Sharps Injuries

Question 1

What counts as an occupational exposure?

Answer 1

1. Needles or sharp objects that are contaminated with blood/bodily fluids that pierce/break the skin
2. Splashing of blood/bodily fluids into skin that is broken (e.g. abraded, chapped, open sores, dermatitis)
3. Contamination of eyes, nose or mouth with blood/bodily fluids
4. Human bite that breaks the skin

Question 2

What is a significant occupational exposure?

Answer 2

Exposures/sharps injuries, as described before, involving a source patient who is infected with a blood borne virus

Question 3

List 6 common injuries that can occur in the dental surgery

Answer 3

1. During IDB, needle goes into thumb
2. Adjusting posts, CoCr dentures etc. out with the mouth
3. Burs or ultrasonic tips left in situ in hand pieces which are placed at elbow height (legs/arms as passing by)
4. Slipping luxators
5. Anaesthetic spraying from palate
6. Unsheathed needles left on messy trays

Question 4

What is the probability of acquiring blood borne virus infection after percutaneous injury (breaking of skin) with a contaminated sharp

Answer 4

HBV(eAg+) = 30% 1 in 3

HCV = 1.8-3% (1 in 30)

HIV = 0.3% (1 in 300)

Question 5

How do we prevent occupational exposure?

Answer 5

.Follow SICPs e.g. hand hygiene, PPE, safe disposal of waste

. Minimal manipulation of sharp instruments and devices and disposal of these items in puncture-resistant containers

. Safety devices/safer sharps (syringe shield, retractable needle)

. Instruments rather than fingers for suturing

.blunt tip suturing needles

Question 6

What does the A in the sharps AWARE acronym stand for?

Answer 6

1. Apply pressure and allow to bleed

- gently squeeze injury site to encourage bleeding

Question 7

What does the W in the be sharps AWARE acronym stand for?

Answer 7

2. Wash affected area with soap and warm running water

- treat mucosal surfaces by rinsing with warm water or saline

Question 8

What does the second A stand for?

Answer 8

3. Assess the type of injury
   - deep injury, penetrating injury + blood contamination, injury with device used on patients artery or vein, solid instrument or hollow bore needle?

Question 9

What does the R stand for?

Answer 9

4. Risk of source blood
   - exposed to a source patient with end stage HIV infection or positive for HCV RNA
   - is the patient known to have HIV/AIDS or hepatitis B/C infection
   - is the patient in a high risk group eg IV drug user

Question 10

What does the E stand for?

Answer 10

5. Establish contact
   - report injury to a senior member of staff
   - call occupational health
   - interview source patient/consent for bloods(not you)
   - record injury (accident book and official reporting)
   - employees who have had injuries must be followed up for prophylaxis, counselling and prevention

Question 11

What is the purpose of taking base line bloods from source patient and HCW?

Answer 11

. If patient is negative, provides reassurance to HCW
. Check HCWs Vaseline HBV antibody status
. Baseline for HCV and HIV for HCW

Question 12

When is post exposure prophylaxis required for HBV?

Answer 12

.Unvaccinated - HBIG x 1 and initiate hep B vaccine series
. Vaccinated but non responder - HBIG x 1 and vaccine booster
. Administered as soon as possible and definitely within 72 hours

Question 13

What post exposure prophylaxis should be used for HIV?

Answer 13

. Anti-retro viral medication used
. Regard as an urgent medical concern, if indicated, start PEP as soon as possible after exposure (hours rather than days)
. Common side effects include headaches, fever and nausea
. 17% of healthcare workers exposed to an HIV-positive source have discontinued all or part of their PEP regimen prematurely because of drug toxicity

Question 14

When should a follow up check be performed after HIV exposure?

Answer 14

.minimum 12 weeks after exposure event, or if PEP was taken, at least 12 weeks from when PEP was stopped

. Negative text at 12 weeks provides high level of confidence of freedom of infection

Question 15

What is an exposure prone procedure?

Answer 15

Invasive procedure where there is a risk that injury to the worker may result in the exposure of the patients open tissues to the blood of the worker

Includes procedures where workers gloves hands may be in contact with sharp instruments, needle tips or sharp tissues (eg spicules of bone) inside a patients open body cavity, wound or confined anatomical space, where the hand or fingertips may not be completely visible at all times