PREVENTION OF NEEDLE STICK INJURIES

Definition:

NEEDLE STICK INJURY

• Needle stick injuries are wounds caused by needles

that accidentally puncture the skin.

• Penetration of the skin by a hypodermic needle or

other sharp object that has been in contact with blood,
tissue or other body fluids before the exposure.
Definition:

SHARPS

• "Sharps" include needles, as well as items such

as scalpels, lancets, razor blade, scissors, metal
wire, retractors, clamps, pins, staples, cutters,
and glass items. Essentially, any object that is
able to cut the skin can be considered a "sharp".
Definition:

BLOODBORNE PATHOGENS

• Are pathogenic microorganisms that are

present in human blood and can cause disease
in humans. These pathogens include Human
Immunodeficiency Virus (HIV), Hepatitis B
Virus (HBV), Hepatitis C Virus (HCV), and
others.
Potential Hazards…

Exposure to blood and other potentially

infectious materials (OPIM) because of:

Unsafe Devices.

Improper handling and disposal of needles and

other sharps.
Other Potentially Infectious Materials (OPIM)…

(1) The following human body fluids: semen, vaginal secretions,

cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid,
peritoneal fluid, amniotic fluid, saliva in dental procedures, any body
fluid that is visibly contaminated with blood, and all body fluids in
situations where it is difficult or impossible to differentiate between
body fluids;
Other Potentially Infectious Materials (OPIM)…

(2) Any unfixed tissue or organ (other than intact skin) from a human
(living or dead); and
Other Potentially Infectious Materials (OPIM)…

(3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or

HBV-containing culture medium or other solutions; and blood,
organs, or other tissues from experimental animals infected with HIV
or HBV.
Who is at risk…
HEALTH CARE
WORKERS
What to do…

Wash the wound with soap and water.

Alert your supervisor and initiate the injury reporting system used in your
workplace.

Identify the source patient, who should be tested for HIV, hepatitis B, and
hepatitis C infections. Your workplace will begin the process to test the
patient by seeking consent.
What to do…
Report to employee health services, the emergency department, or other
designated treatment facility.

Get tested immediately and confidentially for HIV, hepatitis B, and hepatitis
C infections.

Get PEP (Post Exposure Prophylaxis) in accordance with CDC guidelines

when the source patient is unknown or tests positive for: HIV, Hepatitis B
and C.
ONE NURSE’S STORY:

THE UNTHINKABLE HAPPENS…

In 1997, Lisa Black, a 26-year-old nurse and single mom with two
young daughters, was excited about her career. She had always
wanted to be a nurse. One night, she was caring for a patient in the
terminal stages of AIDS. She noticed that his intravenous (IV) tube
was backed up with blood and the line was occluded. To quickly
irrigate the line, she filled a syringe with saline and inserted the pre
attached needle into a rubber port on the patient’s IV line.
ONE NURSE’S STORY:

THE UNTHINKABLE HAPPENS…

While Black was attempting to aspirate the coagulating blood and then flush
the IV line, the patient became startled and jerked, causing the needle to
dislodge from the rubber port of the IV line. The needle punctured the palm
of her left hand. She was terrified. Black followed protocol and immediately
scrubbed the wound, reported her injury, and went to the emergency
department. She was started on a regimen of anti retroviral medications and
a protease inhibitor. She put up with the difficult side effects, thinking that if
she just could get through the side effects and stay on the post-exposure
prophylaxis (PEP) protocol, she would not acquire HIV.
ONE NURSE’S STORY:

THE UNTHINKABLE HAPPENS…

Eight months later, she began to feel ill, and nine months and nine
days after her injury, she was diagnosed with HIV. Several months
later, she learned she also was infected with hepatitis C. Today, she is
an active member of her state nurses association. She has devoted
herself to educating others and fighting for occupational health and
safety protections, so that other health care workers will not have to
suffer her pain. A Tragedy That Should Never Have Happened.
 IV CANNULA
SAFETY
FEATURES

SAFETY
FEATURES
NEEDLELESS IV LINE
IM/SC/ID INJECTION
RE-CAPPING OF NEEDLES
SAFE RE-CAPPING OF NEEDLES

Hinged or sliding shields attached to phlebotomy needles,

winged steel needles, and blood gas needles, act as an "add on"
safety feature.
LANCETS FOR CBG
 Injuries Related to Work Practices
• Injuries occur because of the following:
– Passing or transferring equipment
– Recapping contaminated needles
– Colliding with coworkers
– Decontaminating/processing used equipment

• Injuries occur from sharps left in unusual places:

– Laundry
– Mattresses
– Tables, trays, or other surfaces
 Sharps Safety Continuum

• Prepare to use the device the moment the sharps are

first exposed
• Take precautions while using sharps
• Take precautions during cleanup
• Take precautions during disposal
 Sharps Safety Practices

• Be prepared
• Be aware
• Dispose with care
 Be Prepared

Before Beginning a Procedure

• Organize equipment at the point of use
• Make sure work space has adequate
lighting
• Keep sharps pointed away from the user
 Be Prepared

Before Beginning a Procedure

• Locate a sharps disposal container, or have one

nearby
• Assess the patient’s ability to cooperate
• Get help if necessary
• Ask the patient to avoid sudden movement
 Be Aware

During a Procedure

• Maintain visual contact with sharps during

use
• Be aware of staff nearby
• Control the location of sharps to avoid
injury to yourself and others
 Be Aware

