Needle Stick Injury and Splashes Policy v1 (DOC)

							RESPONSE TO NEEDLE STICK INJURY
AND SPLASHES POLICY


Document Version number: 1.0

Date Written: September 2007

Updated: Not Applicable

Author: Dee May / Helen Evans

Job Title: Infection Control Advisors

Email Address: infection.control@wpct.nhs.uk

Contact Number: 0208 812 7643

Date Approved by Infection Control Committee: September 2007

Next Review Date: September 2009



This policy can only be considered valid when viewed via the
Wandsworth PCT website. If this document is printed into hard
copy or saved to another location, you must check that the version
number on your copy matches that of the one online.


This Policy is valid on: 30 December 2011




                                                    Page 1 of 11
 Response to Needle Stick Injury and Splashes Policy
1     Introduction

1.1   Due to the need for prompt action with an exposure to blood or blood-
      stained body fluids, staff should be made aware of the action to be
      taken at induction before there is a risk of injury, and at regular
      intervals thereafter to ensure that practice is up-to-date.

1.2   This policy deals with sharps / splash incidents which may result in
      accidental exposure to Blood Borne Viruses (BBVs).

2     Purpose

      Health care workers who come into contact with patients’ blood or body
      substances may be at risk of exposure to blood borne viral infections.
      To prevent the likelihood of transmission this policy must be followed in
      the event of a sharps/splash incident.

3     Scope

      The policy is applicable to all healthcare workers who come into
      contact with patients’ blood or body substances.

4     Roles and Responsibilities

      The Director of Provider Services has over-arching responsibility for
      all Infection Control issues at Wandsworth tPCT. The tPCT has an
      Infection Control team who are available to advise on any issues on
      0208 812 7643. The Infection Control Team also provide the
      Infection Control Training.

5     Training Requirements

      The management of needle stick and splash injuries is covered at
      Infection Control Training. Infection Control Training is mandatory for
      all staff as identified in the Training Needs Analysis. Non-clinical staff
      are required to attend Infection Control training at Corporate Induction
      at commencement of employment. Clinical Staff are required to attend
      Infection Control Training at corporate induction at commencement of
      employment and thereafter for updates annually.

6     Blood-borne Viruses (BBVs)

6.1   Blood-borne viruses include Hepatitis B and C and the Human
      Immunodeficiency Virus (HIV).



                                                               Page 2 of 11
6.2   All individuals infected with blood borne viruses may be capable of
      transmitting the virus to others irrespective of whether they are ill or
      apparently fit and healthy. Infectivity depends on a number of
      individual risk factors and will vary from individual to individual. Many
      individuals are unaware that they are infected and thus health care
      workers should always treat all blood and body substances as if they
      are infected. Body substances that have been shown to transmit BBVs
      include:

            cerebrospinal fluid

            peritoneal fluid

            pericardial fluid

            pleural fluid

            synovial fluid

            amniotic fluid

            human breast milk

            semen

            vaginal secretions

            saliva in association with dentistry

            any other body substance containing visible blood, e.g. faeces,
             urine, sputum

            unfixed tissues and organs

            exudate or other tissue fluid from burns or large skin lesions.


7     Prevalence

7.1   The risk to the healthcare worker for each virus is proportional to the
      prevalence of that infection in the population, the infectious status of
      the individual source patient (which may or may not be known) and the
      risk of a significant occupational exposure occurring during the
      procedures undertaken.

7.2   The risk of transmission to a healthcare worker from an infected patient
      following a sharps injury has been shown to be:

      Hepatitis B (e antigen positive)          1:3



                                                               Page 3 of 11
      (if healthcare worker is non-immune)

      Hepatitis C                                  1:30

      HIV                                          1:300

      (UK Health Departments, 1998)

      Certain geographical areas of the world have a higher prevalence of
      blood-borne viruses than others. Such information is useful in certain
      situations e.g. when making epidemiological assessments of risk.
      However, on a day-to-day basis, ethnicity is not used as a determinant
      of risk.

