Wednesday, October 27, 2010

Handling a needlestick injury

If you are a nurse, doctor or healthcare assistant, chances are that at some point you will experience a needle-stick injury as you are trying to take blood, insert cannulas or deliver an injection. In fact, there are over 100 000 needlestick injuries reported in the UK every year! And not just in acute settings - practice nurses have been found to be the most common victims of needlestick injuries.

CULTURE OF SILENCE

The Commission for Health Improvement submitted a confidential questionnaire among healthcare professionals in 2003. Although 57% of the respondents said they had sustained an injury in the past, only 51% of them had reported the injuries – mainly because they perceived that the risk of an infection was “low”. Workload pressure and time constraints are also thought to be reasons for underreporting. Others are afraid that if they are tested and have been found to be infected, they will lose their jobs or be treated differently.
RISKS

In the USA, over 2100 needlestick injuries were report per day! [NIOSH Study, 1999]. From these injuries, 57 incidences of HIV seroconversion were reported, as well as 2000 hepatitis C and 400 Hepatitis C infections. Tuberculosis, syphilis, malaria, herpes, diphtheria, gonorrheau and typhus can also be transmitted this way. In Australia, the claims for needle-stick injuries jumped 12.6% within 2 years and more than 18000 reported being pricked by contaminated syringes.

PREPARATION


1. GET VACCINATED. The risk of transmission of a blood borne pathogen is very low, but HCV, HIV and HBV remains a risk. Hepatitis B is the most transmissible – you have a 30% risk of transmission after exposure. The risk of contracting HIV is a mere 0.3% and Hepatitis C is about 1.8% - depending on the viral load of the source person and the volume of blood transferred. It is therefore well-worth receiving the HBV vaccination.
2. Always wear gloves and eye protection.
3. Use safety needles and cannulas. Discard needles in the sharps bin immediately. Never leave them lying around, not even for a second.
4. Never re-sheath or re-cap a needle. Pay attention when handling scalpels and butterfly needles.
5. Make sure you know your hospitals policy for post occupational exposure management – and implement it if you get injured.

IF YOU ARE INJURED…

1. Immediately wash the site well with water.
2. Get blood taken for serological testing as soon as possible.
3. You may need to have a course of HBV vaccine and a dose of hep B immunoglobulin, depending on your immunization status.
4. A retroviral drug prophylaxis should be promptly taken if there is a risk of HIV exposure. Seek guidance from your superiors re: this drug as you cannot take this lightly.
5. Talk to someone about the injury. It is alright to feel a significant amount of stress, fear and resentment about the injury and the risks you were exposed to. Talk to a counselor and gain support from co-workers.
6. Your workplace needs to treat the injury swiftly, without prejudice and in confidence. If you feel as though they are not treating your injury or illness in that matter – speak up! Likewise, you have the right to a safe working environment. Seek advice if you feel unsafe at work.

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