Needle Stick Injuries In The Community Flashcards
What pathogens are considered as blood borne pathogens
HBV, HCV, HIV
How many cases of HBV have been reported?
2 cases
How many cases of HCV have been reported
3
How many cases of HIV have been reported?
0
How can community needle stick injuries be prevented? (6)
- Educate parents, educators, HCP about the dangers of used needles, syringes, contaminated objects, sharps
- Educate children on potential dangers of injection drug use
- Educate children not to touch/handle needles, syringes, and to report them to adults for safe disposal
- Adequate cleanup of parks and schoolyards to make them needle free
- Addiction treatment support for IVDU
- Infection prevention programs for IVDU
What does the risk of infection from exposure depend on
- Size of the needle
- Depth of penetration
- Whether blood was injected
- The volume blood injected
- Concentrated of virus in the blood
What is the rate of transmitted for HBV
2-40%
*can survive for 1 week on discarded needles
Why are children more susceptible to HBV from needle stick injury
Most provinces have vaccination schedules that target children who are older than usual age at which they sustain accidental needle stick injuries
What to do with child known to be anti-HbsAg antibody positive
No action required
**Child has immunity
What to do with a child known to be HBs-Ag positive
No action required
**Child already has HBV
What to do with a child who has not been fully vaccinated against HBV
Test for anti-HBsAg antibody and HBsAg immediately
*await results if available in next 48h
- If both are negative: give HBIG immediately + HBV vaccine
- If anti-HBsAg positive and HBsAg negative: complete HBV vaccine as schedule
- If HBsAg positive - HBV positive, stop vaccinations, send to ID
What to do if the results are not available in 48h
Give HBIG immediately
Give 1 dose HBV vaccine
Follow up results
What to do with a child who has been fully vaccinated against HBV
Test for anti-HBsAg
- if not available in 48h - give one dose of HBV
If anti-HBsAg antibody positive: no further action
If anti-HBsAg antibody negative - test for HBsAg
- if HBsAg negative: give HBIG and 1x HBV vaccine
- if HBsAg positive: arrange follow up
What is the time range for giving HBIG
Ideally within 48h of injury
Unknown efficacy if >7d from injury
What is the time range for giving the HBV vaccine
Give as soon as possible, latest by 7d
What is the risk of acquiring HCV from a needle stick injury
3-10%
Is there post-exposure prophylaxis for HCV?
No
Why is it important to test for HCV after a needle stick injury?
75% of children infected will develop chronic infection, normally asymptomatic
These children need referral and potentially antiviral treatment
What is the risk for HIV transmission after a needle stick injury?
0.2-0.5%
What helps predict risk for HIV transmission?
- Known HIV-seropositive source
- Needle from high HIV prevalent area
- Injury almost immediately after needle use
- Presence of fresh blood
- Depth of injury, and extent of trauma
- Gauge of needle
- If mucous membrane / nonintact skin: consider extent of exposure
What medications is used as HIV prophylaxis in needle stick injury
3 drug ART
What is the risk reduction in HIV transmission with zidovudine prophylaxis
80%
What is the immediate management of a needle stick injury?
- Clean work with soap and water ASAP - do not squeeze to cause bleeding
- Assess wound extent, and for probability of exposure through open skin lesions, mucous membranes
- Determine HBV and tetanus vaccination status
- Give tetanus vaccine +/- TIG as indicated
- Document injury
- Blood for baseline HBV, HIV, HCV status
- if starting ART: include CBCD, LFT, BUN, Cr - If needle user known - asses for BBP risk factors, and test as needed
- Do not test needle/blood for viruses
What factors to consider when deciding on HIV ART prophylaxis?
- Risk assessment
- Can child tolerate and adhere to 4 week regimen
- Potential benefits, A/E and costs of ART
- Interactions with other medications child is on
