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BDS2 BAMS > Prevention and Management of Sharps Injuries > Flashcards

Prevention and Management of Sharps Injuries Flashcards

1
Q

3 Blood borne viruses

A
  • hep B
  • hep C
  • HIV
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2
Q

what are the potential risks of sharps injuries?

A

contracting a BBV (hep b, hep C or HIV)

bacterial infections

stress and mental impact of sustaining (especially if managed poorly)

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3
Q

4 methods of exposure to sharps injury

A

Needles or sharp objects (e.g. probes, scalpels etc.) that are contaminated with blood/bodily fluids that pierce/break the skin
- Pre, during and post procedure and post disposal (if disposed of poorly)

Splashing of blood/bodily fluids onto skin that is broken (e.g. abraded, chapped, open sores, dermatitis)

Contamination of eyes, nose or mouth with blood/bodily fluids

A human bite that breaks the skin

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4
Q

6 common sharp injuries

A

During IDB, needle goes into thumb

Adjusting posts, CoCr dentures etc. out with the mouth

Burs or ultrasonic tips left in situ in handpieces which are placed at elbow height (legs/arms as passing by)

Slipping luxators

Anaesthetic spraying from palate

Unsheathed needles left on messy trays Needles left on messy trays
- Responsibility of dentist to dispose of sharps equipment not nurse

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5
Q

IDB

A

inferior alveolar nerve block

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6
Q

why is it hard to establish number of occupational exposures in Scotland?

A

incidents under reported to the system

Only secondary care (hospital)
Only see GP, GDP if got to local NHS health board

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7
Q

what BBV is of the highest prevalence of significant occupational exposures

A

hep C
81%
- (HIV 10%; HBV 6%; mixed 3%)

Especially among IV drug users in Scotland

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8
Q

who gets sharps injuries?

A

Doctors 40%

Nurses and healthcare assistance 43%

Dentist/nurse 6%

Midwife 3%

Professions allied to medicine 8%

Other and NK 4%

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9
Q

most common timing of needlestick injuries

A

during the procedure (63%)

but can occur either side

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10
Q

how can a cleaner obtain a sharps injury?

A

when moving waste bags can get needle stick - ended in wrong waste not sharp bin

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11
Q

what should staff know in the case of a needlestick injury?

A

What action to take – you have a legal responsibility to report all sharps injuries
- Law

Who has responsibility to ensure proper assessment
- Not yourself – never assess own injury

Where to go for treatment of the injury and follow-up

How to report the incident so that systems can be revised to reduce future injuries

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12
Q

acronym for what to do following a sharps injury

A

be sharps AWARE

Apply pressure and allow to bleed
Wash don’t scrub
Assess type of injury
Risk of source blood?
Establish contact
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13
Q

be sharps AWARE stands for

A 
Apply pressure and allow to bleed
Wash don’t scrub
Assess type of injury
Risk of source blood?
Establish contact
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14
Q

Apply pressure and allow to bleed

A

Gently squeeze injury site to induce bleeding

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15
Q

Wash don’t scrub

A

Wash affected area with soap and warm running water – DO NOT scrub

Treat mucosal surfaces by rinsing with warm water or saline e.g. eyes

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16
Q

2 areas to Assess in the type of injury

A

high risk material?

significant injury?

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17
Q

Risk of source blood - how to assess

A

establish whether know the source of the blood
- whether their BBV status is known, or IV drug user

assess prevalence of BBV in general population

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18
Q

Establish contact

A

Report injury promptly to a senior member of staff

Call occupational health

Record injury (accident book and official reporting)

Employees who have had injuries must be followed up for prophylaxis, counselling and prevention

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19
Q

examples of high risk materials

A

blood and bodily fluids with visible blood

Saliva*

  • with no visible blood, only risk is HBV
  • need visible blood for HIV and HCV risk
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20
Q

examples of significant injuries

A

percutaneous,

human bite* with skin broken
- biter is at more risk of infection than bitten is pierce the skin and blood in the mouth

exposure of broken skin or mucous membrane to blood or body fluids

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21
Q

what would the risk be of a superficial graze, exposure of intact skin

A

non-significant injury

should still report

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22
Q

examples of high risk injuries

A

deep penetrating injury by a device visibly contaminated with blood

Injury with a device that had previously been placed directly in the source patient’s artery or vein

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23
Q

what would be greater risk - injury by hollow bore or solid instrument?

A

Hollow bore device - greater volume of blood compared to solid which will only have blood on the surface

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24
Q

how to assess the risk of source blood if status unknown?

A

is the patient in a high risk group?

- e.g. intravenous drug user

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25
Q

what can lower the risk of transmission if the patient is HIV+?