During a Procedure
• Do not hand pass exposed sharps from one
person to another
• Use predetermined neutral zone for
placing/retrieving sharps
• Alert others when sharps are being passed
 Be Aware

During a Procedure
• Activate safety feature of devices with engineered
sharps injury prevention features as soon as
procedure is completed
• Observe audible or visual cues that confirm the
feature is locked in place
 Clean Up and Dispose with Care

During Cleanup

• Be accountable for sharps you use

• Check procedure trays, waste materials, and
bedding for exposed sharps before handling
• Look for sharps/equipment left behind
inadvertently
 Clean Up and Dispose with Care

During Cleanup

• Transport reusable sharps in a closed

container
• Secure the container to prevent spillage
 Clean Up and Dispose with Care

While Disposing of Sharps

• Inspect container
• Keep hands behind sharps
• Never put hands or fingers into
sharps container
 Clean Up and Dispose with Care

While Disposing of Sharps

• If you are disposing sharps with attached
tubing
– Be aware that tubing attached to sharps can recoil
and lead to injury
– Maintain control of both tubing and the device
during disposal
 Clean Up and Dispose with Care

After Disposing of Sharps

• Visually inspect sharps container for
overfilling
• Replace containers before they become
overfilled
• Keep filled containers for disposal in a
secure area
 Sharps Injuries in the Operating Room

• Cuts/needle sticks occur in as many as 15% of

operations
– Risk increases with longer, more invasive, higher blood loss
procedures
• Suture needle injuries are most frequent
– Fingers used to manipulate needles and tissue
• Up to 16% of injuries occur while passing sharps
 Sharps Injuries in the Operating Room
• Needleless/no sharps alternatives
– Use alternative cutting methods such as blunt electro cautery and laser devices
when appropriate
– Substitute endoscopy surgery for open surgery when possible
• Engineering controls
– Use round-tipped scalpel blades instead of sharp-tipped blades
– Use blunt suture needle
• Work practice controls
– Use instruments rather than fingers
– Give verbal announcement when passing sharps
– Use “neutral zone” to avoid hand-to-hand passing of sharps
 Your ROLE…
• Adhere to safe practices and assist and support
coworkers in safer practices
• Report injuries or blood/body fluid exposures, sharps
injury hazards, and near misses
• Participate in training for devices and properly use
sharps safety features
• Participate in surveys (e.g., safety culture) and device
evaluations
 Over 80% of needlestick injuries can be
prevented with the use of safe needle devices,
which, in conjunction with worker education
and work practice controls, can reduce injuries
by over 90%.
 If her hospital had exclusively used
needleless IV systems, she never would
have been injured and would not be taking
over 20 pills a day to fight her diseases…

In relation with the

case of Ms. Black…
COMPREHENSIVE SHARP INJURY PROGRAM INCLUDES..

Recommended Guidelines

Improved Equipments design

Effective Disposal System

Employee Training

Safe and recapping procedure, when necessary

Surveillance Program
 Hierarchy of Controls
From Least Effective to Most Effective
• Elimination of hazard—remove sharps and needles and eliminate all unnecessary injections. Jet
injectors may substitute for syringes and needles. Other examples include the elimination of
unnecessary sharps like towel clips, and using needleless IV systems.
• Engineering controls—examples include needles that retract, sheathe or blunt immediately after
use.
• Administrative controls—policies aimed to limit exposure to the hazard. Examples include
allocation of resources demonstrating a commitment to health care worker safety, a needlestick
prevention committee, an exposure control plan, removing all unsafe devices, and consistent training
on the use of safe devices.
• Work practice controls—examples include no re-capping, placing sharps containers at eye-level
and at arms reach, emptying sharps containers before they’re full, and establishing the means for
safe handling and disposing of sharps devices before beginning a procedure.
• Personal Protective Equipment (PPE)—barriers and filters between the worker and the hazard.
Examples include eye goggles, gloves, masks, and gowns.
Frontline Health Care Worker Involvement and Training Requirements
Include the involvement of frontline health care workers (non-managerial
employees responsible for direct patient care) in device evaluation and selection,
with evidence of this participation documented in the exposure control plan.

Provide frontline health care workers with interactive training on the use of safer
devices, work practices, and PPE from a knowledgeable person. Workers must
receive training when hired and at least once a year. Training must be provided
during working hours and at no cost to employees. Training records must be
maintained for three years.
 SHARPS DISPOSAL
An effective system for disposing of used needles and sharps is crucial to
preventing injuries.

• Have disposal containers readily available.

• Workers should place needles in wide-mouth, puncture-proof containers.

• Locate disposal containers specifically where needles and sharps are used to make safe
disposal possible. Replace the containers before they are completely filled - sharps
containers should be removed and replaced when they are three quarters full. Make sure
they are sealed, collected, and disposed of in accordance with local regulations for
biomedical waste.

• All staff should report every incident in which they find needles or sharps left at the
bedside or thrown into the regular garbage.
 SURVEILLANCE PROGRAM
Surveillance programs that provide in-depth analysis of accidents are an important
tool for obtaining information.

The goals of these programs should include:

Determining the rate of injuries.

Investigating the factors that cause the injuries.

Ensuring that injured workers receive proper treatment.

Identifying areas in which the prevention program needs improvement.

Leading to practical strategies for dealing with the problem.