Sharp injury surveillance

Dr Ahmad Zahid bin Aziz

Outline

Introduction

Management Of Exposed HCW

Sharp Injury Surveillance System

Current Situation - 2022

Introduction
HCW exposures to blood
borne pathogens as a result of
needle stick injury are a
significant public health
concern
Based on data collected by
Occupational Health Unit,
MOH from 1998-2005
• Needle stick injury contributes 74.9%
of all injuries
• Nurses sustained the highest number
Introduction (cont)
Globally, US CDC estimates between
600000 and 800000 percutaneous
injuries occur each year nationwide

Increased risk for blood borne virus

transmission

Costly to personnel and healthcare

system
 Definitions
Sharps Health care Blood borne
workers pathogens
all sharps instruments/
devices used in healthcare MOH staff Infectious
facilities microorganisms in
MOH trainees human blood that can
Medical students cause disease in
humans which include,
Health facilities support service workers but are not limited to
HBV, HCV, HIV
Risks of seroconversion due to sharp injury
from a known positive source
HIV – 0.3%
HBV – 6-30% HCV – 1.8% (percutaneous),
0.09% (mucosal)
 Risk Of Acquisition Following Exposure

Prevalence of the
Nature of the
infectious agent in Availability and
exposure and
the general Frequency of Type of virus and efficacy of pre-
efficiency of
population and exposures the viral load and post-exposure
transmission for
within the patient prophylaxis
that exposure
population

Exposure via
percutaneou
s, mucosal,
or nonintact
skin
Pre-exposure Prophylaxis

HEPATITIS B HEPATITIS C HIV

Hepatitis B vaccination for Pre-exposure prophylaxis Pre-exposure prophylaxis
HCW has been highly for HCV is not available for HIV is not available
successful in reducing HBV
infection
Mode of exposure

Percutaneous injury: Mucocutaneous:

• Penetrated by • Blood/ body fluid
Needle splashed to eyes,
• Direct Skin cut nose, mouth, non
intact skin
Will you get infected?

Fluids that are not considered infectious

unless they contain blood
- Feces, nasal secretions, saliva, gastric secretions, sputum, sweat,
tears, urine, and/or vomitus
 Post exposure management
• Other antiseptic like chlorhexidine
also inactivate HIV
Skin exposure  wash with soap & water • Efficacy is unknown in preventing
transmission
• Expressing fluid or blood by
squeezing wound
• No evidence that it will reduce risk of
Mucous membrane  flushed with water transmission

Small wound & punctures  may also be cleansed

with antiseptic, ie alcohol-based hand hygiene agent
Alcohol is virucidal to HIV, HBV, HCV
 Post exposure management (cont)
Report the incident to your location supervisor
Office Hour After Office Hour
Sister in-charge or ward/clinic Sister on-call

Head of unit (if no sister in-charge), eg Officer on-call of respective unit – lab,
lab, pharmacy pharmacy

Concession Company Safety Concession Company Safety Supervisor

Supervisor - if the concession oncall
company’s worker is involved
 Obtaining Information

Attending doctor will be

responsible for assessing
the risk

Source patient Exposure/ Injury

HCW
Date/time, type of fluid,
Assess HBsAg, anti- Assess HBsAg/anti-HBs, anti-
nature of exposure, body
HCV, HIV status
HCV, HIV status location, injury description
Dates of HBV immunizations,
post-immunization
quantitative titer
MANAGEMENT OF
EXPOSED HCW
Post exposure management - HBV
HCW status Post exposure test Post exposure prophylaxis
Source (HBsAg) HCW (anti-HBs) HBIG Vaccination
Documented No action needed
responder after
complete series