A

patient on cART
- Combined anti-retroviral therapy

Undetectable viral load means no risk

  • U = U
  • Undetectable viral load means untransmissible HIV
  • Most in Scotland as they are on treatment
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26
Q

what are the 2 factors which contribute to the risk of blood transmission

A

sero conversion rates

prevalence in general population

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27
Q

what BBV has the highest risk sero-conversion rate

A

highest risk is HBV

- particularly E antigens individuals

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28
Q

how to assess the BBV risk if do not know the source of the needle

A

Do not know the source of needle (e.g. out of bag)

  • Think of prevalence in general population
  • Multiply by risk of sero-conversion

Risk is low

Estimated risk of HCV transmission by NSI:
1/100 x 1/30 = 1/3000 (general population)

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29
Q

how to assess the hep C risk if know the source is an IV drug user

A

Risk of transmission high

2/5 x 1/30 = 1/75
PWID risk, HCV status NK

30
Q

when is post exposure prophylaxis treatment given

A

If HIV transmission risk is less than 1 in 10,000 PEP is not recommended

but should only be prescribed if there are additional factors that may increase the likelihood of transmission.

31
Q

who should interview the source patient/consent for bloods/their status?

A

Not your responsibility to ask source for consent for BBV assessment
- Need another member of the team

Hard operationally for dentist as smaller team
- May have to get them to go with you to A&E to get bloods taken when you are treated

32
Q

if patient source comes back with negative BBV results this indicates

A

reassurance to HCW

33
Q

if the patient source status is known then whats the next step?

A

test for BBVs or conform previous results with consent

34
Q

is the patient source status is unknown or they refuse consent

A

risk assess on circumstance and likelihood for BBV (type of injury and limited information known on patient from records)

35
Q

how to assess BBV status of recipient

A

History of HBV vaccination (partially or fully vaccinated) and response (known responder or non-responder)

  • Hepatitis B is most infectious
  • Dental professionals should all have Hep B vaccine
  • Non-responder or contra-indications to getting vaccine, need to know as different management

History of previous tests for BBVs

Take baseline bloods for storage
- Taken and stored
- End of follow up indicated BBV 
- Test this to see if positive 
Than can see sero-conversion caused BBV and not prior acquired
36
Q

reason for taking baseline bloods from recipient

A
  • Taken and stored
  • End of follow up indicated BBV
  • Test this to see if positive
    Than can see sero-conversion caused BBV and not prior acquired
37
Q

post exposure prophylaxis HBV

A

Immunoglobulin and/or vaccine

38
Q

how does Hepatitis B immune globulin act as a post-exposure prophylaxis agent for HBV?

A
  • Hepatitis B immune globulin (HBIG) provides an estimated 70% - 75% protection from HBV infection
  • If HBIG indicated administer at the same time or within 24hrs of the first dose of vaccine (but not after 7 days have elapsed since exposure)
  • Immediate protection to prevent seroconversion from happening
39
Q

how does the vaccine act as a post-exposure prophylaxis agent for HBV?

A

Vaccine will boost immunity

Takes a few days to respond

40
Q

when is post exposure prophylaxis for HBV not required?

A

Not required for those who have successful response to vaccine

41
Q

post exposure prophylaxis requirement is dependent on…..

A

vaccination status of recipient prior to exposure (vaccination status and responsiveness)

the type of exposure

the HBV status of the source

42
Q

who should assess the sharps injury

A

occupational health team member

complicated

should not be carried out by recipient

43
Q

post exposure prophylaxis for HIV

A

Combined anti-retroviral therapy
- start within 24h of exposure (if indicated)

Common side effects include headaches, fever, and nausea
- Many healthcare workers exposed to an HIV-positive source discontinue all or part of their PEP regimen prematurely because of drug toxicity (unpleasant)

Not routinely recommended if source has confirmed and sustained undetectable viral load or unless risk is less than 1 in 10,000

44
Q

minimum follow up

A

for at least 6-12 weeks after the exposure event

if PEP was taken, follow up should be at least 12 weeks from when PEP was stopped

A negative test at 12 weeks provides a very high level of confidence of freedom from infection

45
Q

follow up is PEP taken

A

follow up should be at least 12 weeks from when PEP was stopped

46
Q

negative follow up indicates

A

very high level of confidence of freedom from infection for recipient

47
Q

whats the best form of prevention of occupational exposure and BBV transmission by sharps

A

best to try and avoid them altogether

48
Q

examples of initiatives to try and avoid occupational exposures and sharps injuries

A

Vaccination

Raising awareness

Safety engineered devices

Risk assessment

Elimination of unnecessary needles

PPE

Recording and reporting

No recapping

PEP

Sharps containers

Work practices

Hand hygiene

49
Q

when did laws get put into action to target protecting HCW from occupational sharps exposures

A

Health and Safety (Sharp Instruments in Healthcare) Regulations 2013

transported from EU Council Directive 2010/32/EU the “Sharps Directive”

50
Q

who does the laws about sharps regulations apply to

A

Employers and employees

Contractors working for HC employer

Students/trainees on placement with HC employers

Community or hospital pharmacies

51
Q

what does the hierarchy of control focus on?

