Immediate Actions for Needlestick Injury in Healthcare Setting

What is Needlestick Injury?

Needlestick injury is caused by using needles that accidentally puncture the skin. This type of injury is hazardous for people who work with hypodermic syringes or hollow needles and other needle equipment i.e. blood collection needles, suture needles, winged steel needles, Phlebotomy needles, IV cannula. Needlestick injuries can happen at any time when people use, disassemble, or dispose of needles. Needles can hide in garbage or linen and injure other workers who encounter them accidentally when not disposed of properly.

Needlestick Injury management
Fig: Needlestick Injury management

Who is at Risk of Needlestick Injury?

Needlestick injury is very dangerous for the worker who may come in contact with needles including-

  1. Nursing staff,
  2. Lab workers,
  3. Doctors,
  4. Housekeepers.

Risk Items for Needlestick Injury:

Injury can occur with a wide range of items but those which have a higher risk of injury include-

  • IV cannula,
  • Needles (Hypodermic or hollow needles, Blood collection needles, Suture needles),
  • Winged steel needles (‘’butterfly‟),
  • Phlebotomy needles.

 Immediate Action After Needlestick Injury:

The below actions should be followed immediately after needlestick injury:

1. First Aid:

  • Contaminated Intact Skin- Wash the wound using running water and plenty of soap
  • Contaminated Eyes – Splashes to the eyes should be irrigated with sterile eyewash (or if none available with tap water). If contact lenses are worn, irrigate the eyes before and after removal of the lenses.
  • Contaminated Mouth- Splashes to the nose or mouth should be flushed with water.
  • Contaminated tissues, dressings, gloves, etc. should be treated as clinical waste and disposed of appropriately.

2. Report and Document:

All needlestick and other sharps-related injuries should be notified without delay. Health and safety committee must be kept on the record.

3. Blood Testing:

Hep B Status, HIV, Hep C Status.

4. Necessary Action After Needlestick Injury:

  • Assess the risk of transmission of infection to the exposed person and start treatment according to risk.
  • If the patient is HIV AIDS positive, high risk, or “unknown” then the exposed health care worker should be offered Post Exposure Prophylaxis (PEP) and counseling.
  • PEP drugs should be given within 1-2 hours and up to 72 hours following exposure.
  • Refer the exposed person to an infectious diseases consultant if the exposure is high risk.

5. Further Action:

  • If patient and health care worker status is unknown and immune status can’t be obtained within 48 hours then give Hepatitis b Immune Globulin (HBIG) and Hepatitis B. Vaccine (first dose).
  • If an exposed person is HBV immune then no further Hepatitis B Vaccine is required. Check Hepatitis B antibody titer of Health Care Worker; if low give the Hepatitis B vaccine booster.
  • If the exposed person is not HBV immune or HBV susceptible, then treat with hyperimmune Hepatitis B Immunoglobulin and offer Hepatitis vaccine course.
  • Advise safe sex until blood test results and source history are reviewed.

6. Follow Up:

  • Must be complete the course of hepatitis B vaccine.
  • Keep the exposed person in follow up with HIV serology 6 weeks and 3 months.
  • Complete work covers or inform adverse outcomes and keep medical records properly.

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