INOCULATION INJURIES

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Issue 1 October 1999

INOCULATION INJURIES

•Minimizing the risk

•Prevention Strategies•Treatment Protocols

Paul Hateley Rona McMillanLead Nurse Clinical Nurse SpecialistInfection Control Infection ControlSt. Bartholomew’s Hospital St. Bartholomew’s HospitalLondon London

MINIMISINGTHERISK

Every employee has a legal responsibility under the Health and Safety at Work Act (1974), to take care of both their own and others Health and Safety.

All health care workers have a legal requirement to identify the hazards and assess the risks relevant to Health and Safety.

Identified risks must be reduced as far as is reasonably practical by introducing suitable safety measures.

Health and Safety at Work Act,(1974)

THE RISKSContaminated blood / body

stained fluid

• Through skin

• Onto broken skin

• Onto mucous membranes

Body fluids that may containHIV and/or Hepatitis B and/or C

• Blood

• Blood stained body fluids

• Semen

• Vaginal secretions

• TissuesCSF, amniotic, pericardial, pleural fluids

Body fluids that are unlikely to contain pathogenic organisms:

• Tears

• Nasal secretions

• Sweat

• Saliva

What is risk assessment?

Assessment of the risk to the health and safety of employees

to which they are exposed while at work

For risk assessments to be effective they need to be:

• Systematic

• An ongoing process monitoring, reviewing and modifying

Assess body fluid risk of task to be undertaken

No risk of splashing No protective clothing

Blood/blood stained Disposable gloves & aprons

body fluid but low

risk of splashing

Blood/blood stained Gloves, waterproof gown & eye

body fluid and high protection

risk of splashing

(Adapted from EAGA 1998)

When undertaking risk assessment:

• Identify hazards / risksActs / regulations that must be complied with will help identify hazards

• Evaluate extent hazards / risksTake into account existing control measures

• Assess the population of staff affected and consequence of the risks

• Risk assessment must be recorded

Occupational transmission of infection to health care workers

• Through skin

• Onto broken skin

• Onto mucous membranes

• Direct contact with infective material

• By droplet spread

Risk of health care workers acquiring HIV and HBV occupationally

• HIV 0.37%

• HBV 20 - 40%following exposure to contaminated blood

(Alder, 1997)

HIV Transmission: Global summary, June 1996

Type of exposure % of global total

Blood transfusion 3-5

Perinatal 5-10

Sexual intercourse 70-80

vaginal 60-70

anal 5-10

Injecting drug use (sharing works etc) 5-10

Heath care (inoculation injury etc) <0.01

(Friedman Kien AE, Cockerell CJ 1997)

Prevention Strategies

Sharps safetyPrevention of inoculation injury

• Never re-sheath used needles

• Take a sharps container with you and dispose of sharps at the point of use

• Never fill a sharps bin to more than 75% of its capacity

• Ensure you take responsibility for your own sharps

Body substance isolation(BSI)

Devised by Lynch and Jackson in 1984

Purpose of BSI

• Reduce risk of cross-infection to patients

• Protect health care workers from acquiring infections occupationally

• Simplify infection control procedures

• reduce cost of the prevention of hospital acquired infections

(Jackson & Lynch, 1992)

Basic elements of BSI• Gloves are worn for anticipated contact with body substances (blood,

urine, faeces, wound drainage etc). To be put on just before contact with body substances

• Protect clothing if soiling with body substances is anticipated

• Eye and face protection as appropriate

• handwashing

• Careful use and disposal of sharps

• Waste contaminated with body substances segregated as clinical waste

In addition

• All specimens categorised the same way

• All linen is treated the same way

Conclusion

• BSI effective infection control strategy

• Senior management support required for successful implementation

• Multidisciplinary agreement

• Ongoing education

• Compliance studies / audits

TreatmentProtocols

Inoculation injuryPrevention is better than cure

Should an injury occur:

• Encourage bleeding / irrigation

• OHD / Virologist

• Hepatitis B status• vaccine

• immunoglobin

• No Hepatitis C vaccine

• Serum storage (Hep B, C and HIV)

• Staff? Test later

• Patient - if known - ? Test with ‘informed’ consent

• Report incident / documentation

Prophylactic therapyDual / triple

• High risk - double

• Known HIV - triple

• Pregnancy - mono only

Drug regimens• AZT - zidovudine

• 3TC - Lamivudine

• Indinavir

• AZT - pregnancy second and third trimester - no foetal damage

Drug therapies

Triple therapy suppresses the viral load, thus increases the CD4 count.

Lamivudine is not recommended for monotherapy

Side effects

• Rare in short courses

• Dose related

• Nausea / vomiting

• Fever

• Myalgia

• Fatigue

• Anaemia

• Leucopenia

• Parasthesia

• Insomnia

• Rashes

Understandthe

optionsand

decidebeforehand!