Documented non- Positive/Unknown - HBIG x2 separated by -

responder after 2 1 month
complete series
Negative No action needed

Response unknown Positive/Unknown < 10mIU/ml HBIG x1 Initiate revaccination

after complete series
Negative < 10mIU/ml None

Any result > 10mIU/ml No action needed

Unvaccinated/ Positive/Unknown - HBIG x1 Complete vaccination

incompletely
vaccinated
Negative - None

Responder - person with anti-HBs ≥10 milli-international units/mL after completing the hepatitis B vaccine series

Complete series - usually consists of three doses administered at 0, 1, and 6 months

Non-responder - person with anti-HBs <10 milli-international units/mL after completing two hepatitis B vaccine series
 SHARP INJURY
SURVEILLANCE
SYSTEM
Sharp Injury Surveillance format

 Must be completed in case sharp injury occurs to HCW

2 sections:
• OHU/SIS-1 (Epidemiology section)
• OHU/SIS-2 (Management of exposed HCW section)
• OHU/SIS-2a (Risk assessment for transmission of disease)
• OHU/SIS-2b (Post-exposure management)
• OHU/SIS-3 (Occupational interventions if the HCW become infected)
OHU/SIS-1
Epidemiology section
Demographic data

Job category

Where did the injury occur?

How did the injury occur?

Which type of device caused the injury?

Was the device contaminated?

What was the procedure conducted?

* To be filled by;
- The Infection control Team/Occupational health Unit-Hospital
- The Occupational Safety and Health Committee Secretary- for the health setting
OHU/SIS-2a
Management of exposed HCW section

Risk assessment of the injury

Risk assessment of the source

Risk assessment of the exposed HCW

* To be filled by the attending Physician

OHU/SIS-2b
Management of exposed HCW section
- Post-exposure management
Post-exposure prophylaxis
• Dose
• Date of commencement

Hepatitis B Immunization needed?

Follow-up blood test (HBV/ HCV/ HIV)

• 6/52, 3/12, 6/12

Seroconversion status

* To be filled by the attending Physician

OHU/SIS-3
Occupational interventions if the HCW become infected

Date of notification

Types of infection (HBV/HCV/HIV)

Particulars of treating physician

Work task assessment (involve Exposure Prone Procedure?)

Serological data

Job modification

Decision by the Advisory Panels

Decision by the Appellate Medical Board

* To be filled by the Hospital Director or District Medical Officer of Health

Current Situation
SHARP INJURY SURVEILLANCE ANGGOTA KESIHATAN NEGERI PAHANG 2016
SEHINGGA JAN JUN 2022

95 89 83 89 87
85 76
75 72
65 75 73 77
75
55 65
45 55
35 26
25 17 14 10 12 11 12
15 23
5 3
2016 2017 2018 2019 2020 2021 Jan Jun 2016 2017 2018 2019 2020 2021 Jan Jun
2022 2022

N 17 14 10 12 11 12 3
o
n
-
N
S
I
N 55 75 73 77 65 75 23
S
I
T 72 89 83 89 76 87 26
o
t
a
l
29
 PECAHAN NOTIFIKASI SIS
MENGIKUT JENIS BAGI KITARAN JAN JUN 2022

Sharps Injury Surveillance

Needle Sharp Injury Other sharps
12% (3 kes)

88% (23 kes)

n = 26
KADAR INSIDEN SHARP INJURY PER 1000 ANGGOTA KESIHATAN DI
PAHANG BAGI TAHUN 2016 SEHINGGA JAN JUN 2022

Kadar Insiden SI per 1000 HCW

11 9.8 9.3 8.8
9 8.3 7.8
6.8 7.3 6.8
7 6.5
5.6 5.4 5.1
5 5.9
3 1.8
1
2016 2017 2018 2019 2020 2021 JAN JUN
2022

Kadar Insiden SI per 6.5 6.8 5.6 5.4 5.1 5.9 1.8
1000 HCW
Kadar insiden SI 9.8 9.3 8.8 8.3 7.8 7.3 6.8
Malaysia (sasaran)

