NEEDLE STICK INJURY
PREVENTION AND
MANAGEMENT
Nirupama Sahoo
ICN
NEEDLE STICK INJURY
Needle stick injuries are wounds caused by needles that accidentally
puncture the skin. Needle stick injuries are a hazard for people who
work with hypodermic syringes and other needle equipment.
These injuries can occur at any time when people use, disassemble, or
dispose of needles.
THE RISK FOLLOWING NSI :-
Other than pain and anxiety, potentially any infection can be
transmitted from a bacteraemia or viraemia, but the main infections
of concern are blood-borne viruses:
Hepatitis B virus (HBV) – 30% risk of transmission
Hepatitis C virus (HCV) – 3% risk of transmission
Human immunodeficiency virus (HIV) – 0.3% risk of transmission
NSI PREVENTION
WHAT TO DO IF NSI OCCURS
Don’t PANIC .
Don’t squeeze the injured site.
Wash with soap & water immediately.
Report to In-charge/Supervisor & Infection Control Nurse.
Provide:
Full history of injury or exposure.
History of Hepatitis B Vaccination.
Serology status of Patient
Fill up NSI Incident form.
DO NOT APPLY ANY CAUSTIC AGENTS
Nature of Exposure
EXPOSURE CATEGORY
Mild exposure Mucous membrane/non-intact skin exposure with small volumes
(few drops) or less duration.
• Superficial wound (erosion of the epidermis) with a plain or low
caliber needle, or
• Contact with the eyes or mucous membranes.
• Subcutaneous injections following small-bore needles.
Moderate •Mucous membrane/non intact skin exposure with large
exposure volumes/major splashes for several min or more OR.
•Percutaneous superficial exposure with solid needle or superficial
scratch.
Sever exposure Percutaneous exposure with
• Large volume transfer,
• By hollow needle, wide bore needle, deep puncture.
• Visible blood on device or
• Needle used in patient’s artery or vein
PEP - HIV
Take first dose of PEP for HIV
If the source status is unavailable , or found
as positive for HIV or source is unknown.
Preferably within 2 hours and definitely within 72
hours of
exposure.
Single tablet of TLE (Tenofovir 300 mg plus
Lamivudine 300mg plus Efavirenz 600 mg) once daily
for 4 weeks.
PEP is continued for 28 days in all source positive and
source unidentified cases, regardless of the risk of
exposure and CD4 count of the source.
Exposure Category HIV SOURCE PEP
Recommendation
Mild exposure, Moderate and Negative Not warranted
Severe exposure
Mild exposure HIV positive and asymptomatic Not warranted
Mild exposure HIV positive and symptomatic PEP recommended
Duration:28 days
Moderate exposure HIV positive and asymptomatic
Single daily dose of
Moderate exposure HIV positive and symptomatic
• Tenovir 300mg
• Lamivudine 300mg
Severe exposure HIV positive and asymptomatic • Efavirenz 600mg
Or symptomatic
Moderate / Severe exposure Unknown (in area with high
prevalence)
Source material- Blood, body fluids or other potentially infectious material
(CSF, synovial,pleural,pericardial and amniotic fluid and pus) or an instrument
contaminated with any of these substances.
PEP not required in the following situations:
If exposed person is HIV positive: Send to ART
clinic for counselling.
If the skin is intact.
If source is HIV negative.
Exposure with low risk specimens like tear, saliva
urine stool vomits, nasal secretion, sweat etc.
For exposures with Mild exposure and HIV
positive and asymptomatic.
Source unknown(if HIV prevalence is low) and
mild exposure
Delay in reporting exposure by > 72 hours(PEP
initiation is optional)
PEP - HBV
Follow up
HIV - 6weeks, 3 months and 6 months after exposure.
HBV and HCV - 3 months and at 6 months after
exposure.
IF THE SOURCE IS POSITIVE OR UNKNOWN.
Q.1 IF THE HEALTH CARE WORKER IS UNVACCINATED OR
INCOMPLETELY VACCINATED
ANS:-HBIg 1dose and complete vaccination, then check HbsAb titre after 2
month of last dose.
Q.2 IF THE HEALTH CARE WORKER IS VACCINATION 3 DOSES
COMPLETED (ANTIBODY TITRE < 10m IU /ml )
ANS:- HBIg 1dose and revaccination of 2nd series, then check HbsAb titre
after 2 month of last dose.
Q.3 IF THE HEALTH CARE WORKER IS NON RESPONDER
ANS:- HBIg 2doses,separated by 1month .
IF THE SOURCE IS NEGATIVE OR UNKNOWN.
Q.1 IF THE HEALTH CARE WORKER IS UNVACCINATED OR
INCOMPLETELY VACCINATED
ANS:-Complete vaccination
Q.2 IF THE HEALTH CARE WORKER IS VACCINATION 3 DOSES
COMPLETED (ANTIBODY TITRE < 10m IU /ml )
ANS:- Revaccination of 2nd series, then check HbsAb titre after 2 month of
last dose.
Q.3 IF THE HEALTH CARE WORKER IS NON RESPONDER
ANS:-No action needed
Q. WHAT ARE THE RISK FOLLOWING NSI ?
ANS:-
Other than pain and anxiety, potentially any infection
can be transmitted from a bacteraemia or viraemia,
but the main infections of concern are blood-borne
viruses:
Hepatitis B virus (HBV) – 30% risk of transmission
Hepatitis C virus (HCV) – 3% risk of transmission
Human immunodeficiency virus (HIV) – 0.3% risk of
transmission
THANK YOU