Meeqat Hospital, Madina.KSA

1. Needle-stick Injuries
Among Health Care
Workers
3/4/2014
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2. 1. Background of the Topic
2. Needle-stick injuries in
Ohud Hospital
Dr. Muhammad AL amin
Infection Control Coordinator
3/4/2014
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3. What are Needle-stick injuries?
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Wounds caused by needles.
Are hazard for the people.
Transmit infectious diseases.
Blood born viruses.
3/4/2014
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4. Frequency
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3/4/2014
Precise national data not available.
600 000 – 800 000 injuries / year occur in
USA.
½ of cases are not reported.
Injuries begun to decrease in USA.
Involve nursing staff, physicians and other
health workers.
Emotional impact can be sever.
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5. Scope of the problem
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3/4/2014
½ of all hepatitis B and C in some parts of
Africa and Asia due to contaminated sharps.
2/3 of hepatitis B and C in Eastern
Mediterranean due to contaminated sharps.
Over 2/3 of hepatitis B in Central and South
American due to occupational exposure.
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6. Risk of Transmission of
Blood born Infection
Occupational
Exposure
Hepatitis B Virus
Hepatitis C Virus
2.7-10%
HIV
3/4/2014
Risk of
Transmission
2-40%
0.3% (1 in 300
chance of infection)
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7. Factors which increase risk of
infection
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3/4/2014
Deep injury.
Visible blood on the device.
High viral titer.
Artery or vein device.
Combined factors.
Un-immunized against hepatitis B.
No post exposure prophylaxis with Zidovidine
(prophylaxis decrease risk by 80%).
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8. Hazards of Needle stick injuries
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3/4/2014
Hepatitis B and C.
HIV.
Brucellosis.
Malaria.
S. aureus and S. pyogenes.
Toxoplasmosis.
Tuberculosis.
8

9. How common are needle stick
injuries?
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Needle stick injuries (too common hazard).
Surgical instrument wound.
Mucus membranes.
Skin contact
3/4/2014
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10. How do needle stick injuries
occur?
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Their use, disassembly or disposal.
30 – 50% of injuries occur during clinical
procedures:
withdrawing a needle from a patient.
 Accessing IV line.
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3/4/2014
During improper sharp disposal.
During clean-up.
Recapping: 25 – 30% of all injuries.
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11. Conditions of work which
increase Needle stick injuries
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Staff reductions.
Difficult patient care situations.
Reduced lighting.
New staff or students.
Needles are disposed improperly.
Emptying disposal containers.
3/4/2014
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12. How can needle stick injuries be
prevented
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3/4/2014
Employee training.
Recommended guidelines.
Safe recapping procedures.
Effective disposal systems.
Surveillance programs.
Improved equipment design.
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13. Devices Involved in Percutaneous
Injuries
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Hollow bore needle:
Hypodermic needle
 Winged-steel needle
 IV stylet
 Phlebotomy needle
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Solid sharp:
Suture needle.
 Scalpel.