* Sasaran Kadar Insiden SI Malaysia = penurunan kadar insiden SI sebanyak 5% berbanding tahun sebelumnya n = 31
26
KADAR INSIDEN NEEDLE STICK INJURY PER 1000 ANGGOTA KESIHATAN DI
PAHANG BAGI TAHUN 2016 SEHINGGA JAN JUN 2022

8
6.5 6.8
7
6 5.6
5.1 5.1
5 4.4
Kadar Insiden

4
3
2 1.6 Kadar Insiden
1
0
2016 2017 2018 2019 2020 2021 JAN JUN
2022
Tahun
Standard : 0 (zero)

n = 23 32
 BILANGAN KES SHARP INJURY DALAM KALANGAN ANGGOTA KESIHATAN
MENGIKUT FASILITI (HOSPITAL , n=22) BAGI KITARAN JAN JUN 2022

12
Non-NSI NSI Total
10 10
8
8
6
Bilangan Kes

4 6 3
3
2
2 1 1 1
1 1 1
0 0 0 0 0
0
Hosp Bentong Hosp Jerantut Hosp Pekan Hosp Rompin HoSHAS HTAA

Fasiliti (Hospital) n = 22
BILANGAN KES SHARP INJURY DALAM KALANGAN ANGGOTA KESIHATAN
MENGIKUT FASILITI (PKD , n=4) BAGI KITARAN JAN JUN 2022

1.2 Non-NSI NSI Total

1 1 1 1 1 1 1 1
1

0.8
Bilangan Kes

0.6

0.4

0.2
0 0 0 0
0
PKD Jerantut PKD Kuantan PKD Pekan PKD Rompin

Fasiliti (Hospital) n=4

 KADAR INSIDEN SHARP INJURY MENGIKUT FASILITI PER 1000
ANGGOTA BAGI KITARAN JAN JUN 2022
PKD Jerantut 2.1

PKD Rompin 2.3

PKD Pekan 3.4

PKD Kuantan 0.9

HTAA 3.3
Fasiliti

HoSHAS 1.3

Hosp Rompin 5.1

Hosp Pekan 12.4

Hosp Jerantut 3.4

Hosp Bentong 2.4

0 2 4 6 8 10 12 14
Kadar Insiden Sharp Injury
BILANGAN KES SHARP INJURY MENGIKUT KATEGORI JAWATAN PER 1000
ANGGOTA KESIHATAN NEGERI PAHANG BAGI KITARAN JAN JUN 2022

8 7 (27%)
7 (27%)
7
6 5 (19%) 7
6 5 (19%)
Bilangan Kes

5
4
3 4 4 2 (8%)
2
1 1 1 2
1
0 0
0
Pegawai Perubatan Pegawai Perubatan PPP Jururawat PPK
Siswazah

Non-NSI NSI Total

Kategori Jawatan

n = 26
 KADAR INSIDEN SHARP INJURY MENGIKUT KATEGORI JAWATAN PER 1000
ANGGOTA KESIHATAN NEGERI PAHANG BAGI KITARAN JAN JUN 2022

PPK; 1.2

Jururawat; 1.2
Kategori Jawatan

PPP; 5.9

Peg Perubatan
Siswazah; 7.3

Peg Perubatan ; 4.7

0 1 2 3 4 5 6 7 8
Kadar Insiden
BILANGAN DAN PERATUS KES SHARP INJURY BERDASARKAN PUNCA INSIDEN
BAGI KITARAN JAN JUN 2022

Unusual location, 3 (12%)

Collided with sharp , 4
(15%)

Handling patient/needle ,
11 (42%)

Disposal related ,
2 (7%)

Handling equipment Operative procedure , 3 (12%)

/specimen , 3 (12%)
n = 26
38
BILANGAN DAN PERATUS KES SHARP INJURY BERDASARKAN TEMPAT INSIDEN
BAGI KITARAN JAN JUN 2022

Others (inside ambulance) 1 ,(4%) ICU / NICU, 1 (4%)

