Preventing needlestick and other sharp injuries 2019
- 1. Preventing Needlestick and Other Sharp Injuries Ms. Jayashree Jaji BSN, RN
- 2. •Background •Safer Sharp Devices •Safe Work Place Practices
- 3. The Problem •CDC estimates 385,000 sharps injuries annually among hospital-based healthcare personnel (>1,000 injuries/day). - Many more in other healthcare settings (e.g., emergency services, ICU, nursing homes) •Increased risk for bloodborne virus transmission •Costly to personnel and healthcare system
- 4. Risks of Seroconversion due to Sharps Injury from a known positive source Virus HBV HCV HIV Risk (Range) 6-30% 2% 0.3%
- 5. What is the Risk for HIV Alone? Percutaneous Mucous Membrane Non-Intact Skin 0.3% 0.1% < 0.1 %
- 6. Occupational HIV Transmission among U.S. Healthcare Personnel, 1985-2004 • 57 documented cases - i.e., HIV negative at time of exposure and become HIV positive during follow up period • 137 other cases No documented exposure and no known risk for HIV infection
- 7. Occupational HIV Transmission Documented Cases (n=57) • 50 (88%) involved percutaneous exposures • 45 caused by hollow-bore needles, half of which were used in a vein or artery • 5 mucocutaneous exposures • 2 exposure route unknown
- 8. Costs of Sharps Injuries • Baseline and follow-up laboratory testing • Treatment of exposed personnel • $71-$5,000 depending on treatment provided • Loss of income / loss of career • Emotional costs • Societal costs
- 9. Preventing Sharps Injuries is our Goal
- 10. How Do Sharps Injuries Happen? • Who gets injured? • Where do they happen? • When do injuries occur? • What devices are involved? • How can they be prevented?
- 11. Who Gets Injured? Nurse 43% Technician 15% Student 4% Dental 1% Housekeeping/ Maintenance 3% Clerical / Admin 1% Other 5% Physician 28%
- 12. Where Do Sharps Injuries Occur? • Patient Room 39% (Inpatient: Medical – ICUs ) • Operating Room 27% • Outpatient 8% • ER 8% • Laboratory 5% • Other 13%
- 13. When Do Sharps Injuries Occur? • During use 41% • After use/before disposal 40% • During and after disposal 15% • Other 4%
- 14. What Devices are Involved in Sharps Injuries? Six Devices Account for 78% of All Injuries • Disposable Syringes 30% • Suture Needles 20% • Winged-Steel Needles 12% • Intravenous Catheter Stylets 5% • Phlebotomy Needles 3% • Scalpels 8%
- 15. How Do Injuries Occur With Hollow-Bore Needles? • Circumstances Associated with Hollow-Bore Needle Injuries June 1995—December 2003 (n=10,239) During Sharps Disposal 13% During Clean Up 9% In Transit to Disposal 4% Handle/Pass Equipment 6% Improper Disposal 9% Access IV Line 5% Transfer/Process Specimens 5% Recap Needle 6% Collision W/Worker or Sharp 10% Manipulate Needle in Patient 28% Other 5% Disposal Related: 35%
- 16. Sharps Injuries Are Preventable Preventable 64%Nonpreventabl e 18% Undetermined 18%
- 17. What Strategies Exist to Eliminate Sharps Injuries? • Eliminate or reduce the use of needles and other sharps • Use devices with safety features to isolate sharps • Use safe practices to minimize risk for hazards
- 18. First Strategy: Eliminate or Reduce Unnecessary Needle Use
- 19. How Can Needle Use Be Eliminated or Reduced? • Use needle-free IV delivery systems • Use alternate routes for medication delivery and specimen collection when available and safe for patient care • Streamline specimen collection systems
- 20. Next Strategy: Use Devices with Safety Features Engineered to Prevent Sharps Injuries
- 21. Safer Sharps Devices Engineered to Prevent Sharps Injuries • Hypodermic Needles With Retractable Needle With Self-Re-sheathing Needle With Add on Safety Feature
- 22. Safer Sharps Devices Engineered to Prevent Sharps Injuries • Phlebotomy Needles - Blunting Needle • Scalpels -Re-Sheathing Disposable Scalpels • Lancets - Retracting Finger/ Heal Lancet • Vascular Access Device - Blunting Winged Steel Needles
- 23. Safety Devices: Key Features • Provide immediate protection after use and throughout disposal • Few devices provide protection during use • Most safety features are not passive • The user must activate the safety mechanism to ensure protection • It is not always obvious how some safety features work • Training is necessary • Safe work practices are important • Safety devices alone do not completely prevent injuries
- 24. 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
- 25. The 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
- 26. Sharps Safety Practices • Be prepared • Be aware • Dispose with care
- 27. 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 • 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
- 28. 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 • 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
- 29. 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 • Transport reusable sharps in a closed container • Secure the container to prevent spillage
- 30. Clean Up and Dispose With Care • Inspect container • Keep hands behind sharps • Never put hands or fingers into sharps container • 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
- 31. Clean Up and Dispose With Care • If You Find Improperly Disposed Sharps in Work Environment • Handle carefully •Keep hands behind sharps at all times •Use mechanical device if you cannot safely pick up sharps by hand
- 32. Sharps Injuries in the Operating Room •Cuts/needlesticks 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
- 33. Sharps Injuries in the Operating Room • Needleless/no sharps alternatives • Use alternative cutting methods such as blunt electrocautery 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
- 34. If you experienced a needlestick or sharps injury or were exposed to the blood or other body fluid of a patient during the course of your work, immediately follow these steps: •Wash needlesticks and cuts with soap and water •Flush splashes to the nose, mouth, or skin with water •Irrigate eyes with clean water, saline, or sterile irrigants •Report the incident to your supervisor •Immediately seek medical treatment
- 35. Post Prophylaxis of Hepatitis B
- 36. Post Exposure Prophylaxis of HIV • PEP must be started within 72 hours after a possible exposure. The sooner you start PEP, the better; every hour counts. • Starting PEP as soon as possible after a potential HIV exposure is important. Research has shown that PEP has little or no effect in preventing HIV infection if it is started later than 72 hours after HIV exposure. • If you’re prescribed PEP, you’ll need to take it once or twice daily for 28 days.
- 39. You are Part of the Prevention Process when You •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
- 40. Always Handle Sharps With Care Have a Safe Day!