Healthcare and Medicine Reference
In-Depth Information
Apply the skin preparation by rubbing the solution onto the skin
commencing at the insertion site and working outwards. Rub for
about 30 seconds and allow the solution to dry completely before
beginning the procedure. An alternative approach, recommended
for peripheral venous cannula insertion, is to use a 'criss-cross'
approach in two directions to minimise the risk of missing areas.
Immediately stop what you are doing
and attend to the injury
Encourage bleeding of the wound by
applying gentle pressure (do not suck the wound)
Needlestick injury
Wash well under running water
Needlestick or sharps injuries are a daily risk for healthcare work-
ers and can lead to infection with bloodborne viruses (BBVs) such
as hepatitis or HIV. The risk of infection following a single sharps
(percutaneous) injury varies depending on the type of BBV. The
risk is approximately:
1 in 3 if the instrument is contaminated with hepatitis B
Apply a waterproof dressing as necessary
If blood or body fluids splash
into the eyes, irrigate with cold water
If blood or body fluids splash
into the mouth, do not swallow.
Rinse out several times with cold
1 in 30 if the instrument is contaminated with hepatitis C
1 in 300 if the instrument is contaminated with HIV, though this
depends on the infectivity of the source patient.
The chances of transmission are higher with hollow-bore needles
compared to other types of sharp injury.
Report the incident to your occupational
health department, or emergency department
and your manager
Prevention of needlestick and sharps injuries
There are a few simple rules to help reduce the incidence of injury.
Do not disassemble needles from syringes or other devices -
Complete an accident form
In the cases of an injury
from a clean or unused instrument
or needle, no further
action is necessary
If the injury is from a used needle
or instrument, risk assessment
should be carried out with the
microbiologist, infection control
doctor or consultant for
communicable diseases.
discard as a single unit.
Do not resheath needles. If essential, use a resheathing device.
Do not carry used sharps by hand or pass to another person.
Discard sharps immediately after use into an approved sharps
container (which you should take with you to the bedside).
Ensure sharps containers are of an appropriate size and available
at the points of use.
Ensure sharps containers are closed securely when three-quarters
full, and disposed of according to local policy.
Peripheral venous cannulae with a device that closes over the
needle tip after it has been withdrawn from the cannula are avail-
able, and provide a safe option.
The risk of a percutaneous injury is increased during a surgi-
cal procedure when suture needles and scalpel blades are used.
use blunt suture needles where possible (not suitable for skin
Figure 3.4 Needlestick injury protocol.
that antiretroviral post-exposure prophylaxis (PEP) is commenced.
Ideally this should be started within an hour of exposure and the
full course lasts 4 weeks. In situations when the treatment is delayed
but the source person proves to be HIV positive, PEP can be given
up to 2 weeks after the injury (though with reduced effi cacy).
The occupational health team will assess the circumstances and
decide whether any action is necessary to reduce the risk of HIV
or hepatitis.
Figure 3.4 shows what to do in the event of a needlestick/sharps
ensure that needle holders with needle tip guards are used
use a disposable scalpel or ensure a blade removal device is used
at the end of the procedure.
When taking blood samples, avoid using a needle and syringe
if possible. A vacuum tube system reduces the risk of needlestick
Legal issues
The Human Tissue Act (HTA) 2004 was introduced following a
high-profi le case regarding the unethical removal and retention of
organs. The act requires that virtually all organs or samples taken
from humans can only be tested or stored with the explicit consent
of the person from whom they were taken. Failure to obtain consent
can render the offender open to a fi ne or imprisonment. Therefore
a doctor may not test a patient for HIV or hepatitis for the benefi t
of an injured healthcare worker if the patient refuses the test.
Managing accidental exposure to bloodborne
Any exposure to blood or body fl uids from a sharps injury, cut or
bite, or from splashing into the eyes or mouth or onto broken skin,
carries a risk of exposure to a BBV. All of these occurrences must
be reported to, and followed up by, the occupational health team. If
there is a strong suspicion of exposure to HIV, it is recommended
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