Sharps Injuries In Healthcare

Sharps Injuries in Healthcare Setting– Incidence and Prevention

Associate Professor Datin Dr. Yasmin Abu Hanifah Dept of Medical Microbiology Faculty of Medicine Universiti Malaya Kuala Lumpur

Blood-borne pathogens

• Bacteria: Bacillus anthracis Leptospira Strept. pneumoniae Borrelia recurrentis Mycobacterium leprae Listeria Brucella

• Protozoa:

Malaria Toxoplasma gondii

• Virus: HAV, HBV, HCV HIV CMV, HSV, EBV Measles Parvovirus B19 Poliovirus Yellow fever

Sharps injuries • How do NSI occur?

• • •

devices associated with NSI activities associated with NSI discarded needles at hospitals, parks, playing fields, beaches, public toilets, communal stairways and alleyways USA : ~5.6 million HCWs, 800,000 injuries per year Half unreported Average hospital : 30 NSI per 100 beds per year.

Transmission of HBC, HCV, HIV in Healthcare setting • Patients ↔ HCW • Direct inoculation of virus into cutaneous scratches, skin lesions, abrasions, or burns, and inoculation of virus onto surfaces of the eyes, nose or mouth through accidental splashes • Blood transfusion/donation • Surgery • Percutaneous injections • Disposal of sharps

Universal Precautions CDC (MMWR 1988:37(24):377-388)

Aim- to prevent parenteral, mucus membrane and non-intact skin exposures to HCWs to blood-borne pathogens

Apply to : • • • • • • • • •

blood semen vaginal secretions pericardial fluid peritoneal fluid CSF amniotic fluid synovial fluid pleural fluid

Not applied to : • • • • • • • •

Tears Urine Feces Nasal secretions Sputum Vomitus Sweat saliva

Standard Precautions • Handwashing • Gloves • Gowns/aprons • Masks/eye shields/goggles/face

shields • Appropriate handling and disposal of waste • Aseptic techniques

Percutaneous injuries during surgery

• 1990 Tokars, 4 US teaching hospitals • 1382 operations, 99 injuries (7.2%) • 5 different surgical specialities:

• • •

O&G General Orthopaedic Trauma Cardiac 73% related to suturing Highest rates – gynaecologic surgeries Others- orthopaedic, cardiothoracic

Tokars et al. Percutaneous injuries during surgical procedures. JAMA 1992. June 3,267(21):2899-90

Risk of virus transmission after percutaneous injury

Ann-Christine Nyquist. Blood-borne Pathogens and Needlestick. Vol XV Number 1, Jan 2000

Virus

Transmission risk %

HBV

6 - 30

HCV

3 - 10

HIV

0.3

Average risk of seroconversion following a percutaneous exposure to an infected source Lanphear BP. Epidemiol rev. 1994;16(2):437-50 virus

Seroconversion risk %

HBsAg +ve, HBeAg –ve

5

HBsAg +ve, HBeAg +ve

19 - 30

Hep C

1-8

HIV

0.31

Hollow-bore needles and other devices associated with percutaneous injuries in NaSH hospitals, by % total percutaneous injuries (n=4.951) June 1995-July 1999.

CDC 1999

Causes of percutaneous injuries with hollow-bore needles in NaSH hospitals, by % total percutaneous injuries (n=3,057) June 1995-July 1999. Source : CDC 1999

Incidence of Sharps Injuries in UMMC 2000 - 2005 YEAR

INCIDENCE CASE

2000

43

2001

61

2002

106

2003

111

2004

89

2005

100

TOTAL

510

Incidence of Sharps Injuries in UMMC by Job Category (January - December 2005) 30 25

* Doctor: Medical officer - 16 House officer - 9

25 20 15 15 10 10

9

8

5

7 2

2

1

St af f

N M ur ed se ic al St ud en St t ud en tN ur se A tte nd an D en t ta lS tu de Pr nt iv at e Po C rt le er an C er li n ic al W as te A ss .N ur La se b. Te ch ni ci D an en ta lA si st an t