8     How Can BBVs be Transmitted?

           By needle stick injury, contaminated sharp object, bite, scratch or
            other skin puncture with contaminated blood or bloodstained body
            fluids.

           Unprotected sexual intercourse with an infected person.

           From infected mother to baby. Either via the placenta or at the time
            of delivery, or through breast-feeding.

           Via exposure prone procedures (when infected healthcare workers
            can infect patients)

           Via sharing contaminated sharps/”works” of injecting drug abusers.

           Via contaminated blood or blood products (not usually a risk in the
            UK but may occur if receiving blood in other countries).

9     Occupational Acquisition of BBVs

9.1   A number of factors are associated with an increased risk of
      occupationally acquired BBV infection:

           Deep injury

           Visible blood on the device which caused the injury

           Injury with a needle which had been placed in a source patient’s
            artery or vein

           High levels of circulating virus in the source patient – as in late
            stage AIDS or during sero-conversion in the early stages of
            infection




                                                                  Page 4 of 11
           These factors will be taken into consideration when assessing the risk
           of BBV transmission following a sharps injury. Such an assessment
           will be undertaken by either the Occupational Health Department or
           other departments, such as Accident and Emergency or Minor Injuries
           Treatment Unit following national guidelines. Risk assessment should
           never be undertaken by the individual who has received the sharps
           injury.

9.2        The risk of HIV transmission after percutaneous exposures involving
           larger volumes of blood, particularly if the source patient’s viral load is
           likely to be high, may exceed the average risk. This may occur if injury
           is sustained with a large hollow-bore needle when the needle contains
           a large volume of blood from either an artery or vein.

9.3        Risk of infection from cutaneous exposure from infected blood/or
           contaminated body fluids will depend on the infectivity of the material
           and the size of the exposed area e.g. people with large areas of
           psoriasis or eczema could be at higher risk of acquiring these
           infections if in contact with infectious material when splashed.

9.4        The highest risk of contamination from cutaneous exposure relates to
           splashes involving mucous membranes such as conjunctivae and
           mouth. Hence the requirement for staff to wear appropriate PPE when
           undertaking splash-inducing procedures e.g. endoscopy, or aerosol
           producing procedures e.g. many dental treatments

10         Sharps /Splash Incidents

10.1       There are three types of exposures in health care settings associated
           with significant risk. These are:

            percutaneous injury (from used needles, scalpel blades, lancets and
             other pointed instruments or equipment; bone fragments, significant
             bites which break the skin, etc)

            exposure of broken skin (abrasions, cuts, eczema, etc) to blood
             and/or blood stained body fluids

            exposure of mucous membranes, including the eyes, nose and
             mouth, to splashes of blood and/or blood stained body fluids

11         Responding to an Injury (Appendix 1)

           It is essential that a risk assessment is undertaken at the earliest
           possible opportunity as delay in receiving prophylaxis (if required)
           could affect outcome. This needs to be undertaken at the time of the
           injury NOT at the end of the shift. Current guidance states that HIV
           prophylaxis should be commenced within one hour of the incident, but
           can still be given after that time.



                                                                     Page 5 of 11
11.1       First Aid

            Encourage bleeding from the wound. Do not suck.

            Wash the area thoroughly with warm running water and soap

            Cover with water-proof dressing

            Eyes or mouth - irrigate with copious amounts of saline or water

11.2       Report

           ALL sharps injuries and splash incidents must be reported to the
           Senior Nurse or Manager on duty (dependent on place of work) as
           soon as possible, but do not delay seeking guidance on the need for
           prophylaxis if a manager cannot be contacted.

           An incident report must be completed by the person affected by the
           event as soon as possible. The completed incident report should be
           sent to the Risk Manager.

11.3       Record Details

           Try to identify the source patient.

