Needle Stick Injuries - Research Paper Example

Needle Stick Injuries Abstract The healthcare workers like doctors, nurses, laboratory and blood bank technicians, the cleaning staff, operation theater assistants and all others who work in hospitals are at a high risk of any disease transmitted to them from patients by different means especially through the needle stick injuries. Although many preventive measures are taken yet the risk is quite high and there are still many cases reported. The nurses are at a particularly higher risk as most of the procedures for giving inject able drugs are to be performed by them. During the past decade, a lot of efforts have been done to reduce this incidence. As a result, now there is much more awareness than ever before. Moreover, certain rules and regulations have been passed regarding the use of safety needles which are made according to certain specifications with a safety mechanism set in them. In addition the practice of re-capping the needle has been eliminated thereby further reducing the incidence. Given below is an account of how needle stick injuries carry a risk of infection transmission and how can it be prevented. NEEDLE STICK INJURIES OF THE HEALTHCARE WORKERS AND THE RISK OF DISEASE TRANSMISSION Needle stick injuries are dangerous in terms of transmitting an infection from one individual to another, but they are completely preventable by improving the medical practices. But still, if they do occur, then the immediate management like first aid, blood tests and counseling are essential. HIGH RISK DISEASES: The needle stick injuries can transmit any organism but the major concern lies with the Human Immunodeficiency Virus (HIV), Hepatitis C virus and Hepatitis B virus. (Australian Prescriber, 2001). RISK OF DISEASE TRANSMISSION: There are many factors contributing to the results of such an injury. These depend upon the nature of injury, and the viral load in the patient. Given below is the estimated risk of disease transmission per exposure to the needle stick injury: Exposure Hepatitis B Hepatitis C HIV Puncture by contaminated needle 1:16-1:3:3 1:55 1:313 Courtesy of ‘Centers for Disease Control, Atlanta (Australian Prescriber, 2001). Talking about the risk of infection from a needle stick injury, in most of the cases the risk is quite low. The risk of infection from a contaminated needle according to Public Health Service guidelines for management of occupational exposure to HBV, HCV and HIV published in 2001is as follows: Occupational Exposure Risk of Transmission HIV 0.3% (or a 1 in 300 chance of infection) HBV 2-40% HCV 2.7-10% But this is the general outline; it all depends upon various factors including the: 1. Viral load of the infected patient who is the source of transmission, 2. The nature of injury like only superficial one or a deep cut and Needle Stick Injuries 4 3. The volume of the infected blood transmitted. (The Online Journal of Issues in Nursing, 2004). OUTCOMES: Now a day the vaccination available is only for Hepatitis B, and no vaccination is available for Hepatitis C or HIV. This is the reason why all healthcare workers are required to have their Hepatitis B vaccination done prior to entering their healthcare profession. For Hepatitis C, the treatment is available, but no vaccination. The treatment has good results if the disease is diagnosed at a relatively earlier stage. If a person comes with an advanced stage of Hepatitis C, the treatment does not show much good outcomes. Human Immunodeficiency Virus (HIV) also does not have any vaccine available, thus this disease is also hazardous if once it occurs. (HSE, 2010). PROCEDURES INVOLVING SHARPS: The needle stick injuries are most common during procedures like drawing a blood sample, giving an intravenous or intramuscular drug, or any other procedure which involves any needle or any other sharp object like hypodermic needles or scalpels etc. Another common exposure is while recapping the used needles. It is now recommended at all medial set ups to immediately dispose of the used needles into the approved sharp containers which break the needle and only the plastic container of the syringe is left behind. Although the gloves are used during all the medical procedures, yet the needles or scalpels are sharp enough to pierce the glove and then the skin. (HSE, 2010). STUDY SHOWING THE INCIDENCE OF NEEDLE STICK INJURIES: Recently a study was conducted by Health Protection Agency (HPA), which collected the data across 150 reporting centers. This study was based on the incidence of occupational exposure to the Blood Borne Viruses (BBV’s) among the healthcare workers. The results of this study showed the needle stick injuries the needle stick injuries to be the most common type of exposure to such viruses. Out of these 63% were caused by the hollow bore needles. Out of these about 45% occurred among the nursing professionals and 37% among the medial professionals. Only about 2% cases were reported amongst the ancillary staff, but most of them were those resulting from the inappropriately discarded needles in the garbage bags. (HSE, 2010). INCIDENCE: Needle Stick Injuries 5 During the year 1996, there were about one million exposures to needle stick injuries reported in USA alone. This figure reduced to about 385,000 per year in 2000. This was possible after the protection standards maintained by the Occupational Safety and Health Administration’s (OSHA) Blood Borne Pathogen Standard. These included the use of safe needle devices, sharp bins, gloves and the elimination of re-capping. (The Online Journal of Issues in Nursing, 2004). The needle stick injuries have a very higher risk of transmitting infection with the freshly contaminated sharps, but the risk is almost equally high for the dried up needles which do not contain the fresh blood. The infections of HIV and HCV