"Needle Stick Injury and Splashes Policy v1"
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: firstname.lastname@example.org 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: 01 March 2012 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