Needlestick Injuries

OVERVIEW

Approach

1. First aid
2. Quantify risk
3. Post procedure prophylaxis
4. Quality assurance
5. Education

MANAGEMENT

Stop the procedure

  • ensure patient and prodeduralist is safe
  • take over care if required

First aid

  • express blood from wound
  • wash wound immediately with soap and water (2% chlorhexidine wash
  • dress

Risk stratification

  • identify source patient and test for HIV, Hep B and C
  • test exposed staff member
  • type injury – depth, type, location, barriers to transmission (double, single gloved), blood on needle

Notify patient and family

  • open disclosure
  • consent for testing

Occupational health involvement

  • initiate the injury reporting system used in workplace (in hours vs out of hours)
  • counselling required with specific risk depending on depth of injury, whether there is visible blood on needle, needle placement in vein or artery, lower risk if solid needle vs hollow
  • document the exposure in detail
  • advice on: safe sex and no blood donation until testing complete

Post-exposure prophylaxis

  • discuss with ID
  • HIV +ve -> post-exposure prophylaxis within 2 hours
  • Hep B +ve -> Hep B immunoglobublin
  • Hep C +ve -> no treatment recommended currently

Systems analysis to look at prevention of further events

  • document thoroughly
  • identify factors that may have lead to exposure and could prevent further exposures
  • a unit policy may be appropriate

Follow up

  • follow up post exposure testing @ six weeks, 3 months and 6 months +/- 1 year
  • if post exposure prophylaxis prescribed -> monitor for toxicity
  • take precautions (safe sex) to prevent exposing others until follow up testing complete
  • review of technique with proceduralist

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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