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BDS4 Operative Dentistry > Sharps Injuries > Flashcards

Sharps Injuries Flashcards

1
Q

What blood borne viruses can you be exposed to through a sharps injury?

A

-hepatitis B -hepatitis C -HIV

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2
Q

What are some examples of an exposure/sharps injury? (4)

A

-needles or sharp objects that are contaminated with b lood/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 bit that breaks the skn

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3
Q

What other kinds of infections can you get from a sharps injury?

A

-bacterial infections

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4
Q

What are some common sharps injuries in the dental practice?

A

-during IDB, needle goes into thumb -adjusting posts, CoCr dentures etc. out with the mouth -burs or ultrasonic tips left in situ in the handpieces which are placed at elbow height (legs/arms passing by) -slippin luxators -anaesthetic spraying from palate -unsheathed needles left on messy trays

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5
Q

How does the number of significant occupational exposures compare to all occupational exposure incidents?

A

It is a lot lower

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6
Q

What is a significant occupational exposure?

A

An exposure where the source is known to be infected with a blood borne virus or suspected to have a blood borne virus (high risk e.g. intravenous drug user)

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7
Q

What blood borne virus are you at most risk of from a sharps injury?

A

Hepatitis C

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8
Q

What blood borne virus are you at least risk of being exposed to through a sharps injury?

A

Hep B

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9
Q

What groups of people are more likely to get a sharps injury/exposure?

A

People working in healthcare

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10
Q

Describe the distribution of needlestick injuries relative to timing.

A

-most happen during a procedure (65%) -some happen post procedure but before disposal (18%) -some happen during or after disposal (17%)

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11
Q

What is the acronym used to remember what to do immediately after obtaining a sharps injury?

A

Be sharps AWARE A - apply pressure W - wash don’t scrub A - assess type of injury R - risk of source? E - establish contact

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12
Q

Describe the first step in the AWARE acronym.

A

Apply pressure and allow to bleed -Gently squeeze injury site to induce bleeding

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13
Q

Describe what you do in the second step in the AWARE acronym.

A

-wash affected aread with soap and warm running water - DO NOT SCRUB -treat mucosal surfaces by rinsing with warm water or saline

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14
Q

What two main factors do you consider when assessing the type of injury?

A

Is it a high risk material? Is it a significant injury?

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15
Q

What would be classed as a high risk/not high risk material?

A

High risk = blood and bodily fluids with visible blood, saliva containing blood. If saliva doesn’t contain blood only risk is for Heb B

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16
Q

What is considered a significant injury?

A

-percutaneous (breached the skin)
-human bite with skin broken (bood involved)
-exposure of broken skin or mucuos membrane to blood or bodily fluids

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17
Q

What is not considered a significant injury?

A

A superficial grace, exposure of intact skin

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18
Q

Give examples of injuries that might occur and would be high risk?

A

-A deep penetrating injury by a device visibly contaminated with blood -injury with a device that had previouslt been placed directly in the source patient’s artery or vein

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19
Q

Is a hollow borne instrument or a solid instrument higher risk? Why?

A

Hollow as it can hold more blood than a solid instrument that will just have blood on the surface

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20
Q

How would you assess the risk of source of blood?

A

Think about: -is the patient known to have HIV/AIDS or hep B/C infection? -Is the patietn in a high risk group? e.g. intravenous drug user -If HIV positve, is the patient on cART? (combined anti-retroviral therapy)

21
Q

What does ‘U=U’ mean with regards to HIV?

A

Undetectable viral load = untransmissable HIV so NO RISK TO YOU if sustain sharps injury

22
Q

How can you achieve ‘U=U’?

A

If on cART therapy

23
Q

If you don’t know the individual in which the sharp was used (needlestick injury from bag etc.), how can you figure out your estimated risk of contracting an infection?

A

Multiply the BBV prevalence by the publish sero-conversion rate

24
Q

Describe what you would do first for the last step in AWARE. (establish contact)

A

-report the injury promptly to a senior member of staff

25
Q

What would you do after reporting the injury to a senior staff member?

