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BDS2 BAMS lectures > Prevention and management of sharps injuries > Flashcards

Prevention and management of sharps injuries Flashcards

1
Q

What infections could you get from a sharps injury

A
  • blood borne viruses (BBVs)

- bacterial infections

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2
Q

What is the impact of getting infected

A

mental as well as physical impact

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3
Q

When are you likely to get a sharps injury

A
  • during procedure
  • post procedure
  • post procedure, post disposal
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4
Q

Do we have a legal responsiblity to report a sharps injury

A

yes

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5
Q

Are you allowed to assess your own injury

A

Never

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6
Q

What is the acronym for what to do following a sharps injury

A

AWARE

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7
Q

What does the acronym for what to do immediately following a sharps injury stand for

A 
A - apply pressure and allow to bleed
W - wash don't scrub
A - assess type of injury
R - risk of source blood?
E - establish contact
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8
Q

How can we achieve ‘apply pressure and allow to bleed’

A

gently squeeze injury site to induce bleeding

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9
Q

How can we achieve ‘wash don’t scrub’

A
  • Wash affected area with soap and warm running water – DO NOT scrub
  • Treat mucosal surfaces by rinsing with warm water or saline
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10
Q

How do we achieve ‘assess type of injury’?

A

Is the injury:
- a high risk material (blood/bodily fluid with visible blood/ saliva)

AND

  • a significant injury (percutaneous/human bite with broken skin/ broken skin or mucous membrane exposure to blood or bodily fluid)
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11
Q

If there is no visible blood in the sharps injury what BBVs do we have to be concerned about

A

Hep B only

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12
Q

what injuries would not count as a ‘significant injury’

A

superficial graze/ exposure of intact skin

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13
Q

What counts as a ‘significant injury’

A
  • A deep penetrating injury by a device visibly contaminated with blood
  • Injury with a device that had previously been placed directly in the source patient’s artery or vein
  • A hollow bore needle or a solid instrument?
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14
Q

What should we consider when working out the risk of source blood?

A
  • Is the patient known to have HIV/AIDS or hepatitis B/C infection?
  • Is the patient in a high risk group? eg intravenous drug user
  • If HIV positive, is the patient on cART?
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15
Q

What does U=U refer to

A

undetectable viral load = untransmissible HIV

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16
Q

What BBVs should we be most concerned about

A

HepB
HepC
HIV

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17
Q

How do we work out the risk of BBV transmission following a needlestick injruy

A

Need to know:

  1. BBV prevalence
  2. seroconversion rate

Multiply them together

n.b. need to take into consideration if source was in a high risk group

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18
Q

When is post exposure prophylaxis recommended for potential HIV infections from needlestick injuries

A

Only if transmission risk is less than 1/10,000 and only if there are additional factors that may increase the likelihood of transmission

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19
Q

What are the published seroconversion rates of HepB

A

1/3 (e antigen positive)

20
Q

What are the published seroconversion rates of HepC

A

1/30

21
Q

What are the published seroconversion rates of HIV

A

1/300 (if not on ART)

22
Q

How do you ‘establish contact’

A
  • Report injury promptly to a senior member of staff
  • Call occupational health
  • Record injury (accident book and official reporting)
  • Employees who have had injuries must be followed up for prophylaxis, counselling and prevention
23
Q

How do you assess the BBV status of the source

A

Source known
- test for BBVs or confirm previous results with consent

Source unknown/ doesn’t consent to testing
- risk assessed based on circumstances and likelihood of BBV

24
Q

How do you get consent for blood testing of source to occur

A

Someone else has to interview the source and get consent for bloods (important it isn’t you)

25
Q

How do you assess the BBV status of recipient (you)

A
  • History of HBV vaccination (partially or fully vaccinated) and response (known responder or non-responder)
  • History of previous tests for BBVs
  • Take baseline bloods for storage (to compare against)
26
Q

When is post exposure prophylaxis for HBV required

A

for those who had an unsuccessful response to the vaccine

27
Q

What is the post exposure prophylaxis for HBV

A

Immunoglobulin (quick response)

and/or

Vaccine (slower response)

28
Q

How effective is HBV immune globulin at protecting from HBV infection

A

70-75% (if administered at same time or within 24 hurs of first dose of vaccine)

29
Q

What is the post exposure prophylaxis for HIV

A
  • Combined anti-retroviral therapy
  • start within 24h of exposure (if indicated)
  • Common side effects include headaches, fever, and nausea
  • Not routinely recommended if source has confirmed and sustained undetectable viral load
30
Q