0 D oc to r

Total case

20

Job category

1

2

Location

2 2 2 1 1 1 1 1 1 1

Disposal Area

2

Pasca Other hospital

3

SCN PTj Perubatan Tranfusi

3

5UA Mortuary

3

10U 8E

3

13U TSSU

4

7E 8U

4

Laundry Radiology

4

4U

4

7D Laboratory

4

11U 7U

6

8D 5UB

6

12U 9U

12

Outpatient clinic Labour ward

PTj Trauma & Kecemasan Operation theater

Dental Faculty

Total case

Incidence of Sharps Injuries in UMMC by Locations (January - December 2005)

10 10 10 10

8 6

5 4 3 2 1

0

2 1 1 1 1 1 1 1

Electro-cautery device Liver biopsy needle BMA needle Wire Microtome blade Skin hook Winged steel needle

0 2

Vacuitaner

3

Dental probe

7

Not known

7

Suture needle

10

Scalpel

10

Stylet

Lancet

60

Hollow bore needle

Total case

Incidence of Sharps Injuries in PPUM by Type of Sharp (January - December 2005) 54

50

40

30

20

7

Type of sharps

u

ri n

se ,B

D u g us e

D

of ef it o re em ev ic d is e p le Wh It os ft em ile a in l re a p W p ro c p h tr ro app ile u pr d in p ed ia B g u et tt te f i ro w n pl g ee m ac i t n In tr e e s m as p te re i h p nt p b s o ar ag o s D at f h m is io ar as ul n p ti s s o em f b st re in ep b u W l se in it pr h g ... of d d ra e r S eu vi w tu ce in sa ck g o b a b r l.. y n e . q It e i te ed u em ip m le m pi pr fr en er ot o t ce m ru d d r u in si b g d be e fr r o o f m di o s ... po s B al ef c o on re ... u se o f ite m

ft er

A

Total case

Incidence of Sharps injuries in UMMC by How Injuries Occur (January - December 2005) 30

20

15

10 28

25

17 14 8 8 7

5 5

How it occur?

4 3 3 1 1

0 1

Staff with exposure to HIV, Hep.B and C

Year

HIV

Hepatitis B

Hepatitis C

Hepatitis B &C

2000

1

-

-

-

2001

-

-

-

-

2002

2

2

-

-

2003

4

2

-

-

2004

-

3

2

-

2005

2

8

2

1

TOTAL

9

15

4

1

Sharps injury management • • • • • • • • •

Apply first aid Report to the supervisor/manager and ICN Complete NSI-OSHA form to report Take 5 ml blood from source patient and injured HCW Test for HIV, HBV, HCV ATT injection and wound dressing If source patient was HIV, HBV, HCV positive, contact ID for counseling, PEP Prophylaxis with anti retrovirals started within 2 hours Hep B exposure: Ig + vaccine (HBsAb<10mIU/mL)

Help prevent SI – Be prepared • • • • • • • •

Vaccination Organise your work area Well-lit Sharps bins within reach Receive training on handling sharps Assess any hazards Use safety devices to reduce risk Consistent evaluation of procedures with intent to modify to reduce risk

Prevention of sharps injuries – Be aware

• Keep exposed sharp in view • Be aware of people and you • Stop if you feel rushed or distracted • Focus on your task • Avoid hand-passing sharps & use verbal

alerts when moving sharps • Watch for sharps in linen, beds, on the floor, or in waste bins (use forceps to handle)

Prevention of sharps injuries Dispose sharps with care • • • • • • • •

Avoid recapping needles Be responsible for the device you use Do not remove used needles from disposable syringes Do not bend, break or manipulate used needles Activate safety features after use Dispose devices in rigid sharps container Do not overfill Keep fingers away from the opening of the sharps containers

Conclusion

• Culture of safety. • Organisation makes SI prevention a

prominent priority • Management and staff have a shared commitment to prevent SI • Staff is encouraged to report SI promptly • Appropriate management of occupational exposure