A

-call occupational health -Record injury (accident book and official reporting)

26
Q

What should employees who have sustained injuries be provided with?

A

Follow up for prophylaxis, counselling and prevention

27
Q

How can the BBV status of the source be assessed (risk) ?

A

By interviewing the source (patient) and getting consent for blood

28
Q

Who speaks to the patient about risk and blood tests?

A

Another staff member - it is NOT your responsibility

29
Q

If the source is known and consents to bloods, what does this mean happens?

A

Tests for BBV or confirmation of previous results with consent take place If the patient if negative then this provides reassurance to the health care worker

30
Q

What happens when the source is unknown or does not consent to testing?

A

The risk to the worker is assessed based on circumstances and likelihood of BBV

31
Q

How is the BBV status of the recipient (you) assessed?

A

-history of HBV vaccine (partially or fully vaccinated) and response (known-responder or non-responder) -history of previous tests for BBV

32
Q

What are baseline bloods? When are they taken and why?

A

-Bloods taken before testing done for BBV’s -taken after injury sustained -if later indicated you have a blood borne virus then the baseline bloods will be tested to prove whether or not the injury is what caused the BBV

33
Q

What are the post exposure prophylaxis options for HBV?

A

Immunoglobin and/or vaccine

34
Q

The type of post exposure prophylaxis for HBV you get is dependent on what?

A

-the vaccine status prior to exposure -the type of exposure -the HBV status of the source

35
Q

Describe the protection you get from the immunoglobin.

A

-gives immediate protection to prevention 0 conversion happening
-will provide an estimated 70-75% protection from HBV infection

36
Q

-gives immediate protection to prevention 0 conversion happening -will provide an estimated 70-75% protection from HBV infection

A

IT will boost your immunity but not for a couple of days

37
Q

If it is indicated that the HB immunoglobin should be used, when should it be administered?

A

at the same time or within the first 24 hours of the first dose

38
Q

What is the post exposure prophylaxis for HIV?

A

-Combined anti-retroviral therapy

39
Q

When should the cART therapy be started after exposure?

A

Within 24 hours (if indicated that there is a risk)

40
Q

When is it recommended to have combined anti-retroviral therapy? Why?

A

Not routinely recommended if the source has a confirmed and sustained undetectable viral load. only recommended for high risk Lots of side effects - headaches, fever, nausea (not a nice treatment)

41
Q

What is the minimum follow up that there should be after a sharps injury?

A

-follow up for at least 6-12 weeks after the exposure event -if PEP (post-exposure prophylaxis) was taken, follow up should be at least 12 weeks from when PEP was stopped

42
Q

What does a -ve test at 12 weeks provide?

A

A very high level of confidence of freedom from infection

43
Q

How can you prevent occupational exposures and BBV transmission?

A

-no single way to do this
Take steps such as: -vaccination -raising awareness -PPE -Elimination of unnecessary needles -No recapping -PEP -Sharps containers -work practices -hand hygiene -risk assessment -safety engineered devices -recording and reporting

44
Q

Describe the hierarchy of controls for preventing sharps injuries. (least effective to most effective)

A

-PPE -Work practices (minimal manual ma nipulation of sharps, instruments rather than fingers for suturing, puncture resistant containers) -administration -engineering controls e.g. safer shars devices -elimination or substitution e.g. blunt tip suture needles

45
Q

What are the main requirements of the regulations set out for sharps injuries for employers?

A

-promote the safe suse and disposal of medical sharps -provide info and training a for employees -respond effectively if an injury occurs -review procedures regularly

46
Q

What are the main requirements of the regulations for employees?

A

-an employee who receives a sharps injury at work must notify their employer as soon as practicable
You have a legal responsibility to report injuries

47
Q

Do safer syringes in dentistry work?

A

Safer devices DO NOT automatically eradicate risk Need to be used properly to be effective

48
Q

What is the most important elements in prevention of injuries?

A

Staff training and strict adherence on handling contaminated sharps

BDS4 Operative Dentistry (10 decks)

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