NEEDLE STICK INJURIES

Definition :

A sharp may be defined as any object or instrument, which may cause a
puncture or incisional wound in the skin. The term includes glass ampoules,
hypodermic and suture needles, blades and sharp edges of human tissue, e.g.
bone, nail and teeth.

Injuries from sharps, when contaminated with blood or other body fluids (see
page 6), carry the risk of transmitting hepatitis B virus (HBV), hepatitis C virus
(HCV) and human immunodeficiency virus (HIV).

Other diseases might also be transmitted through percutaneous injury include
syphilis and malaria.

A needlestick injury is a percutaneous piercing wound typically set by a needle point, but possibly also by other sharp instruments or objects. Commonly encountered by people handling needles in the medical setting, such injuries are an occupational hazard in the medical community.

Frequency of occurrence :

Needlestick injuries are a common event in the healthcare environment. When drawing blood, administering an intramuscular or intravenous drug, or performing other procedures involving sharps, the needle can slip and injure the healthcare worker. This sets the stage to transmit viruses from the source person to the recipient.

These injuries also commonly occur during needle recapping and as a result of failure to place used needles in approved sharps containers. During surgery, a surgical needle may inadvertendly penetrate the glove and skin of the surgeon or assistant. Penetrating accidents of the surgeon or assistant with the scalpel or other sharp instruments are also handled as a needlestick injury.

These produce very minor bleeding and trauma so sometimes they are neglected.

Risk of infections :

1.Hepatitis B Virus
The risk of infection with Hepatitis B (HBV) in unimmunised individuals following
a sharps or splash injury from a HBV positive source patient is in the region of 1
in 50, rising to 1 in 2.5 to 1 in 3 if the source patient is also e antigen positive1.
2.Hepatitis C Virus
The risk of infection to an individual following a needlestick injury from a Hepatitis
C (HCV) positive patient is in the order of 1 in 30 (3%)1.
3.HIV
The risk of seroconversion following significant percutaneous exposure has been
estimated as one infection in every 300 exposures (0.33%). HIV infection
associated with contamination of the mouth or eyes is very rare – mucous
membrane exposure risk is approximately one in a thousand (0.1%)2.
Other
Other diseases that might also be transmitted through percutaneous injury
include syphilis and malaria.

Prevention :

1. Being very careful during the procedures.

2. Wearing protective gloves.

3. Properly disposing used needles and blades.

4. Recording proper Medical History of the patient , when ever possible , that gives the doctor an idea about the risks involved.

Immediate first aid:

Percutaneous injuries:

• Encourage bleeding, preferably under running water, but not by
sucking

• Then wash the wound with soap and water without scrubbing for at
least five minutes. Antiseptics and skin washes should not be used.

• Dry and cover the wound with a waterproof plaster. Splashes onto non-intact skin (e.g. abrasions, cuts, and eczema):

• Wash liberally with water. Splashes into the eyes, mouth or other mucous membranes:

• Irrigate with copious amounts of clean water. If contact lenses are
worn, eye irrigation should take place before and after removing the
lenses.

Hepatitis B prophylaxis

Current CDC guidelines call for the administration of hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine. While the efficacy of the combination as not been evaluated in the needlestick injury setting, it has been shown to be the most efficacious approach in the perinatal setting. The approach has no contraindications during pregnancy and lactation.

Hepatitis C prophylaxis

CDC guidelines acknowledge that there is no active PEP for HCV, only recommendations intended to achieve early identification of chronic disease and, when detected, referral for evaluation of treatment options. According to the CDC identification of acute infection with HCV may not necessitate active intervention. However, there is some evidence that treatment with interferon alfa-2b may be beneficial preventing chronic hepatitis.

HIV prophylaxis

CDC guidelines generally recommend a PEP protocol with 3 or more antiviral drugs, when it is known that the donor was HIV positive; however, when the viral load was low and none of the above noted risk factors are met, the CDC protocol utilizes 2 antiviral drugs. Such a 2 drug protocol should also be considered when the donor status cannot be determined (i,e injury by a random needle in a used sharps’ container), but there is an increased risk that the source was from a risk group for HIV.

PEP drugs for prevention of HIV infection are given for 4 weeks and may include nucleoside reverse transcriptase inhibitors (NRTIs), nucleotide reverse transcriptase inhibitors (NtRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and a single fusion inhibitor.

Surveillance.

Regular surveillance should be carried out for the proper disposal of wastes & the affected medical professional should be monitored  regularly along with health check up.

N.B … Any case of needle stick injury should immediately be  reported  without delay.

Check the following link  http://www.sciencedaily.com/releases/2009/11/091125134707.htm

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