Sharps

Question 1

name blood borne viruses

Answer 1

• hepatitis B
• hepatits C
• HIV

Question 2

how can contamination occurs with exposure or a sharps injury

Answer 2

• needles or sharp objects (eg probes, scalpels) contaminated with blood or bodily fluids piercing or breaking the skin
• splashing of blood or bodily fluids onto skin that is broken (abraded, chapped, open sores, dermatitis)
• contamination of eyes, nose or mouth with blood or bodily fluids
• a human bite that breaks the skin

Question 3

name common sharps injuries

Answer 3

• during IDB, needle goes into thumb
• adjusting posts, CoCr dentures etc out with the mouth
• burs or ultrasonic tips left in situ in hand-pieces which are placed at elbow height (legs / arms passing by)
• slipping luxators
• anaesthetic spraying from palate
• unsheathed needles left on messy trays

Question 4

can you pass sharps to the dental nurse to dispose of them

Answer 4

no

it is your responsibility to dispose of them yourself

Question 5

looking at the epidemiology in scotland, which BBV poses the highest risk

Answer 5

Hepatitis C

highest prevalence in Scotland

Question 6

name people who are likely to have sharps injuries

Answer 6

most common to least

• nurses and healthcare assistants
• doctors
• professions allied to medicine
• dentist / dental nurses
• others and NK
• midwife

Question 7

what are the possible timings for needlestick injuries to happen

Answer 7

most common to least

• during procedure
• after procedure and before disposal of sharps
• during disposal or after disposal

Question 8

what should all staff know with regards to management of exposure in the event of a needle stick

Answer 8

• what action to take
• legal responsibility to report all sharps injuries
• get injury properly assessed (cannot assess your own injury)
• where to go for treatment for the injury and follow up
• how to report the incident so that systems can be revised to reduce future injuries

Question 9

what are the steps to how to manage a sharps injury

Answer 9

AWARE

Apply pressure and allow to bleed
Wash don't scrub
Assess the type of injury
Risk of source blood?
Establish contact

Question 10

what is the first thing that should be done with a sharps injury

Answer 10

squeeze the injury site to induce bleeding

Question 11

how can you clean the injury site

Answer 11

wash affected area with soap and warm running water
do not scrub
treat mucosal surfaces by rinsing with warm water or saline

Question 12

when assessing the type of injury, what are the categories

Answer 12

• high risk material
• significant injury
• non-significant injury

Question 13

what is included in high risk material for a type of injury

Answer 13

• blood and bodily fluids with visible blood

- saliva (if there is no visible blood there is only a risk of HBV [hep C and HIV cannot go through saliva on its own])

Question 14

what is included in significant injury for a type of injury

Answer 14

ask has it actually breached the skin

• percutaneous
• human bite with broken skin (with no visible blood the only risk is HBV [hep C and HIV cannot go through saliva on its own])
• exposure of broken skin or mucous membrane to blood or bodily fluids

Question 15

who is more at risk of a BBV from a human bite - the person biting or the person being bitten?

Answer 15

person who is biting is more at risk of an infection than the person being bitten
- if this person pierces skin and gets blood in their mouth then there is more risk for them

if the person who has been bitten has the other person’s saliva on their skin the risk is little in comparison

Question 16

what is included in a non-significant injury for a type of injury

Answer 16

• exposure of intact skin
• superficial graze
  these should still be reported even if there is no risk of injury

Question 17

when is a sharps injury considered a risky injury

Answer 17

• if it breaks the skin [especially with blood contamination]
• a deep penetrating injury by a device visibly contaminated with blood
• injury with a device that has previously been placed directly in the source patient’s artery or vein

Question 18

what questions should be asked to work out the risk of the source blood?

Answer 18

• is the patient known to have HIV / AIDS or hepatitis B / C infection
• is the patient in a high risk group (eg an intravenous drug user?)
• if HIV positive is that patient on cART?

Question 19

what is cART?

