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CPS Statements 2018-2020 > Needle Stick Injuries In The Community > Flashcards

Needle Stick Injuries In The Community Flashcards

1
Q

What pathogens are considered as blood borne pathogens

A

HBV, HCV, HIV

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2
Q

How many cases of HBV have been reported?

A

2 cases

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3
Q

How many cases of HCV have been reported

A

3

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4
Q

How many cases of HIV have been reported?

A

0

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5
Q

How can community needle stick injuries be prevented? (6)

A
  1. Educate parents, educators, HCP about the dangers of used needles, syringes, contaminated objects, sharps
  2. Educate children on potential dangers of injection drug use
  3. Educate children not to touch/handle needles, syringes, and to report them to adults for safe disposal
  4. Adequate cleanup of parks and schoolyards to make them needle free
  5. Addiction treatment support for IVDU
  6. Infection prevention programs for IVDU
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6
Q

What does the risk of infection from exposure depend on

A
  1. Size of the needle
  2. Depth of penetration
  3. Whether blood was injected
  4. The volume blood injected
  5. Concentrated of virus in the blood
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7
Q

What is the rate of transmitted for HBV

A

2-40%

*can survive for 1 week on discarded needles

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8
Q

Why are children more susceptible to HBV from needle stick injury

A

Most provinces have vaccination schedules that target children who are older than usual age at which they sustain accidental needle stick injuries

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9
Q

What to do with child known to be anti-HbsAg antibody positive

A

No action required

**Child has immunity

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10
Q

What to do with a child known to be HBs-Ag positive

A

No action required

**Child already has HBV

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11
Q

What to do with a child who has not been fully vaccinated against HBV

A

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
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12
Q

What to do if the results are not available in 48h

A

Give HBIG immediately
Give 1 dose HBV vaccine
Follow up results

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13
Q

What to do with a child who has been fully vaccinated against HBV

A

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
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14
Q

What is the time range for giving HBIG

A

Ideally within 48h of injury

Unknown efficacy if >7d from injury

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15
Q

What is the time range for giving the HBV vaccine

A

Give as soon as possible, latest by 7d

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16
Q

What is the risk of acquiring HCV from a needle stick injury

A

3-10%

17
Q

Is there post-exposure prophylaxis for HCV?

A

No

18
Q

Why is it important to test for HCV after a needle stick injury?

A

75% of children infected will develop chronic infection, normally asymptomatic
These children need referral and potentially antiviral treatment

19
Q

What is the risk for HIV transmission after a needle stick injury?

A

0.2-0.5%

20
Q

What helps predict risk for HIV transmission?

A
  1. Known HIV-seropositive source
  2. Needle from high HIV prevalent area
  3. Injury almost immediately after needle use
  4. Presence of fresh blood
  5. Depth of injury, and extent of trauma
  6. Gauge of needle
  7. If mucous membrane / nonintact skin: consider extent of exposure
21
Q

What medications is used as HIV prophylaxis in needle stick injury

A

3 drug ART

22
Q

What is the risk reduction in HIV transmission with zidovudine prophylaxis

A

80%

23
Q

What is the immediate management of a needle stick injury?

A
  1. Clean work with soap and water ASAP - do not squeeze to cause bleeding
  2. Assess wound extent, and for probability of exposure through open skin lesions, mucous membranes
  3. Determine HBV and tetanus vaccination status
  4. Give tetanus vaccine +/- TIG as indicated
  5. Document injury
  6. Blood for baseline HBV, HIV, HCV status
    - if starting ART: include CBCD, LFT, BUN, Cr
  7. If needle user known - asses for BBP risk factors, and test as needed
  8. Do not test needle/blood for viruses
24
Q

What factors to consider when deciding on HIV ART prophylaxis?

A
  1. Risk assessment
  2. Can child tolerate and adhere to 4 week regimen
  3. Potential benefits, A/E and costs of ART
  4. Interactions with other medications child is on
25
Q

When should HIV ART prophylaxis be started?

A

before 72h - ideally within 1-4 hours of injury

26
Q

What options are available for ART prophylaxis?

A
  1. Young children: zidovudine + lamivudine + lopinavir/ritonavir
  2. > 12yo + >35kg: emtricitabine + tenofovir + raltegravir or dolutegravir
27
Q

What follow up should occur if ART is started?

A

2-3 days later to look at adherence, A/E

at end of 28d of therapy

28
Q

What are side effects of ZDV and 3TC (lamivudine)

A

Anorexia, nausea, vomiting, diarrhea, abdominal pain, fatigue, headache, neutropenia, elevated LFTs

29
Q

What are side effects of LPV/r (lopinavir/ritonavir)

A

Vomiting, diarrhea, abdominal discomfort

30
Q

Which ART can cause renal tubular dysfunction after prolonged use?

A

TDF (tenofovir)

31
Q

What follow up is done after a needle stick injury and the child is on ART

A
  1. Reassess at 2-3 days - phone or visit
  2. Follow up at 2 and 4 weeks, includes CBC, LFTs, Cr
  3. At 4 weeks: give second dose of HBV vaccine IF only 1 dose given prior, or if no antibody or antigen detect (no infection, no immunity)
  4. At 6 weeks: test for anti-HIV antibody
  5. At 3mo: test for anti-HIV antibody, anti-HCV antibody
  6. At 6mo:
    - test for anti-HIV antibody, anti-HCV antibody, anti-HBsAg antibody
    - give 3rd HBV vaccine if only 2 dose previously received
32
Q

When can you use a 4th generation combination HIV p24 antigen - HIV antibody test

A

At the 6mo check IF the child does not also have HCV, and the anti-HIV antibody was negative at 3mo

33
Q

What do you do if anti-HBsAg antibody test is negative 6mo

A

Give 3rd dose of vaccine
Check again in 1-2mo

If still negative - check for HBsAg

If HBsAg also negative
Give 4th dose of vaccine and check again in 1-2mo

If still negative - refer

CPS Statements 2018-2020 (16 decks)

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