Prevention Of Needlestick Injury Among Chinese Nurses

1. Prevention of Needlestick Injuries Zhao X (China)

2. Introduction

Each year more than 1.5 million NSIs happen among Chinese HCWs, an average of 4410 NSIs per day

Near 80 percent of health workers in China have experience of NSI

17.9 percent have more than 5 times needlestick injuries

Resource from: http://www.nursing.net.cn

3. Risks of Needlestick Injuries

as many as 20 different pathogens are capable of transmission from patients or laboratory specimen to healthcare workers (HCWs) in the event of a NSI.

Of these 20 pathogens, HIV, HBV, and HCV are the three most common diseases transmitted via NSI.

A single exposure to HIV, HBV, or HCV in the context of a NSI places a HCW at average risks of infection of 0.3%, 6% to 30%, and 1.8%, respectively (CDC 2004; NIOSH 2000).

4. Hepatitis B Virus ( H B V )

In America

12, 000 HBV infections occurred in HCWs in 1985

500 HBV infection occurred in HCW in 1997

Intervention implemented:

widespread immunizations of American HCWs for HBV

But, there is a 6%-30% risk that an exposed, susceptible HCWs will become infected with HBV.

5. Hepatitis C Virus ( H C V)

The precise number of HCWs who acquire HCV occupationally is not known in China.

In the United States, HCWs exposed to blood in the workplace represent 2% to 4% of the total new HCV infections occurring annually.

One study in the United States show that HCV transmission occurred only from hollow-bore needles compared with other sharps.

6. Human Immunodeficiency Virus ( H I V)

The first case of HIV transmission from a patient to a healthcare worker was reported in 1986

Through December 2001, American Central for Disease Control and Prevention (CDC) had received voluntary reports of 57 documented and 138 possible episodes of HIV transmission to HCW in USA

The average risk of HIV transmission after a percutaneous exposure is estimated to be approximately 0.3%

7. Cost of Needlestick Injuries

Cost

Direct costs:

initial and follow-up treatment of exposed HCWs

(it is estimated to range from 4000-2,4000 depending on the treatment

provided)

Indirect cost

Emotional cost (fear, anxiety)

lost time from work, etc

8. Host Environment Agent Epidemiologic Homeostasis

9. Epidemiology of needlestick injury

Who?

Where?

When?

How?

10. Who is at risk of injury?

11. Where do injuries occur?

12. How do injuries occur?

13. What device are involved in percutaneous injuries?

Disposal syringes (32%)

Suture needles (19%)

Winged steel needles (12%)

Scalpel blades (7%)

Intravenous (IV) catheter stylets (6%)

Phlebotomy needles (3%)

14. Hollow-bore needles (59%) !!!

15. Importance of hollow-bore needle injuries

NIOSH (2000) point out that the risk of infection for a HCW in the event of a NSI depends on

his or her immune status at the time of injury

the pathogen involved

the severity of the injury (e.g. how much blood was the worker exposed to?)

whether or not effective treatment is available

16.

Devices requiring manipulation or disassembly after use is associated with a higher rate of injury

17. Prevention Strategies

Hierarchy for prevention of needlestick injury

First: eliminate and reduce the use of needles where possible .

Using alternate routes for medication delivery and vaccination when

available and safe for patient care.

Second: isolate the hazards.

Provide a rigid cover that allows the hands to remain behind the needle.

Ensure that the safety feature is in effect before disassembly and remains in effect after disposal

Be an integral part of the device

Be simple and obvious in operation

18.

Handle hypodermic needles and other sharps minimally after use and use extreme care whenever sharps are handled or passed.

Use the "hands-free" technique (described below) when passing sharps during clinical procedures.

Do not bend, break, or cut hypodermic needles before disposal.

Do not recap needles.

Dispose of hypodermic needles and other sharps properly.

How can you prevent needlestick injuries?

19.

Many accidental needlestick injuries occur when staff are recapping needles.