           Complete the Checklist Form - Following Sharps/Splash incident
           (Appendix 1) to help with the risk assessment and take it to the nearest
           Accident and Emergency Dept. (Kingston or St. George’s Hospitals)

           The Checklist will help to establish if the member of staff has had a
           significant exposure to a high risk body fluid and provides guidance on
           the important questions that will be asked by the assessing clinician
           when undertaking risk assessment.


                                  CONTACT DETAILS
Wandsworth PCT staff

During office hours:
QMH and community staff:
As soon as possible after injury, inform the Occupational Health (OH) service
where you have been seen before (for QMH contact Orchard Hill):

                 St. George’s Hospital OH (020) 8725 2633
                 Orchard Hill OH (020) 8770 8308

Otherwise:
 Attend the nearest Accident and Emergency Department (either Kingston or
St. George’s Hospital). Identify yourself as a healthcare worker who has
sustained a sharps injury requiring risk assessment


                                                                  Page 6 of 11
GP Practice staff

During office hours:
As soon as possible after injury, inform Occupational Health Tel. No. (020)
8682 3248

Out of hours:
Staff should attend St. George’s Hospital Accident and Emergency
Department. Identify yourself as a healthcare worker who has sustained a
sharps injury requiring risk assessment



       When attending for risk assessment, the staff member affected must
       take the completed Checklist to ensure that appropriate information is
       available to the clinician undertaking the risk assessment. The staff
       member may be required to have a blood sample taken and stored for
       further testing if necessary. You may also be required – dependent on
       the risk assessment – to have medication or immunisation to reduce
       the likelihood of sero-conversion. Any concerns due to exposure, drug
       treatment or employment etc. can be discussed in confidence at this
       time

       If the source is identified the clinician undertaking the risk assessment
       will arrange for testing of that patient’s blood via their GP / clinician.

       If seen out of hours, the Occupational Health Department will arrange
       co-ordination of results and follow-up and determine whether further
       blood tests will be required at 3, 6 and 12 months. This will be
       undertaken the following working day after injury.

11.4   Forms

       Complete the WtPCT’s Accident and Incident Report (AIR) form. See
       Trust web page:
       http://www.wandsworth-pct.nhs.uk/work/policies/default.asp?expid=29

       If the exposure is from a Hepatitis B, C or HIV positive source,
       RIDDOR form 2508 will be completed by the Occupational Health
       Physician once confirmation of the test results are known.

12     Hepatitis B – Vaccination / Prophylaxis

       All health care workers at risk of exposure to blood/body fluids as part
       of their work should be offered vaccination against Hepatitis B.




                                                                 Page 7 of 11
12.1   Primary Course

       This consists of 3 injections at 0, 1 and 6 month intervals followed by a
       blood test to determine antibody levels.

       Some people may not develop antibodies even after further doses of
       vaccination.

       In addition to primary immunisation, Hepatitis B specific
       immunoglobulin may be required within 24 hours in the event of
       accidental exposure from a high risk Hepatitis B source.

12.2   Accelerated Course

       Accelerated Hepatitis B immunisation consists of injections at 0, 1 and
       2 month intervals which may be administered to a non-immunised
       person in the event of accidental exposure from medium to low risk
       Hepatitis B source.

12.3   Routine Follow-up

       It is recommended that all health care staff who receive Hepatitis B
       vaccine should be screened by Occupational Health department every
       five years to ensure antibody levels remain sufficiently high to provide
       protection in the event of an injury. A booster dose may be given if
       necessary.

13     HIV – Vaccination / Prophylaxis

13.1   Although there is no protective vaccine for exposure to HIV there are
       certain drugs which, if taken soon after exposure, offer some protection
       to the exposed individual. Ideally, this should be received within 1 – 2
       hours of injury but can still be administered for up to 72 hours post-
       injury.

