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Sharps Injuries

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Sharps injuries happen when you least expect them. You can’t always prevent them but you can do a lot to reduce the risk. It might be the patient is delirious and moved their arm, or you missed the sharps bin when trying to put the ABG needle into it, and it falls into your hand; it could even be when handling soiled waste and there are blood products on them. As soon as you realise you have been exposed; the key things are to first stay calm, and then think back to your medical school training.

Follow these points below:
  • Encourage the wound to bleed (applying pressure), while holding it under running water
  • Wash the wound with running water and plenty of soap
  • Do not scrub the wound
  • Do not suck the wound
  • Dry the wound and cover it with a waterproof plaster or dressing
  • Seek urgent medical advice from Occupational Health Services (discussing need for effective prophylaxis)
  • Report the injury to your employer
But what happens next?
You will be given guidance by occupational health, or if the injury happens out of core hours, discussion with the emergency department (if available) and seniors to get further guidance. Although there are often variations, the below will normally be considered.
  • Do you need PEP? Indicated in high risk exposures, including those where there is blood from cannula or vein. It is indicated within 72 hour of the exposure event.
  • HBV antibody status or immunisation.
  • What is the status of the patient? Is the patient known to have a bloodborne virus? Or are they considered high risk? If this is not known, then the patient should be consented for testing. They will contact the team looking after the patient to consent & take the testing bloods. They will usually update you with the results.
  • You should be counselled regarding the below:
    • Need for HCV, HBV and HIV status in 3-6 months
    • Need for LFTs in 3-6 months
    • Considering safe sex practices
    • Considering Blood donation status (do not give blood until you are given the all clear)
    • To see your GP if you have a fever
So are we good at following the above (2)?
The short answer is no. studies have shown that only 3% of ‘sharps’ injuries follow local guidelines.

But what are the risks?
Seroconversion figures are below:
  • 0.3% for percutaneous exposure to HIV-infected blood
  • 0.1% for mucocutaneous exposure to HIV-infected blood
  • 0.5-1.8% for percutaneous exposure to HCV infected blood with detectable RNA value
  • 30% for percutaneous exposure of a non-immune individual to an HBeAg positive source
General measures to reduce the chance of sharps injuries, according to Public Health England, are to follow the below:
  • Wash hands before and after every patient or patient environment (including linen or curtains)
  • Ensure gloves are worn if bodily fluid exposure is anticipated
  • Wash hands before and after putting on gloves
  • Cover breaks in exposed skin (including wounds & skin lesions) with waterproof plasters and consider wearing gloves
  • Avoid unnecessary use of sharps
  • Handle sharps with care
  • Avoid wearing open footwear in situations where blood may be spilt, or where sharp instruments or needles are handled.
  • Clear up spillage of blood promptly and disinfect surfaces.
  • Pre-employment occupational health assessment for those with damaged skin, who have increased risk, to give advice on minimising risks
  • Follow safe procedures for disposal of contaminated waste.
References:
(1) https://www.hse.gov.uk/healthservices/needlesticks/
(2) Thomas, W.J.C. and Murray, J.R.D., 2009. The incidence and reporting rates of needle-stick injury amongst UK surgeons. The Annals of The Royal College of Surgeons of England, 91(1), pp.12-17.
(3) https://www.nhsemployers.org/retention-and-staff-experience/health-and-wellbeing/taking-a-targeted-approach/partnership-working-across-your-organisation/health-and-safety
(4) https://www.who.int/injection_safety/toolbox/docs/en/AM_HCW_Safety.pdf
(5) https://patient.info/doctor/needlestick-injury-pro

Written by Dr Marcus Smith GPF2

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