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