What is the follow up from PEP

A
  • As a minimum, follow-up should be for at least 6-12 weeks after the exposure event
  • if PEP was taken, follow up should be at least 12 weeks from when PEP was stopped
  • A negative test at 12 weeks provides a very high level of confidence of freedom from infection
31
Q

What is the most likely BBV that you might get

A

HCV (generally more common)

32
Q

How do you prevent occupational exposures and BBV transmission

A
  • vaccination
  • elimination of unnecessary needles
  • No recapping
  • raising awareness
  • PPE
  • sharps containers
  • PEP
  • safety engineered devices
  • Recording and reporting
  • work practices
  • risk assessment
  • hand hygiene
33
Q

Who do the EU council directive 2010/32/EU - the “sharps directive” apply to

A
  • Employers and employees
  • Contractors working for HC employer
  • Students/trainees on placement with HC employers
  • Community or hospital pharmacies

The regulations apply to employers whose primary activity is to organise manage and provide healthcare and their employees, and includes NHS and independent sector providers, GP and GDP practices, hospices, nursing homes and situations where HCWs are providing care to people in their own homes

34
Q

Describe how the the hierarchy of controls fits into the EU directive

A

Historically, the focus on sharps injuries has been about changing behaviours of sharps users and effective follow up and support after an injury, rather than prevention. PREVENTION of exposure is the underlying principle of the EU directive.

Measures to prevent sharps injuries can best be implemented using the hierarchy of controls (HoC) and principles of prevention frameworks. The HoC focuses on the most effective measure of removing the hazard first, rather than relying on training, behavioural or changes to work practices and the use of protective equipment.

35
Q

What is the order of the hierarchy or controls (from most to least effective)

A
  • elimination/substitution e.g. blunt tip suture needles
  • engineering controls e.g. safer sharps devices (SSDs)
  • administration
  • work practices e.g. minimal manual manipulation of sharps, instruments rather than fingers for suturing, puncture resistant containers
  • PPE
36
Q

What are the main requirements of the Sharps directive for employers

A
  • Promote the safe use and disposal of medical sharps
  • Provide information and training for employees
  • Respond effectively if an injury occurs
  • Review procedures regularly
37
Q

What are the main requirements of the Sharps directive for employees

A

An employee who receives a sharps injury at work must notify their employer as soon as practicable (regulation 8)

supported by
Information and training on what to do in the event of a sharps injury (regulation 6(4))

38
Q

What are the different types of safety devices on syringes

A
  • active (requires you to launch mechanism to disable sharp)

- passive

39
Q

Do safe syringes work in dentistry

A
  • Safer devices do NOT automatically eradicate risk
  • Staff training and strict adherence to policies on handling of contaminated sharps are THE MOST IMPORTANT elements in prevention

when educational programmes were implemented alongside a safer sharps device, lower rates of sharps injuries were sustained for longer

40
Q

Define exposure prone procedures (EPPs)

A

Those invasive procedures where there is a risk that injury to the worker may result in the exposure of the patient’s open tissues to the blood of the worker

41
Q

When can HBV infected HCWs perform exposure prone procedures

A

Must:

  • have a viral load <200 IU/ml (either from natural suppression or 12 months after cessation of antiviral therapy)
  • are subject to annual plasma viral load monitoring
  • are under joint supervision of a consultant occupational physician and their treating physician
42
Q

When can HCV infected HCWs perform exposure prone procedures

A

Must have cleared infection (HCV RNA negative) as a consequence of natural clearance or at 6 months after cessation of ART

43
Q

When can HIV infected HCWs perform exposure prone procedures

A

Must either:
- be on effective combination antiretroviral therapy (cART), AND
have a plasma viral load <200 copies/ml,
be an elite controller,*and
be subject to plasma viral load monitoring every three months, and
be under joint supervision of a consultant occupational physician and their treating physician, and be registered with the UKAP-OHR

44
Q

Conclusions

A
  • Prevention of sharps injuries remains the best policy
  • Successful prophylaxis requires careful planning in advance
  • Staff training plays an important role
  • Important to report all work-related injuries
  • Good treatment options for all BBVs enabling return to EPPs (subject to meeting set criteria)
45
Q

Conclusions?

A
  • Prevention of sharps injuries remains the best policy
  • Successful prophylaxis requires careful planning in advance
  • Staff training plays an important role
  • Important to report all work-related injuries
  • Good treatment options for all BBVs enabling return to EPPs (subject to meeting set criteria)

BDS2 BAMS lectures (9 decks)

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