3/4/2014
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14. Desirable Characteristic of
Devices with safety Features
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The device is needleless.
The device is easy to use and practical.
The device is safe and performs reliably.
The safety feature is an integral part of the
device.
3/4/2014
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15. What should the employers of
Health care implement.
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Analyze needle stick injuries.
Proper training.
Promote safety awareness.
Establish procedures to encourage the
reporting.
Evaluate the effectiveness of prevention efforts
3/4/2014
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16. Health care workers protection
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3/4/2014
Use devices with safety features.
Avoid recapping needles.
Safe handling and disposal of medical
waste.
Report all needle stick injuries.
Follow recommended infection prevention
practices.
Participate in blood-born pathogen training.
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17. Hospitals should
implement the followings:
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Properly trained health care workers.
Encourage the reporting and timely follow up.
Promotion of safety awareness.
Analyze needle stick injuries to identify
hazards.
3/4/2014
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18. 3/4/2014
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19. 3/4/2014
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20. Types of injuries
Needle stick injuries
Splash to skin and
mucus membrane
6 (16%)
Blades (Scalpel)
3/4/2014
28 (74%)
4 (10%)
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21. Departments
ICU
Operating Room
(OR)
5 (13)
Medical Wards
4 (10%)
Surgical Wards
4 (10%)
Gynecology and
Obstetrics
Pediatrics and
Nursery
3 (8%)
Others
3/4/2014
15 (39%)
5 (15%)
2 (5%)
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22. State of Vaccination
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3/4/2014
31 of 38 (81%) were vaccinated for
Hepatitis B.
2 needed booster doses.
5 of 38 (13 %) were not
vaccinated.
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23. Blood Born Diseases in sera
of patients
Hepatitis B
9 (24%)
Hepatitis C
7 (18%)
Not Known
20 (58%)
3/4/2014
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24. Time of reporting
Same day
After 1 day
13 (34%)
After 2 days
5 (13%)
After 3 days
3 (9%)
> 3 days
2 (5%)
Not recorded
3/4/2014
11 (29%)
4 (11%)
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25. What is the message of this
Surveillance?
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3/4/2014
Rate of the needle stick injuries is known.
Search for factors that cause the injuries.
Should receive proper treatment.
Identify areas in which the prevention
program need improvement.
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26. Conclusion
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3/4/2014
Ensure that health care workers are properly
trained in the safe use and disposable needles.
Encourage the reporting and timely follow up of
all needle stick injuries.
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27. 3/4/2014
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28. HIV Post-Exposure Prophylaxis (cont.)
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Basic regimen:
zidovudine (AZT) 300mg bid + lamivudine (3TC) 150mg bid
x 28 days
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Expanded regimen:
Basic regimen
+
Kaletra (lopinavir/ritonovir)
{or atazanavir (Reyataz)
or indinavir (Crixivan)
or nelfinavir (Viracept)
or efavirenz (Sustiva)}
x 28 days

29. HIV Post-Exposure Prophylaxis
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Initiate PEP as soon as possible, preferably within 2 hours of
exposure.
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Offer pregnancy testing to all women of childbearing age not
known to be pregnant.
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Seek expert consultation if viral resistance is suspected.
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Administer PEP for 4 weeks if tolerated.

30. Hepatitis C
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Perform baseline and follow-up testing for anti-HCV and alanine
aminotransferase (ALT) 4 – 6 months after exposure.
Perform HCV RNA at 4 – 6 weeks if earlier diagnosis of HCV
infection desired.
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Confirm repeatedly reactive anti-HCV results with supplemental
tests.
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Post-exposure prophylaxis (PEP) not recommended.

31. 
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Perform follow-up anti-HBs testing in persons who
receive hepatitis vaccine.
Test for anti-HBs 1 – 2 months after last dose of
vaccine.
Anti-HBs response to vaccine cannot be ascertained if
HBIG was received in the previous 3 – 4 months.

32. Recommended PEP for exposure to HBV
Vaccination and
antibody response
status of exposed
workers
Source HBsAg
positive
Source HBsAg
negative
Source unknown or
unavailable for testing
HBIG x 1 and initiate
HB vaccine series
Initiate HB vaccine
series
Initiate HB vaccine
series
No treatment
No treatment
No treatment
-known non-responder
HBIG x 1 and initiate
revaccination
or HBIG x 2
No treatment
If known high risk
source, treat as if
source HBsAg positiive
Antibody response
unknown
Test exposed person. No treatment
No treatment if HBsAb
positive.
If inadequate antibody
titer, administer HBIG
x1 and vaccine
booster
Unvaccinated
Previously vaccinated
- known responder
Test exposed person for
HBsAb. No treatment if
HBsAb positive.
If inadequate antibody
titer, administer vaccine
booster and re-check
titer in 1 – 2 month