Prevention management of sharps injuries

Question 1

What are 3 examples of blood borne viruses that can be transmitted from a sharps injury?

Answer 1

• Hep B
• Hep C
• HIV

Question 2

Is it just blood borne viruses that can be transmitted via a sharps injury?

Answer 2

• No, can also have bacterial infections transmitted

Question 3

How can people be exposed to blood borne viruses by other people? (4 points)

Answer 3

• Needle or sharp object that are contaminated with blood/bodily fluids that pierce/break the skin
• Splashing of blood/bodily fluids onto skin that is broken
• Contamination of eyes, nose or mouth with blood/bodily fluids
• A human bite that breaks the skin

Question 4

What are common ways of obtaining a sharps injury in the dental setting? (6 points)

Answer 4

• During IBD, needle goes into thumb
• Adjusting posts, Co Cr dentures etc. out with the mouth
• Burs or ultrasonic tips left in situ in handpieces which are places at elbow height
• Slipping luxators
• Anaesthetic spraying from palate
• Unsheathed needles left on messy trays

Question 5

In an event of a needle stick injury or similar, what should all staff know? (4 points)

Answer 5

• What action to take (legal responsibility to report all sharp injuries)
• Who has responsibility to ensure proper assessment (never yourself)
• Where to go for treatment of the injury and follow-up
• How to report the incident so that systems can bde revised to reduce further injuries

Question 6

What does the pneumonic AWARE stand for in relation to sharps injuries?

Answer 6

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

Question 7

What does the first ‘A’ in the pneumonic AWARE stand for?

Answer 7

• Apply pressure and allow to bleed

- Gently squeeze injury site to induce bleeding

Question 8

What does ‘W’ in the pneumonic AWARE stand for?

Answer 8

• Wash don’t scrub
• Wash the affected area with soap and warm running water - DO NOT scrub
• Treat mucosal surfaces by rinsing with warm water or saline

Question 9

What does the second ‘A’ in the pneumonic AWARE stand for?

Answer 9

Assess the type of injury

• High risk, significant or non-significant

Question 10

What is classed as a ‘High risk material’ sharps injury? (2 points)

Answer 10

• Blood and bodily fluids with visible blood

- Saliva (with no visible blood, only risk of HBV)

Question 11

What is classed as a ‘significant injury’ sharps injury? (3 points)

Answer 11

• Percutaneous
• Human bite with skin broken
• Exposure of broken skin or mucous membrane to blood or body fluids

Question 12

What is classed as a ‘non-significant injury’ sharps injury? (2 points)

Answer 12

• Superficial graze
• Exposure of intact skin
• (but you should still report it)

Question 13

What does ‘R’ in the pneumonic AWARE stand for? (4 points)

Answer 13

• Risk of source blood
• Is the patient known to have HIV/AIDS or Hep B/C infection?
• Is the patient in a high risk group? e.g. IV drug user
• IF HIV positive, is the patient on cART?

Question 14

In relation to viral load what does U=U mean?

Answer 14

• Undetectable viral load = untransmissible HIV

Question 15

What does ‘E’ in the pneumonic AWARE stand for? (5 points)

Answer 15

• Establish contact
• 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 by prophylaxis, counselling and prevention

Question 16

It is important to interview the source patient and get consent for bloods. Is this your responsibility if you are the one who sustained the injury?

Answer 16

• No

Question 17

What are the 2 types of post exposure prophylaxis for HBV?

Answer 17

• Immunoglobin and/or vaccine
• Immunoglobin will give you immediate protection
• The vaccine will give you long term immunity but this will not happen for a few days

Question 18

What is the type of post exposure prophylaxis for HBV dependent on? (3 points)

Answer 18

• Vaccination status prior to exposure
• The type of exposure
• The HBV status of the source

Question 19

What is the % protection from HBV infection does Hep B immune globulin (HBIG) provide?

Answer 19

• Estimated 70-75%

Question 20

If HBIG is indicated for someone with a sharps injury, when should this be administered?

Answer 20

• At the same time or within 24hours of the first dose of vaccine (but not after 7 days have elapsed since exposure)

Question 21

What is the post exposure prophylaxis for HIV?

Answer 21

• Combined anti-retroviral therapy

- Start within 24hrs o f exposure (if indicated)

Question 22

What are common side effects of combined anti-retroviral therapy for HIV exposure? (3 points)

Answer 22

• Headaches
• Fever
• Nausea

Question 23

What follow up should be done after a sharps injury has occurred? (3 points)

Answer 23

• As a minimum, follow up should be 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

Question 24

What are the main requirements of employers in prevention of sharps injuries? (4 points)

Answer 24

• Promote the safe use and disposal of medical sharps
• Provide info and training for employees
• Respond effectively if an injury occurs
• Review procedures regularly

Question 25

What are the main requirements of employees in prevention of sharps injuries? (2 points)

Answer 25

• An employee who receives a sharps injury at work must notify their employer as soon as practicable (regulation 8)
• Supported by: information and training on what to do in the event of a sharps injury

Question 26

Can you still sustain a sharps injury from a needle with a safety device?

Answer 26

• Yes
• You get active and passive devices
• You need to enable the active device or there will still be a risk from the device