Answer 19

combination antiretroviral therapy

Question 20

if the patient has HIV how can their blood not pose a risk

Answer 20

if the patient has an undetectable viral load
HIV is not transmissible
U = U

Question 21

list BBV from most infectious to least infectious

Answer 21

• HBV (1/3)
• HCV (1/30)
• HIV (1/300)

Question 22

how can you work out the risk of the source blood if you don’t know who the source is

Answer 22

take the prevalence of that BBV in Scotland and multiply by the risk of seroconversion

Question 23

who do you have to establish contact with after receiving a sharps injury

Answer 23

• report injury promptly to a senior member of staff
• call occupational health
• record injury (accident book and official reporting)

Question 24

employees who have had injuries must be followed up with what

Answer 24

prophylaxis
counselling
prevention

Question 25

if you know the source, how should you assess the BBV status of the source

Answer 25

test for BBVs or confirm previous results with consent if patient negative this will provide reassurance to the healthcare worker

Question 26

if the source is unknown or if the source does not consent to testing, how should you assess the BBV status of the source

Answer 26

risk assessed based on circumstances and likelihood of BBV need to think on type of injury use information you have about the source (if known) from your records

Question 27

how should you assess the BBV status of the recipient (the person who gets the sharps injury)

Answer 27

- look at history of HBV vaccination and response > are they partially or fully vaccinated > are they a known responder or non-responder - history of previous tests for BBVs - take baseline bloods for storage (blood is taken and stored so at the end of the follow up stage when you have a blood test to indicate if you have BBV or not, the stored blood is also tested to prove the seroconversion is associated with that infection - proves you got infected from that injury and you haven't had the infection for a while)

Question 28

what is included in post exposure prophylaxis HBV

Answer 28

immunoglobulin and / or vaccine - hepatits B immune globulin (HBIG) provides an estimated 70-75% protection from HBV infection (gives immediate preventative protection to protect seroconversion) IF, HBIG indicated administer at the same time or within 24 hours of the first dose of vaccine (but not after 7 days have elapsed since exposure) [vaccine boosts immunity but won't happen for a few days]

Question 29

what is the post exposure prophylaxis procedure dependent on

Answer 29

- vaccination status prior to exposure - the type of exposure - the HBV status of the source

Question 30

where do you go fro more info on the HBV prophylaxis for reported exposure incidents

Answer 30

chapter 18 - the green book

Question 31

what is included in post exposure prophylaxis for HIV

Answer 31

- cART start within 24 hours of exposure (if indicated) not routinely recommended if source has confirmed and sustained undetectable viral load only really recommended if the risk is high

Question 32

what are the common side effect for post exposure prophylaxis for HIV

Answer 32

- head aches - fever - nausea not the nicest to take

Question 33

what is included in the follow up after a sharps injury

Answer 33

- follow up should be at least 6-12 weeks after the exposure event - if PEP was taken, follow up should be at least 12 weeks from when PEP was stopped - a negative test at 12 weeks provides a very high level of confidence of freedom from infection

Question 34

how can occupational exposure to sharps injuries and BBV transmissions be prevented

Answer 34

- Vaccination - Elimination of unnecessary needles ○ Best thing to prevent sharp injury is to avoid sharps altogether - No recapping - PEP - Sharps containers - PPE - Raising awareness - Safety engineered devices - Recording and reporting - Work practices - Risk assessment - Hand hygiene

Question 35

what does the law say about sharps safety

Answer 35

EU Council Directive 2010/32/EU the "sharps directive" Health and safety (sharp instruments in healthcare) regulations 2013 "to achieve the safest possible working environment by preventing injuries involving medical sharps" This was transcribed into health and safety regulation in 2013

Question 36

who does the regulations about sharps safety apply to?

Answer 36

* Employers and employees * Contractors working for HC employer * Students / trainees on placement with HC employers * Community or hospital pharmacies Your employers should protect you and you should protect your future employees

Question 37

what is the hierarchy of control for sharp safety from most effective to least effective

Answer 37

- elimination of sharps or substitution (eg blunt tip suture needles) - engineering controls (safer sharps devices SSDs) ~ need to justify why you wouldn't use these devices - administration - work practices > minimal manual manipulation of sharps > instruments rather than fingers for suturing > puncture resistant containers - PPE

Question 38

what are the main requirements from the sharps regulations for employers

Answer 38

• Promote the safe use and disposal of medical sharps ○ educate • Provide information and training for employees • Respond effectively if an injury occurs • Review procedures

Question 39

what are the main requirements from the sharps regulations for employees

Answer 39

• An employee who receives a sharps injury at work must notify their employer as soon as practicable ○ Duty to report This is supported by • Information and training on what to do in the event of a sharps injury

Question 40

how is it possible to still get an injury from safer sharps devices

Answer 40

- if the patient jumps - post procedure disposal > device can be active or passive = active means you actually have to launch the mechanism to disable to sharp so if this is not launched there is still a sharps risk = passive activates the mechanism themselves

Question 41

guidance for managing BBV infected HCWs

Answer 41

look at lecture cos this guidance seems too in depth / specific for us to have to know lol sorry