14     Hepatitis C - Vaccination / Prophylaxis

14.1   There is currently no vaccine available for prevention of Hepatitis C
       infection.

15     Staff Support

15.1   Needle stick and splash injuries, especially those resulting in
       Prophylaxis can cause a great deal of worry for members of staff
       directly affected by the incident and it is important for managers to
       recognise this and support the member of staff through this period.

15.2   Occupational Health services are also available to advise and support
       staff following such incidents and are contactable on 0208 725 2633.



                                                                Page 8 of 11
16     Blood-borne Virus-infected Healthcare Workers

16.1   Healthcare workers who are known to have a BBV are restricted from
       certain aspects of patient care. These restrictions are in place in order
       to reduce the risk of transmission of BBVs to patients from infected
       healthcare workers whilst carrying out certain procedures known as
       Exposure Prone Procedures (EPP’s)

16.2   EPP’s are those invasive procedures where there is a risk that injury to
       the worker may result in the exposure of the patient’s open tissues to
       the blood of the worker (bleed-back). These include procedures where
       the worker’s gloved hand may be in contact with sharp instruments,
       needle tips or sharp tissues (e.g. shards of bone or teeth) inside a
       patient’s open body cavity, wound or confined anatomical space.
       However, other situations, such as pre-hospital trauma care and care
       of patients where the risk of biting is predictable (e.g. such as with a
       disturbed and violent patient) should be avoided by healthcare workers
       restricted from performing EPP’s.

17     Review and Monitoring

17.1   All NHS trusts must ensure that policies are in place to identify and
       manage employees with blood borne viruses.

17.2   All staff are under legal and ethical duties to protect the health and
       safety of their patients. They also have a right to expect that their
       confidentiality will be respected and protected.

17.3   All risk assessments must be sent to Occupational Health.

17.4   Needlestick and splash injury incidents are analysed by the Trust’s
       Risk Manager and Infection Control department and are monitored by
       the Infection Control Committee and Provider Safety Committee.
       Figures will be presented and any trends will be highlighted, this will
       enable the Trust to consider how recurrences might be prevented.
       The Infection Control Team Tool is undertaken on an annual basis.

17.5   The Provider Infection Control Committee will meet bi-monthly to
       review the effectiveness of this policy and ensure best practice.




                                                                 Page 9 of 11
                                                                     Appendix 1

RISK ASSESSMENT FOLLOWING SHARPS/SPLASH INJURY

To be completed by staff member who has sustained the sharps/splash injury
and then taken to Accident & Emergency Department and / or Occupational
Health.

PERSONAL DETAILS
Name:                                        Date of Birth:
Post:                                        Place of Work:
Telephone Number:                            Manager:
Home:
Work:
Date:                                        Time of Accident/Incident:

DETAILS OF THE INJURY
Brief description of the incident with blood/blood stained body fluids
(please tick box if applicable)

SHARPS INJURY:
    Needle/scalpel blade or other sharp instrument
    Scratch
    Bite
    Cut
    Bone
    Other
CONTAMINATION:
   Abrasion
   Eczema
   Psoriasis
   Other
EXPOSURE TO MUCOUS MEMBRANE
     Eye
   Other
Which high risk body substance?

      Blood
      Blood stained body fluid
      Vaginal secretions
      Saliva (if visibly blood stained e.g. in association with dentistry)
      Used needle
      Other please specify ……………………………………………………………




                                                                Page 10 of 11
C        Source Patient History (if known, to be completed by doctor/nurse
         managing the staff member NOT the injured person)

        Name……………………..      Tel No: ……………………………………
        Address: ……………………………………………………………………………
        DOB   ………………………………………………………………………………
        GP / Clinician details: ……………………………………………………..
        Source patient infected with
       HIV
       HBV
       HCV
       Source patient on medication for one (or more) of above illnesses
       IV drug user (present or previous)
       Does client have high-risk behaviour? (ask only if appropriate and in the
        strictest confidence)




                                                                Page 11 of 11