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Avoidance and Management of Sharps Injuries

1. Occupational Injuries

All blood and body fluids should be considered as potentially infectious. Some clients may be infected (knowingly or unknowingly) with Hepatitis B, Hepatitis C or HIV and it is important to know what action to take in the event of a sharps injury or contamination incident.
Sharps injuries/contamination incidents include:

  •  Inoculation of blood by a needle or other ‘sharp’
  •  Contamination of broken skin with blood
  •  Blood splashes to mucous membrane e.g. eyes or mouth
  •  Contamination where the individual has an open wound and clothes have been soaked by blood
  •  Bites (where the skin is broken).

The risks of transmission from infected carriers in the event of a sharps injury have been estimated to be approximately:

  • • Hepatitis B (high-risk carrier) 1 in 3
  • • Hepatitis C 1 in 30
  • • HIV 1 in 300.

2. Prevention

  1. a) Vaccination

It is strongly recommended that you receive a full course of Hepatitis B vaccine which can be provided through your GP or at a travel clinic. For pre-exposure prophylaxis we would recommend an accelerated schedule consisting of 4 doses at 0, 1, 2 and 12 months. It is very important that you have a blood test 2 months after completion of the course to check that you have responded adequately.
If the response is not sufficient, the doctor will investigate whether there is a specific reason for non-response to the vaccine. It is most important for non-responders to know their status. They may need to be protected by other measures (e.g. immunoglobulin) following a needlestick injury. There are, as yet, no vaccines available against Hepatitis C or HIV.
b) Safe Handling of Sharps
The best protection against sharps incidents is prevention.
See Section D – 4 Safe Handling of Sharps.

c) Management of Sharps Injuries
If a sharps injury/contamination incident occurs:

1. Encourage bleeding from the wound by squeezing gently.
2. Do not suck the wound
3. Wash the wound in soap and warm running water (do not scrub)
4. Dry and cover the wound with a dressing
5. If a splash to the skin, eyes or mouth occurs, rinse with plenty of water
6. An incident form should be completed as soon as the recipient of the injury is able
7. Seek immediate advice from the local Accident and Emergency Department.

You may be offered a booster dose of vaccine (even if you have been fully vaccinated) to provide additional protection. If you have not yet completed the course of vaccine you will be given the next dose of vaccine and advised on how to complete the schedule. If you have not started a course of vaccine, an accelerated course consisting of 3 doses at 0, 7 and 21 days followed by a 4th dose at 12 months after the first dose should be given.
Dependent on the incident your doctor may also take a blood sample from you at the time and retest you approximately 6 months later to provide reassurance that you have not been infected.
If the client involved in the contamination incident is known to be a Hepatitis B or Hepatitis C carrier, please pass on this information to the doctor so they can organise appropriate follow-up blood tests for you.
If the client involved in the contamination incident is known to be HIV positive you should attend the Accident and Emergency Department without delay (preferably within the hour) explaining clearly to the receptionist/triage nurse what has happened so you can be seen as priority. This is to enable a rapid risk assessment to be done and to decide whether there is an indication for offering you post-exposure prophylaxis. This is likely to be most effective if given as quickly as possible after the exposure hence the need for prompt assessment.

 

Decontamination of Equipment

1. Introduction

The aim of decontaminating equipment is to prevent potentially pathogenic organisms reaching a susceptible host in sufficient numbers to cause infection.
Certain items are classified as single-use only. These items must never be re-used. If in doubt, refer to the manufacturer’s recommendations.
Re-usable equipment should be appropriately decontaminated between each patient using a risk assessment model. Use only the method advised by the manufacturer - using any other process may invalidate warranties and transfer liability from the manufacturer to the person using or authorising the process. If you have any doubts about the manufacturer’s recommendations, seek further advice.
Definitions

  • Cleaning is a process ‘which physically removes contamination but does not necessarily destroy micro-organisms.’ The reduction of microbial contamination cannot be defined and will depend upon many factors including the efficiency of the cleaning process and the initial bio-burden (amount of contamination). Cleaning is an essential prerequisite of equipment decontamination to ensure effective disinfection or sterilisation can subsequently be carried out
  • Disinfection ‘is a process used to reduce the number of viable micro-organisms, which may not necessarily inactivate some viruses and bacterial spores.’ Disinfection will not achieve the same reduction in microbial contamination levels as sterilisation

 

  • Sterilisation (e.g. autoclaving) is a process used to render the object free from viable micro-organisms, including spores and viruses. It is essential that all instruments in contact with non-intact skin be sterile.

 

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