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Flashcards in Sharps Deck (41)
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name blood borne viruses

- hepatitis B
- hepatits C


how can contamination occurs with exposure or a sharps injury

- needles or sharp objects (eg probes, scalpels) contaminated with blood or bodily fluids piercing or breaking the skin
- splashing of blood or bodily fluids onto skin that is broken (abraded, chapped, open sores, dermatitis)
- contamination of eyes, nose or mouth with blood or bodily fluids
- a human bite that breaks the skin


name common sharps injuries

- during IDB, needle goes into thumb
- adjusting posts, CoCr dentures etc out with the mouth
- burs or ultrasonic tips left in situ in hand-pieces which are placed at elbow height (legs / arms passing by)
- slipping luxators
- anaesthetic spraying from palate
- unsheathed needles left on messy trays


can you pass sharps to the dental nurse to dispose of them

it is your responsibility to dispose of them yourself


looking at the epidemiology in scotland, which BBV poses the highest risk

Hepatitis C
highest prevalence in Scotland


name people who are likely to have sharps injuries

most common to least
- nurses and healthcare assistants
- doctors
- professions allied to medicine
- dentist / dental nurses
- others and NK
- midwife


what are the possible timings for needlestick injuries to happen

most common to least
- during procedure
- after procedure and before disposal of sharps
- during disposal or after disposal


what should all staff know with regards to management of exposure in the event of a needle stick

- what action to take
- legal responsibility to report all sharps injuries
- get injury properly assessed (cannot assess your own injury)
- where to go for treatment for the injury and follow up
- how to report the incident so that systems can be revised to reduce future injuries


what are the steps to how to manage a sharps injury


Apply pressure and allow to bleed
Wash don't scrub
Assess the type of injury
Risk of source blood?
Establish contact


what is the first thing that should be done with a sharps injury

squeeze the injury site to induce bleeding


how can you clean the injury site

wash affected area with soap and warm running water
do not scrub
treat mucosal surfaces by rinsing with warm water or saline


when assessing the type of injury, what are the categories

- high risk material
- significant injury
- non-significant injury


what is included in high risk material for a type of injury

- blood and bodily fluids with visible blood
- saliva (if there is no visible blood there is only a risk of HBV [hep C and HIV cannot go through saliva on its own])


what is included in significant injury for a type of injury

ask has it actually breached the skin

- percutaneous
- human bite with broken skin (with no visible blood the only risk is HBV [hep C and HIV cannot go through saliva on its own])
- exposure of broken skin or mucous membrane to blood or bodily fluids


who is more at risk of a BBV from a human bite - the person biting or the person being bitten?

person who is biting is more at risk of an infection than the person being bitten
- if this person pierces skin and gets blood in their mouth then there is more risk for them

if the person who has been bitten has the other person's saliva on their skin the risk is little in comparison


what is included in a non-significant injury for a type of injury

- exposure of intact skin
- superficial graze
these should still be reported even if there is no risk of injury


when is a sharps injury considered a risky injury

- if it breaks the skin [especially with blood contamination]
- a deep penetrating injury by a device visibly contaminated with blood
- injury with a device that has previously been placed directly in the source patient's artery or vein


what questions should be asked to work out the risk of the source blood?

- is the patient known to have HIV / AIDS or hepatitis B / C infection
- is the patient in a high risk group (eg an intravenous drug user?)
- if HIV positive is that patient on cART?


what is cART?

combination antiretroviral therapy


if the patient has HIV how can their blood not pose a risk

if the patient has an undetectable viral load
HIV is not transmissible
U = U


list BBV from most infectious to least infectious

- HBV (1/3)
- HCV (1/30)
- HIV (1/300)


how can you work out the risk of the source blood if you don't know who the source is

take the prevalence of that BBV in Scotland and multiply by the risk of seroconversion


who do you have to establish contact with after receiving a sharps injury

- 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 with what



if you know the source, how should you assess the BBV status of the source

test for BBVs or confirm previous results with consent

if patient negative this will provide reassurance to the healthcare worker


if the source is unknown or if the source does not consent to testing, how should you assess the BBV status of the source

risk assessed based on circumstances and likelihood of BBV
need to think on type of injury
use information you have about the source (if known) from your records


how should you assess the BBV status of the recipient (the person who gets the sharps injury)

- look at history of HBV vaccination and response
> are they partially or fully vaccinated
> are they a known responder or non-responder

- history of previous tests for BBVs

- take baseline bloods for storage
(blood is taken and stored so at the end of the follow up stage when you have a blood test to indicate if you have BBV or not, the stored blood is also tested to prove the seroconversion is associated with that infection - proves you got infected from that injury and you haven't had the infection for a while)


what is included in post exposure prophylaxis HBV

immunoglobulin and / or vaccine

- hepatits B immune globulin (HBIG) provides an estimated 70-75% protection from HBV infection (gives immediate preventative protection to protect seroconversion)

IF, HBIG indicated administer at the same time or within 24 hours of the first dose of vaccine (but not after 7 days have elapsed since exposure)
[vaccine boosts immunity but won't happen for a few days]


what is the post exposure prophylaxis procedure dependent on

- vaccination status prior to exposure
- the type of exposure
- the HBV status of the source


where do you go fro more info on the HBV prophylaxis for reported exposure incidents

chapter 18 - the green book