MANAGEMENT OF NEEDLE STICK INJURIES AND HOW TO AVOID THEM




A needle-stick injury can be  a very demoralizing event. Although the risk of contracting a blood-borne pathogen is relatively low, the psychological & emotional trauma that follows the injury can be very depressing.

However, where the risk is significant, the immediate administration of post-exposure prophylaxis is mandatory that may reduce the chance of seroconversion to some pathogens.

Other than that there is also a need for Psychological counselling. The provision of counselling can mitigate the psychosocial consequences of the accident.

People working in a hospital set up usually have the  necessary first hand treatment aids that many times help in controlling and curbing any potential infection. But for people working in community centers such  facility may not be available immediately.

What are the Infections  ?

  1. The major blood-borne pathogens of concern are the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV).
  2. Estimating the probability  and progression of transmission following a needle-stick injury is difficult as there are many factors which contribute to the risk. These include the extent of injury  and the viral load of the source patient at the time of the injury. Hollow needles with visible traces of fresh blood from the patient carry the highest risk, while splashes to mucosal surfaces and intact skin carry the lowest risk.
  3. The frequency of  acquiring  infection is greatest for HBV and least for HIV, with HCV being of intermediate risk.

How to reduce the chances of infection ?

  1. Proper disposal of needles and sharps
  2. Being as careful as possible while treating patients and more careful when the history of the patient is known.
  3. Safe disposal of sharps is the most important means of reducing needle-stick injuries. Sharps containers should not be easily accessible, as they can pose a threat to visitors to clinics, especially young children.
  4. Use of skin and eye protectors.

Post Exposure Immediate Management

  1. Immediate washing of the wound with soap and water thoroughly
  2. Small wound and puncture may be cleansed with antiseptic eg alcohol based hand hygiene agent
  3. Disinfection of wound and dressed.
  4. Mucosal contact: immediately and liberally wash the exposed parts with water or saline
  5. Seek proper medical advice for proper wound care and post-exposure management
  6. If the infectivity of the source patient is unknown, serological testing should be immediately undertaken after obtaining informed consent.
  7. Issues relating to the so-called window-period, where viral replication is present but antibodies have not appeared, may  create confusion and warrants a proper serological testing.
  8. Assessing the severity of exposure ( Blood Tests )
  • anti-HIV antibody
  • complete blood picture
  • renal/liver function tests
  • serum glucose
  • HBsAg
  • anti-HCV
  • pregnancy test for female health care personnel
  • Obtain anti-HIV , HBsAg and anti-HCV status from source patient if possible.

For those on post-exposure prophylaxis, monitor

  • anti-HIV antibody
  • complete blood picture
  • renal/liver function tests
  • serum glucose
  • amylase
  • Post-exposure prophylaxis

HEPATITIS B

The source patient should be tested for hepatitis B surface antigen (HBsAg) as soon as possible. No further action is required if the test is negative.

If the injured person has been vaccinated against HBV and seroconversion has been documented, then no further action is required. When seroconversion has not been documented, a booster dose of hepatitis B vaccine should be given immediately.

HIV INFECTION

If a decision is made to commence antiretroviral prophylaxis, therapy must begin as soon as possible after the injury (preferably within two hours) but may still be indicated if a longer interval has elapsed and the risk of transmission is thought to be high. Therapy continues for four weeks.

Few of the anti retro-viral systems that are used are

Few of the anti retro-viral systems that are used are

  • zidovudine (ZDV)
  • Lamivudine (3TC)
  • Stavudine (d4T)
  • Didanosine (ddI)

SYPHILIS

In settings where the prevalence of syphilis is high, testing of the source patient is indicated. If there is evidence of active syphilis, a single dose of benzathine penicillin (2.4 million units intramuscularly) should be administered. Interpretation of syphilis serology can be difficult and expert advice should be sought.


POST-EXPOSURE TESTING

HIV testing should be repeated at six and 12 weeks post-exposure (and again at six months if post-exposure prophylaxis has been given).

Tests for HCV are performed at six, 12 and 24 weeks (HBV testing should be added if the injured person is not immune).

Repeat testing is not routinely performed if the source case is negative for the relevant pathogens.

What to do When the source is unknown ?

If the source of the needle-stick injury is unknown, for example exposure from a needle discarded in a linen bag, the protocol for hepatitis B prophylaxis and serological follow-up should be followed.

Establishing the need for HIV post-exposure prophylaxis is problematic in this situation. In general, unless it is likely that the needle was associated with a patient known to be infected with HIV, post-exposure prophylaxis is not indicated. For example, in a general practice not specialising in HIV the risk that the needle is contaminated is extremely low.

Psychological Counselling

In many cases a health personnel can go in to depression and  can be full of anxiety following a needle stick injury. In such cases a proper counselling is very much needed.


CONCLUSION

Needle stick injuries is always very stress inducing. It’s the fear of the unknown. Before we conclude the article , we would like to recap some final pints to make you more safe from the Needle Stick Injuries in your Dental Clinic 

  1. Always Take Full history of the Patient with Mandatory tests for HIV Before you start any surgical procedure on any patient , get them to do mandatory HIV test. If the test is negative then you can be more assured while doing the procedure. In case of needle prick you won’t be as stressed as getting pricked by a needle used on patient with no history or HIV screening.
  2. Be careful while surgery and suturing  You might have done a dental procedure many times but you can never stop to be careful enough while handling needles and syringes. Be careful and take care.
  3. Wear Double Gloves  These come very handy in case of slight nicks and gloves provide the initial protection.
  4. Don’t stop being careful even after the surgery is done Many dentists have the tendency to get carefree once the surgery is done. DO NOT DO THAT. Even after the surgery is over keep a conscious view of the instruments. Many times doctors get a needle prick after completing the procedure while removing the gloves or washing the hands. You can never be complacent until you leave the operative area completely. 

Wish You a Successful Dental Practice and Stay Safe from Needle Pricks




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