Infection Control Guidelines for Sharp injuries and needle stick post exposure prophylaxis Dr. NAHLA ABDEL KADERوMD, PhD. INFECTION CONTROL CONSULTANT, MOH INFECTION CONTROL CBAHI SURVEYOR Infection Control Director, KKH.

1. 
١

2. OBGECTIVES
What the risk of exposure?
 How we can prevent the exposure?
 If the exposure is already done, what
is the exposure management plan?

٢

3. What are Bloodborne Pathogens?

Microorganisms that may be present in human
blood and other potentially infectious materials
(OPIM) that may cause disease in humans.
٣

4. Diseases Caused by Bloodborne
Pathogens
HIV / AIDS
 Hepatitis B
 Hepatitis C


Arboviral infections –
La Crosse, St. Louis
Brucellosis
 Creutzfeldt-Jakob
CreutzfeldtDisease




Malaria
Syphilis
Viral Hemorrhagic
Fevers – West Nile
٤

5. Bloodborne Pathogen Exposures


Puncture from contaminated needles,
broken glass, or other sharps
Contact between non-intact skin and
noninfectious body fluids


cut/abrasion, scratch, acne, sunburn
Direct contact between mucous
membranes and infectious body fluids

splash in the eyes, nose, or mouth
٥

6. INJURY
TYPES OF EXPOSURE
Percutaneous
Exposure
Mucous
Membrane
High Risk
Exposure
Moderate Risk
Exposure
.
Cutaneous
Low Risk
Exposure
٦

7. Most Needle Stick Injuries occur
during the following activities





Recapping, bending, or breaking needles;52%
52%
Inserting a needle into a test tube or specimen
container and missing the target;15%
15%
Injury from a person carrying unprotected
sharps;Sharps that are present in unexpected
places, like linens: 13%
13%
During complex surgical procedures;Handling or
disposing of waste that contains used sharps, 12%
12%
Patients moving suddenly during injections:8%
٧

8. Exposure Prevention

The single most effective
measure to control the
transmission of Bloodborne
Pathogens is:
Standard Precautions

Treat all human blood and other
potentially infectious materials like
they are infectious for Hepatitis B
and HIV
٨

9. Standard Precautions
Hand washing and proper use of PPE.
Regular cleaning and decontamination of work
surfaces with a cleaning agent labeled as
effective against HBV/HIV&HCV.
Vaccination against Hepatitis-B.
HepatitisProper Sharp Waste disposal.




٩

10. VACCINATION
١٠

11. Safer Sharps
١١

12. 

Continuous training and education
of Health Care Personnel in all
hospital departments on Proper
Sharp Disposal.
KKHKKH-IFC / Sharp
12

13. 





Avoid rushing when handling needles and sharps.
Dispose all needles and other sharps promptly. These
items should not be left on food trays or inadvertently
deposited in trash containers.
DO NOT re-cap needles.
rePlace used disposable items in puncture resistant
biohazard containers for disposal.
In the event recapping is unavoidable, the one-handed
onescoop technique or a needle recapping device shall be
used.
Sharps waste shall be contained in “Sharps
“Sharps
Containers”
Containers” which are rigid and puncture resistant. 13

14. To safely recap needles use “the oneonehand”
hand” technique
Step 1

Place the cap on a flat surface, then remove
your hand from the cap.
Step 2

With one hand, hold the syringe and use the
needle to “scoop up” the cap.
Step 3

When the cap covers the needle completely,
use the other hand to secure the cap on the
needle hub. Be careful to handle the cap at the
bottom only (near the hub).
14

15. 





Sharps containers shall be labeled as “sharps waste” and
“sharps
biohazardous with international biohazardous symbol.
Sharp containers shall be filled up to three quarters and taped
closed or tightly lidded.
Sharps containers are placed in yellow bags by housekeeping
personnel for storage and then processing.
Sharps waste is disposed of in sharps containers as close to site
of use as possible.
InIn-patient rooms shall have wall mounted “Sharps Container
system “ which is kept near the patient’s bed and is securely
locked. Other direct patient care areas shall have wall mounted
“Sharps Container” system and/or rigid puncture resistant
containers having the biohazardous symbol printed on.
KKHKKH-IFC / Sharp Injuries Prevention / IPP NO: 012
15

16. 16

17. 17

18. 18

19. 19

20. DEVELOP EXPOSURE
MANGEMENT PLAN,
EDUCATE & TRAIN
THE STAFF AND
MONITORING THE
STAFF COMPLAINCE.
٢٠

21. IMMEDIATE CARE
OF INJURY
Risk
Reduction
PLAN
MANGEMENTOF EXPOSED
HCWS
INCIDENCE
DOCUMENTATION
RISK ASSESMENT
٢١

22. 


The employee concerned should immediately wash
away the contaminating fluid. If blood or body fluids
get in the mouth, spit out and then rinse mouth with
water several times.
If there is a puncture wound, wash with soap and
water and disinfected by Alcohol or Betadine.
If the eyes are contaminated (may be more dangerous
than an NSI) rinse well with tap water or saline.
٢٢

23. 


