Inoculation Injury Management

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					Inoculation Injury Management


              Community Infection
              Prevention and Control
              Team 2011
Definition of Sharps



    “Sharpsare anything that
   penetrates the skin to cause
             injury”
Types of Inoculation injuries

   Percutaneous

   Needles
   Instruments
   Teeth, bone
   Glass / ampoules
   Human bites and
    scratches
Types of Inoculation injuries
   Mucous membrane

   Contamination or splashing
    of the mucous membrane
    with blood or body fluids
   eyes, nose, mouth or
   conjunctiva with blood or
    body fluids

   Contamination or splashing
    with blood or body fluids of
   any open wound or
   skin lesion e.g. eczema
Inoculation Injuries in General Dental
practice (Safer Needles Network 2006a)

   Large number of injuries
    occur during administration
    of anaesthesia

   However , many injuries
    occur after the injection has
    been carried out
Common Injuries in Dental Practice


   During needle re -sheathing / removal

   During Surgery decontamination

   During Instrument tray clearing

   Incorrect placement of syringes
Blood Borne Viruses


   Blood borne viruses (BBV) are viruses that
    some people carry in their blood and which
    may cause severe disease in certain people
    and few or no symptoms in others. The virus
    can spread to another person, whether the
    carrier of the virus is ill or not.
Blood borne Viruses



 Hepatitis B (HBV)
 Hepatitis C (HCV)
 H.I.V
Hepatitis B Virus (HBV)

   Blood-borne viral infection that can be
    prevented through vaccination.

   The hepatitis B virus (HBV) causes hepatitis
    (inflammation of the liver)

   Can also cause long-term liver damage
Hepatitis C (HCV)


   Virus that can cause long-lasting infection
    and can lead to liver disease.

   There is no vaccination to prevent HCV.
Human Immunodeficiency Virus

   Causes Acquired Immune Deficiency
    Syndrome (AIDS).

   HIV destroys the body's ability to fight
    infection by attacking the immune system.

   This results in infected individuals becoming
    susceptible to opportunistic infections.
Risk of BBV transmission

   35
   30
   25
   20
   15
   10
    5
    0
        Hep B 33.3% (1 in Hep C 3.3 % (1 in HIV 0.33% (1 in
               3)               30)              300)
 How much   blood is required to
  transfer a blood-borne virus?
   As little as 0.00004 ml from an infected
    patient




               A blue needle holds 0.1ml
Body Fluids

   High risk
    –   Blood
    –   Amniotic fluid        –   Pericardial fluid
    –   Vaginal secretions    –   Synovial fluid
    –   Semen                 –   Saliva - dentistry
    –   Breast milk
    –   Cerobrospinal fluid
    –   Peritoneal fluid
Increase risk of transmission depends on:

   How deep the injury is                   High Risk Activities:
                                             IV drug users
   Visible blood present                    Blood transfusion pre-1991
                                             Residence in Sub Sahara
   Needle from source patient’s              Africa/Far East
    artery/vein                              Detention in Prison since 1980
                                             Male homosexual/bisexual
   Terminal ill HIV related illness in      Prostitutes
    source patient                           HIV
                                             Sexual partners of listed
                                             Babies of high risk mothers
DO NOT
             Do NOT use      Do NOT use     Used sharps
RECAP
             clinical bins   general-       should NEVER
NEEDLES
             for sharps      purpose bins   be passed
You are
             disposal.       for sharps     between
risking a
                             disposal       healthcare
sharps
                                            workers. The
injury***.
                                            sharps user is
                                            responsible for
                                            its disposal.
Sharps/ splash injury: prevention




                        Take sharps
       Dispose of       container to       Dispose of
       sharps           site of use          sharps
       immediately      and dispose       container as
       after use in a   of sharps           soon as
       designated       directly into        it is full
       sharps           sharps             (indicated
       container.       container after    by arrow).
                        use
Sharps/ splash injury: prevention


     A disposable apron and
     gloves should be worn         Always risk assess the
     where there is a risk of    procedure you are about to
      exposure to, or when
                                perform and wear appropriate
      handling, blood, body
         fluids or tissues.          personal protective
                                         equipment
     In addition, a visor and
     mask ** should be worn
     where there is a risk of
           splashing.
Sharps/ splash injury: prevention
         Never attempt to separate a needle and syringe;
          discard as one unit*.

         Store sharps containers at waist level or above, NEVER
          on the floor or above shoulder level, and

         ALWAYS out of reach of children and vulnerable adults.

         Use temporary closure mechanism when container not
          in use.

         Complete location sticker on sharps container and sign
          and date at assembly, locking and disposal.
Sharps/ splash injury: prevention

     If a needle and syringe must
      be separated, the appropriate
      slot on the sharps container
      should be used to remove the
      needle from the syringe.
      Needle forceps can also be
      used.

     If recapping a needle is
      absolutely unavoidable, a
      needle guard should be used.

     The one-handed technique
      can be used if staff are
      trained and competent to do
      so.
Policy and Procedure
   Each practice should have clear guidelines including :


   Inoculation injury management policy

   Flowchart for assessing and dealing with needlestick injury

   Programme for Hepatitis B immunisation

   Appropriate PPE
Scenario


       A dental nurse whilst cleaning
  instruments prior to autoclaving cuts her
 finger on a periodontal scaling instrument

    How will you manage this situation ?
   Identify the wound
   Instigate basic first aid
   Assess the significance of the injury
   Risk assessment
   Hepatitis B status
   Report
   Seek expert guidance - Occupational health
    /A&E
   Its 5 pm , Friday afternoon and leading to a bank
                     holiday weekend.

      Following an inferior dental block a dentist
    accidentally sticks the needle into his thumb and
    notices blood accumulating under his glove . The
     patient is a 28 year old male on his second visit
                       to the practice

           How will you manage this situation ?
   As before but ensure



          All operative procedures are
                      stopped
Individuals Exposed To Blood Borne Viruses
in Health Care Settings


   Any person exposed to the risk of blood borne viruses in any
    healthcare setting (including a domiciliary care situation) should
    be assessed and managed according to the principles laid out
    in the guidance provided by Occupational Health or A & E
    department at Doncaster Royal Infirmary.

   Support will be available to the individual during and after the
    incident. This support can be accessed through several sources
    including line management, Human Resources or Occupational
    Health.
First Aid Percutaneous injury

   Aim to reduce bio burden
o   Wash under running water
o   Apply downstream pressure to help
    extrude infectious material
o   Apply waterproof dressing

   Report and document incident to
    manager
o   Seek advise from Occupational health

o   Do not squeeze , suck or scrub area
First Aid Mucous Membrane


   Flush affected area with
    copious amounts of
    cold water

   Report and document
    incident to manager

   Seek advise from
    Occupational Health
information that may be
required at Occupational
     Health or A&E
 Details of injury
 Patient’s name
 Patient’s date of birth
 Any known history of BBV’s
 History of high risk activities
Who should arrange for
 source patient blood
       testing?
 Source patient testing should NOT be
  carried out by the injured member of
  staff
 Blood can only be taken & tested with
  consent
 Sample is saved and stored for 10
  years
 Post exposure prophylaxis (PEP)
   may be recommended if the
    injury is high risk and the
  source patient is known to be
            HIV positive

				
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posted:10/16/2011
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