Sharps Injuries Flashcards by Roisin Mousa

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

-hepatitis B -hepatitis C -HIV

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

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

-bacterial infections

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What are some common sharps injuries in the dental practice?

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

It is a lot lower

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What is a significant occupational exposure?

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

Hepatitis C

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

Hep B

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

People working in healthcare

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Describe the distribution of needlestick injuries relative to timing.

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

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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Describe the first step in the AWARE acronym.

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

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

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

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

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

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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What is considered a significant injury?

-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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What is not considered a significant injury?

A superficial grace, exposure of intact skin

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

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

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

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How would you assess the risk of source of blood?

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)

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

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

How can you achieve ‘U=U’?

If on cART therapy

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?

Multiply the BBV prevalence by the publish sero-conversion rate

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

-report the injury promptly to a senior member of staff

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

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

What should employees who have sustained injuries be provided with?

Follow up for prophylaxis, counselling and prevention

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

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

Who speaks to the patient about risk and blood tests?

Another staff member - it is NOT your responsibility

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

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

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

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

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

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

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

-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

What are the post exposure prophylaxis options for HBV?

Immunoglobin and/or vaccine

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

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

Describe the protection you get from the immunoglobin.

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

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

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

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

What is the post exposure prophylaxis for HIV?

-Combined anti-retroviral therapy

When should the cART therapy be started after exposure?

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

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

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)

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

-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

What does a -ve test at 12 weeks provide?

A very high level of confidence of freedom from infection

How can you prevent occupational exposures and BBV transmission?

-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

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

-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

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

-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

What are the main requirements of the regulations for employees?

-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

Do safer syringes in dentistry work?

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

What is the most important elements in prevention of injuries?

Staff training and strict adherence on handling contaminated sharps