after all medical procedures 2.Safe handling and immediate safe disposal of sharps: not recapping needles; using special containers for sharp disposals; using needle cutter/destroyers; using forceps instead of fingers for guiding sutures; using vacutainers where possible 3. Safe decontamination of instruments; 4. Use of protective barriers whenever indicated to prevent direct contact with blood and body fluid such as gloves, masks, goggles, aprons, and boots. 5.A HCP who has a cut or abrasion should cover the wound before providing care</p> <p>PEP for HIV1.</p> <p>A rapid baseline testing of HIV both for source as well as patient has to be done as soon as possible PEP to be initiated as early as possible preferably within 2 hours and within 72 hours 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.</p> <p>2.</p> <p>3.</p> <p>4.</p> <p>STEPS FOLLOWED IN PEP STEP 1 Manage exposed site STEP 2 Establish eligibility for PEP STEP 3 Counsel for PEP STEP 4 Prescribe PEP STEP 5 Laboratory Evaluation STEP 6 Follow up, Monitoring and Adherence</p> <p>Categories of exposure Mild exposure Mucous membrane/non-intact skin with small volumes Mucous membrane/non intact skin with large volumes or Percutaneous superficial exposure with solid needle Severe exposure Percutaneous with large volume</p> <p>Moderate exposure</p> <p>Categories based on test result of source HIV negative Source is not HIV infected but consider HBV and HCV HIV positive and clinically asymptomatic HIV positive and clinically symptomatic Status of the patient is unknown, and neither the patient nor his/her blood is available for testing (e.g. injury during medical waste management the source patient might be unknown). In a region with high HIV prevalence a negative result is of less value due to the high possibility of window period</p> <p>Low risk High risk Unknown</p> <p>Exposure</p> <p>Status of source</p> <p>HIV+ and asymptomatic HIV+ and Clinically symptomatic</p> <p>HIV status unknown</p> <p>Mild</p> <p>Consider 2-drug PEP</p> <p>Start 2- drug PEP</p> <p>No PEP or consider 2 drug PEP</p> <p>Moderate Start 2-drug PEP</p> <p>Start 3-drug PEP</p> <p>No PEP or consider 2 drug PEP</p> <p>Severe</p> <p>Start 3-drug PEP</p> <p>Start 3-drug PEP PEP</p> <p>No PEP or consider 2 drug</p> <p>Drugs Used Zidovudine (AZT) 300 mg twice a day Stavudine (d4T) 30 mg twice a day Lamivudine (3TC) 150 mg twice a day Protease Inhibitors 1st choice : Lopinavir/ritonavir (LPV/r) 2nd choice : Nelfinavir (NLF) 3rd choice : Indinavir (IND) drink 8 10 glasses of water everyday to prevent stones Regimen 2-drug regimen 1st choice: Zidovudine (AZT) + Lamivudine (3TC) 2nd choice: Stavudine (d4T) + Lamivudine 3 drug regimen expert opinion needed on third drug NOT RECOMMENDED ddI + d4T combination NNRTI such as Nevirapine should not be used in PEP</p> <p>Hepatitis B VirusHBV vaccination status of exposed person Action after exposure Never vaccinated Give complete hepatitis B vaccine series HEP B IV Ig , 0, 1 and 6 months of Hep B recombinant sub unit vaccine Give Hep B Vaccine Booster Give Hep B Vaccine Booster</p> <p>Vaccinated, anti-HB-S not known Vaccinated more than 5 years ago</p> <p>Hepatitis C Virus No prophylaxis available against hepatitis C. No evidence that interferon, with or without ribavirin is effective. Post-exposure management for HCV is based on early identification of chronic HCV disease.</p>

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