decrease within few hours, yet the HBV remains stable and is infectious for about more than a week. (Wikipedia, 2010). INCIDENCE ACCORDING TO TYPES OF SYRINGES: A study conducted by the American Nurses Association in 2008 revealed the following results regarding the percentage of nurses affected by needle stick injuries using different types of syringes according to the safety mechanism. The data collected shows the values from years 2006, 2007 and 2008: 2008 2007 2006 Hands and fingers stay behind the needle when activating the safety mechanism 64% 65% 71% Safety feature activated using one hand 63% 73% N/A Syringe is permanently disabled after the safety mechanism is activated 62% 69% 72% Needle withdraws into the barrel 57% 63% 63% Safety feature is integral to the design of the syringe 49% 61% 64% No add-on pieces such as sheaths, shields or caps 40% 45% 59% (The Free Library, Oklahama Nursing Association, 2008). PREVENTION: Needle Stick Injuries 6 There are certain precautionary measures which must be kept in mind in an attempt to avoid getting exposed to such an incidence. These include: a. Thorough washing of hands before and after any intervention, b. Wearing gloves and eye protection, c. Using the safety needles and cannulas, d. Once used, the needles should immediately be thrown into sharps bin, e. Avoiding re-capping or re-sheathing of a used needle, f. Avoiding lack of attention while handling sharps, g. Paying even more attention for butterfly needles. They are even more dangerous. (The Impacted Nurse, the nurses desk, 2007). SAFETY NEEDLES: The safety features for needle devices as recommended by National Institute of Occupational Safety and Health (NIOSH) in 1999 describes the following features: 1. Needleless devices, 2. Essential safety mechanism, 3. The device should work passively i.e. it does not require an activation by the user, however if activation is necessary, it should be a single handed technique and the worker’s hand should be behind the exposed sharp, 4. It must be easy for the user to know that the safety feature is activated, 5. There should be no activation of the safety feature, 6. The device should have a reliable performance, 7. It should be easier to use and practical and 8. It should be safe and effective for the patient care. (The Online Journal of Issues in Nursing, 2004). MANAGEMENT: Once exposed to a needle stick injury, time is important, it should not be wasted and certain steps must be taken immediately. Immediate washing of the site should be done. Squeezing the wound is not of much benefit. The post occupational exposure management of the hospital should be consulted. The type of exposure is important than the patient itself. Serological testing of both the recipient and the donor are required in order to check for the infection status. Hepatitis B immunization may be required if necessary. It depends upon previous vaccination. Needle Stick Injuries 7 If the infecting organism is HIV, retroviral drug prophylaxis may be required. (The Impacted Nurse, the nurses desk, 2007). HIGH RISK NEEDLES: The United States National Surveillance System for Health Care Workers (NaSH) has identified six devices to be the culprit for majority of needle stick and sharps related accidents. These include: a. Hypodermic needles, b. Suture needles, c. Winged steel needles (butterfly), d. Scalpel blades, e. IV catheter stylets and f. Phlebotomy needles. Figure 1. Devices Involved in Percutaneous Injuries g. According to this report, the hollow bore needles are considered to be the most dangerous in terms of transmitting an infection. This is because they may become filled with the infected blood. (The Online Journal of Issues in Nursing, 2004). EVENTS CAUSING NEEDLE STICK INJURIES: The events causing these infections are shown according to the percentage ratio in following figure. These events include: 1. Manipulating the needle in patient (26%), 2. Disposal (23%), Needle Stick Injuries 8 3. Collision with worker or sharps (10%), 4. During clean up (10%), 5. Accessing an IV line (6%) and 6. Recapping needles (6%). (The Online Journal of Issues in Nursing, 2004). Thus the needle stick injuries are quite common among the health care workers and especially the nurses who have to work in close collaboration with the procedures involving the use of sharps. There are preventive measures and there are treatments as well available in some cases. Yet, prevention is better. Now many hospitals prefer to use the safety needle which has reduced this incidence. Now much of the awareness is present than before and it is likely to reduce the event even more. Needle Stick Injuries 9 REFERENCES AustralianPrescriber (2001, July). Needle-stick injuries in primary care. Retrieved November 12, 2010, from http://www.australianprescriber.com/magazine/24/4/98/100/ CDC (1999, November 22). NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings. Retrieved November 12, 2010, from http://www.cdc.gov/niosh/docs/2000-108/#2 HSE (2010, September 28). Needle-stick Injuries. Retrieved November 12, 2010, from http://www.hse.gov.uk/healthservices/needlesticks/index.htm impactednurse.com (2007, June 7). needle stick injury. Retrieved November 12, 2010, from http://www.impactednurse.com/?p=334 The Free Library (2008, September 1). Workplace safety and needlestick injuries are top concerns for nurses. Retrieved November 12, 2010, from http://www.thefreelibrary.com/Workplace+safety+and+needlestick+injuries+are+top+concerns+for+nurses-a0183985389 The Online Journal of Issues in Nursing (2004, September 4). Needle stick and Sharps Injury Prevention. Retrieved November 12, 2010, from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/InjuryPrevention.aspx Wikipedia (2010, September 29). Needlestick Injury. Retrieved November 12, 2010, from http://en.wikipedia.org/wiki/Needlestick_injury Read More