Should be in detail with completion of the
appropriate form.
Report should include details of the incident ,date &
time of incident , people involved ,any witnesses to
the incident.
All occupational exposures must be fully
documented to meet relevant legal requirement.
٢٣

24. The injury
The source
The exposed
HCWs
٢٤

25. INJURY
Percutaneous Exposure to Blood
Highest Risk
Increased Risk
No
Increased Risk
BOTH
Large vol. of bl.
EITHER
Large vol. of bl.
NEITHER
Large vol. of bl.
+
OR
NOR
High titre of
HBV,HCV,HIV
High titre of
HBV,HCV,HIV
High titre of
HBV,HCV,HIV
٢٥

26. The source
HBsAg
HCV-Ab
HIV-Ab
٢٦

27. The exposed
HCWs
HBsAg
And
Anti-HBsAb
HCV-Ab
HIV-Ab
٢٧

28. 
SOURCE is –ve for HBV,HCV, HIV.

SOURCE of unknown infectious or
unable to be tested.
tested.

SOURCE is +ve or likel to be +ve.
٢٨

29. 
Source is –ve for HBV,HCV,HIV
Anti-HBs Ab Titre
> 10 IU /ML
IMMUNE
< 10 IU /ML
NON IMMUNE
POST-EXPORUE PROPHYLAXIS
٢٩

30. Source of unknown infectious status
or unable to be tested


If after every effort has been made to ascertain
the HBV ,HCV ,HIV status of the source ,the
status is uncertain then the relative risk of the
source being + ve , must be inferred when
giving recommendations concerning
prophylactic measures.
If concern exists that there is a high risk of the
source being infected with HBV,HCV,HIV the
HCWs should be manged as in case of source
is +ve or likely to be +ve.
+ve
+ve.
٣٠

31. 
Source is +ve or likely to be +ve forHBV
forHBV
Anti-HBs Ab
Anti-HBc Ab
+Ve
IMMUNE
- Ve
NON IMMUNE
POST EXPOSURE PROPHYLAXIS
٣١

32. Postexposure
Prophylaxis
Immunogluline
Vaccination
Follow up
٣٢

33. Clinical or serological
Evidence of acute
hepatitis
Seek for clinical advise
Repeat HBs Ag at
1 & 6 months
No plasma,bl,body tissue
donation.
Protect sexual partner.
Highest risk
٣٣
percuteneous
exporure,modify WP.

34. Source is +ve or
likely to be +ve for HCV
Screening
HCV-IgG
-Ve
-No infection
-Early infection
-False -ve
+Ve
-Current
infection
-past infection
-False +ve
Confirmatory
HCV-RNA by
real-time PCR
+ve
Confirms
active HCV
replication
-ve
Does not
confirm
absence of
٣٤
HCV
replication

35. Clinical or serological
evidence of acute
hepatitis
Seek for clinical advise
HCV-RNA by PCR repeated
After 2 months
HCV-IgG repeated after
6 to 9 months
No plasma,bl,body tissue
donation
Protect the sexual partner .
Hihgest risk percutaneous
exposure,modify WP.
٣٥

36. Source +ve or likely to be +ve for HIV
+ve
+ve
The risk of transmission of infection




The average risk estimated for all types of
percutaneous exposure is 0.5%.
The overall risk estimate from m.m. exposure is
m.m.
0.08%.
08%.
No evidence of HIV transmission via intact skin
exposure.
Although HIV is present in a number of bodliy
fluids, the incidence of transmission from
secretions not containing visible blood is low.
٣٦

37. Source is +ve or likely to be +ve for
HIV




Postexporue Prophylactic treatment is
indicated.
It must be commenced as soon as possible
.preferably within hours rather than days .
It should be administrated for 4 weeks.
If PEP is offered & taken &the source is later
determined to be HIV -ve ,PEP should be
discontinued.
٣٧

38. Repeated HIV screening
at 1 & 3 & 6 months
Until screening for
seroconversion
is completed
٣٨

39. 


All staff should be aware of the need to comply
with Infection Control Policy.
All staff should be aware of whom to contact
for advice concerning occupational exposure.
All HCWs should be aware of immediate care
of injuries &their rights & responsibilities
following an occupational exposure.
٣٩

40. 



Standard precautions must be employed when
handling blood or bodily substances
All bodily fluids such as semen, vaginal
secretions, CSF, synovial ,pleural ,peritoneal
,pericardial should be consider potentially
infectious.
The use of needless or self sheathing devices must
be encourage.
Overstuffing sharps containers & recapping of
needles must not be allowed .
٤٠

41. 


The operating room & emergency room are
particularly areas of high risk to HCWs.
Gowns, gloves ,eye protection are recommended
when procedures involving blood or bodily fluids
are likely to take place.
A hands free technique ,where the same sharp
item is never touched by more than one person at
the same time ,should be implemented in the
operating room.
٤١

42. ٤٢