A

the most effective measure of removing the hazard first, rather than relying on training, behavioural or changes to work practices and the use of protective equipment.

Assess if risk from sharps

  • Yes - can you eliminate risk of sharp
  • Most cases cannot change to blunt tip

Need to think of alternatives
- Engineering controls
- Safer sharps devices
- Disabling the sharp point (covering it)
If unable to use a safer sharps device (need justification) then look at processes, PPE and behavioural processes to minimise injuries

52
Q

what is the underlying principle of EU directive to minimise occupational sharps exposure

A

prevention of exposure
- utilises hierarchy of controls

Historically, the focus on sharps injuries has been about changing behaviours of sharps users and effective follow up and support after an injury

53
Q

the main requirements of the regulations for employers

A

need to assess the risk of sharps injuries under the COSHH regulations.
- Where risk are identified, the sharps in healthcare regulations require them to take specific risk control measures

Promote the safe use and disposal of medical sharps

Provide information and training for employees

Respond effectively if an injury occurs

Review procedures regularly

54
Q

the main requirement of the regulations for employees

A

An employee who receives a sharps injury at work must notify their employer as soon as practicable (regulation 8)
- Clearly employers need to have adequate processes in place to allow for prompt notification particularly for out of hours and for those working in the community.

A number of underlying principles within the directive that relate to this duty

  • Workers should take care, as so far as possible, of their own health and safety
  • Never assume there is no risk of exposure following a sharps injury
  • The need to promote a no blame culture to ensure that incident reporting procedures focus on systemic failures rather than individual mistakes

supported by
- Information and training on what to do in the event of a sharps injury (reporting incidences) (regulation 6(4))

55
Q

how can an employee make a claim against an employer

A

by reporting the sharps injury exposure

  • no report = no evidence that employer failure caused infection
56
Q

reason in the future why sharps injuries should be reported by the employee now

A

to prevent future injuries

- learn lesson

57
Q

are safety devices in wide use

A

yes in GDH

but many practices don’t use them

58
Q

passive safety device

A

Activate themselves

Risk post procedure

59
Q

active safety device

A

Require you to launch the mechanisms which enable the sharp

60
Q

do safety devices cause a decrease in sharps injuries

A

General decrease in risk post procedures
US data suggest that effectiveness of safer devices ranges from 29%-89%
- Need to ensure disabled before disregarding

can still get injury e.g. if patient jumps

61
Q

what are the most important elements in sharps injury prevention

A

staff training and strict adherence to policies on handling contaminated sharps

  • safety devices do not automatically eradicate risk
  • your responsibility to know how to use and activate them properly
62
Q

exposure prone procedure

A

Those invasive procedures where there is a risk that injury to the worker may result in the exposure of the patient’s open tissues to the blood of the worker

EPPs

63
Q

management of HBV infected HCW

A

HBV infected healthcare workers may perform EPPs if they:

  • have a viral load <200 IU/ml (either from natural suppression or 12 months after cessation of antiviral therapy), and
  • are subject to annual plasma viral load monitoring, and
  • are under joint supervision of a consultant occupational physician and their treating physician,

used to be fear on old therapy that a breakthrough will cause viral load to spike – risk minimal on new treatment

cannot practice if infected or have high viral load

64
Q

management of HCV infected HCW

A

Must be HCV RNA negative

  • As a consequence of natural clearance, or
  • At 6 months after cessation of antiviral therapy

Can only practice if clear infection
- 90%+ will clear infection if treated and after 6 months and can return practice

65
Q

management of HIV infected HCW

A

Must either

  • Be on effective combination antiretroviral therapy (cART), AND
  • Have a plasma viral load <200 copies/ml
  • Be an elite controller, and
  • Be subject to plasma viral load monitoring every 3 months, (Blood taken by occupational health to assess viral load)
  • Be under joint supervision of a consultant occupational physician and their treating physician, and
  • Be registered with the UKAP-OHR
66
Q

will the patients find out if their HCW has a positive BBV result

A

NO

  • No notification exercises now for BBV positive healthcare workers
  • No adverse repercussions to dentist if report sharps injury and acquire BBV
67
Q

best policy in terms of occupational sharps injuries

A

prevention

- staff training important

68
Q

what does successful prophylaxis require

A

careful planning in advance

69
Q

EPP

A

exposure prone procedures

70
Q

seroconversion

A

time period during which a specific antibody develops and becomes detectable in the blood. After seroconversion has occurred, the disease can be detected in blood tests for the antibody

BDS2 BAMS (54 decks)

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