Safety is in the details
Safety in the ICU

Needle Stick Injuries: Management and Prevention

April 20, 2016

 

Needle stick injuries are most frequently caused while disposing or disassembling needles, which may contain blood and body fluids of another person. These preventable injuries are estimated to cause 1000 infections per year in the US [1] as the puncture into the skin exposes healthcare workers to over 20 blood-borne pathogens [2].


A report released by the Healthcare Protection Agency [HPA] in 2012 states that the number of health care workers exposed to needle stick injuries doubled in 2011 when compared to the number in 2002 [3]. In that same period, the amount of nurses exposed to infection was similar as that in other medical and dental professions together (237 and 231 correspondingly). The CDC estimates 385K needle stick and sharps injuries occur every year in hospital settings in the US.


In the ICU, the risk of infection from blood-borne pathogen transmission is higher than in other hospital departments [4]. This is why needle stick injury prevention in the ICU is very important.


Why are needle stick injuries a concern?

Ironically, while caring for the health of others, healthcare staff put themselves at risk.  Needle stick injuries carry the risk of infection to healthcare staff, which may even prove fatal and are sometimes hard to detect even years after they occur [5].


This was the case when surgeon Robert Pickard, who died from Hepatitis C in 2012, unknowingly treated patients for years before discovering he was infected. It is thought that Dr. Pickard was originally infected from a needle stick that occurred during a routine operation. Just recently, two of his roughly 8,000 patients were found to be infected with Hepatitis C, prompting the hospital to reach out to all former patients to get their blood tested. [6]


A report published by the World Health Organization (WHO) in 2002 cited HIV (2.5%) and Hepatitis B and C (40%) as the viruses, most commonly transferred by needle stick injuries in a hospital setting [7]. However, the list of other infectious organisms that can be transmitted through needle stick injuries includes Cytomegalovirus, Hepatitis D virus, Human T-lymph tropic retroviruses, Epstein-Barr virus, Parvovirus B19, Malarial parasites, etc.


How to manage needle stick injuries?

First aid first

Stick to the basics – clean the infected area. The area should be allowed to bleed, and then cleaned with soap and running water.


Bleeding is encouraged as it can minimize the risk of infection. The blood actually serving as the cleaning fluid of the body itself carries the bacteria and other dangerous substances from the body as bleeding occurs. The infected area should then be washed carefully with cold water.


If there is fear of direct contact with the infected fluids in areas such as the mouth or the eyes, then those areas should be washed and cleaned with cold water as well.


Taking post-exposure medication

If it is known that a certain patient has a certain infectious disease, and the needle stick can be located to that particular patient (documentation guidelines required today should allow for such knowledge), then the medical care staff can be quick to treat themselves by taking post-exposure medication. For example, if a patient is known to have HIV, the healthcare worker should immediately take a Post-Exposure Prophylaxis [PEP]. It is recommended to take the medication within an hour. It can be taken within 72 hours, but efficiency decreases over time. 


The affected healthcare worker should be examined after a certain period, taking all the required blood tests so that a proper follow-up of the infection status is conducted. The affected healthcare worker should not return to work until the infection issue has been resolved.


How to prevent needle stick injuries?

Analyzing and controlling the hazards are key to prevention. Practicing universal precautions, comprehensive documentation and educating staff are keys to success. The Occupational Safety and Health Administration’s (OSHA) Blood-borne Pathogens Standard in the US, and the Protection against Infection with Blood-borne Viruses Guidance [8] published by the UK department of health are examples for guidelines published for the protection and education of healthcare workers.


The steps to prevent needle stick injuries are simple, though with the pressure often found in the hospital environment, not all medical staff adhere to them as strictly as they should. A research sites lack of engineering controls/ modern safer devices, lack of documentation, lack of post-exposure evaluation and lack of comprehensive device evaluation as some of the most common violations of the needle stick prevention act [9].


Engineering controls

Use of modern and safer needles and other engineering control devices, have also contributed to a significant reduction of needle stick injuries. Needle capping is no longer needed and other instruments blunt or sheath, or retract the needle immediately after use. According to the needle stick prevention act [10] signed in 2000, which shifted the focus in exposure control from behavior to devices, safer devices are now a requirement, as part of the effort to reduce and even eliminate needle stick and sharps injuries.


A needle-free delivery system can decrease the risk of needle stick injuries during stopcock manipulation in IV therapy and patient monitoring. MarvelousTM stopcock can help prevent needle stick injuries thanks to its needle-free luer activated valve. Once the line is inserted (IV or arterial) with the MarvelousTM  stopcock in place, all priming, blood sampling and drug administration can be done without the use of a needle, syringes are attached directly to the stopcock.


Employee involvement in device evaluation

Nurses are invited today to be more involved in evaluating the tools and devices they use. The American nurses association developed the ANA Needle stick Safety and Prevention Guide [11] for this purpose. The guide defines 3 categories for device evaluation; screening devices, simulation exercises, and pilot testing.


Nurses and medical staff should avoid usage of sharps and needles in the health care environment where ever possible. For example, whenever possible, it is preferred to use oral medicine administration, thus avoiding injections. However, if injections cannot be prevented, modern regulation and innovation has provided healthcare personnel with safe devices and safety procedures all designed to protect them as they help heal others.


We invite you to learn more about MarvelousTM at the upcoming AACN NTI conference [12].

 

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References:
1. http://www.nursingworld.org

2. Centers for Disease Control and Prevention (CDC). (1998a). Guidelines for infection control in health care personnel. Infection Control and Hospital Epidemiology, 19(6)

3. Eye of the Needle: 2012, Health Protection Agency

4. http://www.cdc.gov/niosh/topics/bbp/

5. Centers for Disease Control and Prevention. (1998b, October 16). Recommendations for prevention and control of hepatitis C virus (HCV). MMWR, 47(RR-19), 1-39.

6. http://www.dailymail.co.uk/health/article-3465320/Surgeon-8-000-patients-risk-hepatitis-C-named-emerges-caught-virus-operation.html

7. World Health Organization. (2002).The world health report 2002: Reducing risks, promoting healthy life. Geneva: WHO
8. Guidance for Health Care Workers: Protection against Infection with Blood-borne Viruses, Dept. of Health (UK) 
9. Arbury, S., & Williams, D. (2004). OSHA’s blood-borne pathogen standard. Presentation at the American Nurses Association Capacity Building Workshop on Preventing Needle stick Injuries, April 22, 2004
10. https://www.osha.gov/needlesticks/needlefaq.html
11. American Nurses Association. (2002). ANA’s needle stick prevention guide. 
12. http://www.aacn.org/dm/nti/ntihome.aspx?selnti=nti2016&menu=nti2016&lastmenu=divheader_past_and_future_ntis

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