Recapping is a dangerous practice: If at all possible, dispose of needles immediately without recapping them.

If it does become necessary for you to recap a needle (for example, to avoid carrying an unprotected sharp when immediate disposal is not possible), do not bend or break the needle and do not remove a hypodermic needle from the syringe by hand.

Recapping?

20. Recapping: The "one-hand" technique Step 1 Place the cap on a flat surface, then remove your hand from the cap. Step 2 With one hand, hold the syringe and use the needle to "scoop up" the cap. Step 3 When the cap covers the needle completely, use the other

21. Handling sharps

During a clinical procedure

When passing sharps, especially when there is sudden motion by staff members carrying unprotected sharps

when clients move suddenly during injections

when sharps are left lying in areas where they are unexpected (such as on surgical drapes).

Giving verbal announcements when passing sharps

Avoiding hand-to-hand passage of sharp instruments by using a basin or neutral zone

Ensuring cooperation from patients

Dispose a contaminated needle immediately after use

22. Safe passing of sharp instruments

Uncapped or otherwise unprotected sharps should never be passed directly from one person to another.

In the operating theater or procedure room, pass sharp instruments in such a way that the surgeon and assistant are never touching the item at the same time.

This way of passing sharps is known as the "hands-free" technique:

23. "hands-free" technique: First step: The assistant places the instrument in a sterile kidney basin or in a designated "safe zone" in the sterile field. Second step: The assistant tells the service provider that the instrument is in the kidney basin or safe zone. Third step: The service provider picks up the instrument, uses it, and returns it to the basin or safe zone.

24. When giving injections

Unexpected client motion at the time of injection can lead to accidental needlestick injuries. Therefore, always warn clients when you are about to give them an injection.

To protect clients, always use proper client preparation when giving an injection, and be sure that you handle IV fluids and multidose vials correctly.

25. If you are a head nurse in the unit, what you can do to prevent NSI?

Educating your staff

A reduction in the use of invasive procedures

(as much as possible)

A secure work environment

An adequate staff-to-patient ratio

26.

Risk-taking personality profile

Perceived poor safety climate in the workplace

Perceived conflict of interest between providing optimal patient care and protecting staff themselves

HCWs most readily change their risk behaviors when they thinks

They are at risk

The risk is significant

Behavior change will make a difference

The change is worth the effort

If you are a head nurse in the unit, what you can do to prevent NSI?

27. Introduction of safety devices

Vanish point syringe

Work principle

How to use it appropriately

Cost

28. Introduction of safety devices

Sharps Container

Work principle

How to use it appropriately

Cost

29. Post-exposure Treatment

Source patient details

Risk assessment

Action plan

Introduction of Nottingham Report Form Following Contamination from Blood or Body Fluids

30. Post-exposure treatment

Available data from animal studies (Ferreiro & Sepkowitz 2001) indicated that

systemic infection after a NSI does not occur immediately if antiviral therapy is delivered expeditiously, establishment of infection may be prevented.

Therefore,

If you are injured by contaminated needle, ensure effective treatment to be available as soon as possible

31. Useful information after exposure

Disease Control and Prevention Center of Yannan Province

Telephone number: 0871-3611773

(available: 8am-11am, 2:30pm-5:30pm)

Health Education Institution of Yannan Province


(available: 24hours)

Disease Control and Prevention Center of Kunming


(available: 8am-11am, 2:30pm-5:30pm)

32. Useful websites

Disease Control and Prevention Center of the Peoples Republic of China

http://www.chinacdc.net.cn/n272442/n272530/index.html

American Disease Control and Prevention Center (CDC)

http://www.cdc.gov/

American Occupational Safety & Health Administration (OSHA)

http://www.osha.gov/

33. DISCUSSION

Share your experience of needlestick injuries

Your experience might help others!

34.

Thank you

for listening!

Prevention Of Needlestick Injury Among Chinese Nurses

Health & Medicine