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Preventing Needlesticks and Other Sharps
Injuries…
Everything You Need to Know
The ProblemCDC 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, home care, nursing homes)
Increased risk for bloodborne virus transmission
Costly to personnel and healthcare system
Risks of Seroconversion due to Sharps Injury from a known positive source
Virus
HBV HCV HIV
Risk (Range)
6-30%* ~ 2% 0.3%
(*Risk for HBV applies if not HB vaccinated)
What is the Risk for HIV Alone?
Percutaneous 0.3%
Mucous membrane 0.1%
Non-intact skin <0.1%
Costs of Sharps InjuriesBaseline and follow-up laboratory testingTreatment of exposed personnel
$71-~$5,000 depending on treatment providedLost productivityTime to complete paperworkLoss of income / loss of careerEmotional costsSocietal costs
O’Malley, et. al. Costs of Management of Occupational Exposure to Blood and Body Fluids.
ICHE, July 2007, v 28, No. 7.
Who Gets Injured?
Nurse43%
Technician15%
Student4%
Dental1%
Housekeeping/Maintenance
3%
Clerical / Admin
1%
Other5%
Physician28%
Occupational Groups of Healthcare Personnel Exposed to
Blood/Body Fluids,
NaSH June 1995—December 2003
(n=23,197)
When Do Sharps Injuries Occur?
During use 41%
After use/before disposal 40%
During and after disposal 15%
Other 4%
Source: NaSH, June 1995—December 2003
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%Source: NaSH, June 1995—December 2003
How Do Injuries Occur With Hollow-Bore Needles?
During Sharps Disposal
13%
During Clean Up9%
In Transit to Disposal
4%
Handle/Pass Equipment
6%
Improper Disposal
9%
Access IV Line5%
Transfer/Process Specimens
5%
Recap Needle6%
Collision W/Worker or
Sharp10%
Manipulate Needle in Patient
28%
Other5%
Circumstances Associated with Hollow-Bore Needle Injuries NaSH June 1995—December 2003
(n=10,239)
Disposal
Related: 35%
Sharps Injuries Are Preventable
Preventable64%Nonpreventabl
e18%
Undetermined18%
Preventability of Needlesticks in 78 NaSH Hospitals, June 1995--December 2004 (n=11,625)
First Strategy:
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
Needle-Free IV Delivery Systems
IV delivery systems use valved ports and connectors, pre-pierced septa using blunt cannulas, or recessed protected needle connectors
Use aseptic technique when handling these systems!!!
Needle-Free IV Delivery Systems
Next Strategy:
Safer Sharps Devices Engineered to Prevent Sharps Injuries
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
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
Sharps Safety Practices
Be preparedBe awareDispose with care
Before Beginning a Procedure
Be Prepared
Organise equipment at the point of use
Make sure workspace have adequate lighting
Assess the patient’s ability to cooperate and - Get help if necessary
Ask the patient to avoid sudden movement
Obtain assistance from other staff or a family member to assist in calming or restraining a patient as necessary.
Proper placement of sharps
container
If using a fixed sharps container it should not be fitted higher than 1.4 meter
Before the beginning of a procedure that involves the use of a needle or other sharp device:Identify the location of
the sharps disposal container; if moveable, place it as near the point-of-use as appropriate for immediate disposal of the sharp.
If the sharp is reusable, determine in advance where it will be placed for safe handling after use.
Before the beginning of a procedure that involves the use of a needle or other sharp device:
If multiple sharps will be used during a procedure, organize the work area (e.g. procedure tray) so that the sharp is always pointed away from the operator.
During a Procedure That Involves the Use of Needles or Other Sharp Devices:Maintain visual
contact with the procedure site and location of the sharp device.
During a Procedure That Involves the Use of Needles or Other Sharp Devices:When handling an
exposed sharp, be aware of other staff in the immediate environment and take steps to control the location of the sharp to avoid injury to oneself and other staff.
During a Procedure That Involves the Use of Needles or Other Sharp Devices:
During a Procedure That Involves the Use of Needles or Other Sharp Devices:If the procedure necessitates reusing a needle
multiple times on the same patient (e.g., giving local anesthesia), recap the needle between steps using a one-handed technique or a fixed device that enables one-handed recapping.
One handed recapping
Locking the cap of the needle
Using a one-handed technique recapping
Manipulate or remove sharps using a mechanical device
Activate the safety feature as the procedure is being completed, observing for audio or visual cues that the feature is locked in place.
Safety syringes
During Clean-up following a Procedure:
During Clean-up Following a Procedure:
Do not use bare hands to sort procedure tray
Use a mechanical device to pick up the sharp if it cannot be performed safely by hand.
After Disposal:
Visually inspect sharps containers for evidence of overfilling before removal.
Use a mechanical device to remove sharps from overfilled boxIf a sharps container
is overfilled, obtain a new container and use forceps or tongs to remove protruding devices and place them in the new container.
During Disposal:
If a sharps container is overfilled, obtain a new container
Improperly Disposed Sharps:
If an improperly disposed sharp is encountered in the work environment, handle the device carefully, keeping the hands behind the sharp at all times.
During disposalNo recapping
During a procedureDo not carry sharps without a tray .
Wrong disposal can harm others
Do not dispose sharps into regular garbage
Improper Disposal
Assemble container correctly
Do not use sharps box without cover
FLOW SHEET FOR NEEDLE STICK/SHARPS INJURYNEEDLE STICK/SHARPS INJURYWASH THE INJURY UNDER RUNNING
WATER (DO NOT SUCK/SQUEEZE FROM THE
INJURED SITE)COVER INJURY WITH AN
IMPERMEABLE DRESSINGNOTIFY SUPERVISOR IF INJURY IS SERIOUS GO TO ER FOR
APPROPRIATE TREATMENT
FLOW SHEET NEEDLESTICK/SHARPS INJURY
COMPLETE AN OVA FORM (INCLUDE PATIENT/SOURCE MEDICAL NO.)
GO TO EHS WORKING HOURS/AFTER WORKINH HOURS GO TO ER)
GO TO GP LAB FOR BLOOD WORKSIF POSSIBLE DO BLOOD WORKS FROM
SOURCE PATIENT AFTER CONSENT FROM TREATING PATIENT
GO BACK TO EHS AT THE SPECIFIED FOLLOW-UP DATES GIVEN TO YOU FOR BLOOD WORKS
THANK YOU !!!