c. HCW shall ensure that their PPE is positioned properly and secured.
d. Use a mouthpiece, resuscitation bag, or other ventilation device to prevent direct contact with patient’s secretions.
[Link] Needle Stick Injury (NSI)
NSI is an accidental penetration of the health care worker’s skin by a sharp instrument, during or after performance of a medical, surgical or
Lab procedure. The NSIs can result from needles, syringes, glass, broken equipment, lancets scalpel blade and broken glass ware etc.
Preventive Measures
· Plan for safe handling and disposal before beginning any procedure using needles or sharps.
· Avoid the use of needles where safe and effective alternatives are available.
· Avoid recapping needles; if necessary, use one handed technique/scoop method.
· Dispose of used disposable sharps or needles promptly in sharps puncture-resistant container having disinfectant, with a lid. Such
containers must be located in ALL patient care and laboratory areas, easily accessible to working personnel.
· All sharps must be appropriately disposed as per the Waste disposal policy.
Actions to Be Taken After NSI
· Wash the area with soap and water, do not press or squeeze the injury site.
o Flush splashes to the nose, mouth, or skin with water,
o Irrigate eyes with clean water or saline.
· Clean the area with the available antiseptic and cover the site with dressing.
· Inform supervisor/shift In-charge. Note patient’s name and medical record number.
· Visit RHS Diagnostic Lab for screening.
· Patient’s blood samples are requested for HBsAg, Anti HCV, and Anti-HIV screening if not previously tested positive for each of these
infections.
· Employee’s blood samples are checked for HBsAg, Anti HBsAg, Anti HCV and Anti-HIV.
· Report all needle stick and other sharps-related injuries promptly to ensure that you receive appropriate follow up care.
Post-Exposure Evaluation and Follow Up
· Administer or arrange for administration of prophylaxis per CDC guidelines recommendations.
· Post exposure precautions and counseling regarding safe sex and risk should be discussed.
· Testing of source patient infectious status should be done as soon as possible to obtain the result within the first few hours.
· If the source person is negative for HIV, hepatitis-B and hepatitis-C then the exposed employee does not need to be tested further.
· HIV evaluation (if source is positive):
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a. consult Pathologist on call immediately. Remember this is an emergency and post exposure prophylaxis should be initiated within
24 hours.
b. HIV antibody testing should be sent immediately before starting post exposure prophylaxis with antiretroviral drugs.
c. Follow up HIV testing should be done at 6 weeks, 3 months, and 6 months.
· HCV evaluation (if Source is Positive):
a. Baseline testing for Anti-HCV
b. HCV PCR Qualitative (RNA) after 6 weeks if early diagnosis desired by physician/ Gastroenterologist.
c. Anti-HCV antibody after 4-6 months.
Note: No effective post exposure prophylaxis available for hepatitis C
· Hepatitis B evaluation (if source positive)
a. If previously vaccinated against hepatitis B: get anti HBs titers if not done after vaccination. For those with documented antibody
response to vaccine, monitoring of antiHBs levels or booster doses are not recommended.
Management
Exposed Person Exposure Source
HBsAg + HBsAg - Status Unknown (1)
Unvaccinated Give HBIG 0.06 ml/kg IM & initiate HB Initiate HB vaccine Initiate HB vaccine series+
vaccine
Vaccinated Do anti-HBs on exposed person: No treatment Do anti-HBsAg on exposed person:
(antibody status If titer >10 mIU/ml: no treatment necessary If titer >10 mIU/ml: no treatment
unknown) If titer < 10 mIU/ml: give HBIG + HB If titer < 10 mIU/ml: give HBIG + HB
vaccine vaccine
(1) If known high risk source, treat as if source were HBsAg positive
[Link] Handling and Disposal of Sharps
Purpose: To provide guidelines for all staff, in regard to safe handling and disposal of sharps.
Definition of Sharp: Sharp is any item having corners, edges, or projection capable of cutting or piercing skin.
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