Ward / Patient's bedside,

10 (38%)

ED, 9
(34%)

Clinic, 1 (4%)

Treatment Room, 2 (8%) Operation theatre, 2 (8%) n = 26

 BILANGAN KES & % KECEDERAAN ALATAN TAJAM MENGIKUT JENIS
ALATAN TAJAM BAGI KITARAN JAN JUN 2022
Jumlah Kes Sharp
Injury (%)

2 (7%)
21 (81%)
• Suturing Needle
• Hypodermic/ Hollowbore 1 (4%)
Needle 1 (4%)
Jenis
Alatan • Scalpel blade 1 (4%)
Tajam • Capillary tube glass
• External ventricular drain 26
(EVD)
JUMLAH
SHARP INJURIES MANAGEMENT BAGI KITARAN JAN JUN 2022

MANAGEMENT OF CASES NO OF CASE

(n = 26)

26 (100%)
Required Follow Up • All cases still under
follow up

Discharged Medically 0

Required Post HBIG 0

Exposure Prophylaxis HIV 5 (19%)
 NUMBER OF CASES WITH SOURCE STATUS AND NUMBER OF CASES STARTED
WITH POST EXPOSURE PROPHYLAXIS (PEP) JAN JUN 2022

SOURCE STATUS JAN JUN POST EXPOSURE MANAGEMENT

2022
(n= 26 ) HIV PEP Hep B

HIV + ve 1 1 case started PEP -

Hep B and Hep C +ve 1 1 case started PEP -

Hep C +ve 2 1 case started PEP -
Metamphetamine abuser but 1 1 case started PEP -
negative infective screening
Unknown 5 1 case started PEP -
Known Source , No High Risk 17 - -
Behavior

JUMLAH 26 5 case started PEP -

QA/NIA: KADAR INSIDEN
NEEDLE STICK INJURY
DALAM KALANGAN
ANGGOTA KESIHATAN
 PENCAPAIAN INDIKATOR QAP NEEDLE STICK
INJURY MENGIKUT KATEGORI FASILITI DAN BAGI
NEGERI PAHANG TAHUN 2021

Jumlah Anggota Kadar Insiden

Kategori Fasiliti Kesihatan Berisiko Bilangan NSI /1000

Hospital 8,401 20 2.4

Pejabat Kesihatan 4,854 3 0.6

Daerah
Pejabat Kesihatan
Pergigian Daerah 1,332 0 0

Jumlah 14,585 23 1.6

44
 PENCAPAIAN INDIKATOR QA/NIA KESIHATAN PEKERJAAN
2015 SEHINGGA 2021
Indikator : Incidence Rate Of Needle Stick Injury Among HCW

Standard : 0 (zero)

Formula : Jum. Kes Tertusuk Jarum X 1000

Jum. Anggota Kesihatan Terdedah

Jan Jun
Tahun / Perkara 2015 2016 2017 2018 2019 2020 2021
2022

Jumlah Kes
Tertusuk Jarum 47 55 75 73 77 65 75 23

Jumlah Anggota
Kesihatan Yg
Mengendali 4,711 8,476 11,087 12,965 14,179 14,854 14,664 14,585
Terdedah

Kadar Insiden 9.9 6.5 6.8 5.6 5.4 4.4 5.1 1.6
 KADAR INSIDEN NEEDLE STICK INJURY ANGGOTA
KESIHATAN DI PAHANG 2015 SEHINGGA JAN JUN 2022

Kadar Insiden
Kadar insiden SI per 1000 HCW
7.5 6.8
6.5
6.5
5.6 5.4
5.5 5.1
4.4
4.5
3.5
2.5
1.6
1.5
0.5
2016 2017 2018 2019 2020 2021 Jan Jun
2022
Kadar Insiden 6.5 6.8 5.6 5.4 4.4 5.1 1.6

Jumlah anggota yang terdedah 8476 11087 12965 14179 14854 14664 14585