Dr Paul Grime MBChB MSc MRCPI MFOM

Chair, Safer Needles Network UKConsultant/Honorary Senior Lecturer in Occupational Medicine,

Royal Free Hospital, London. UK

National NSI Conference 2006 – Ireland

22nd April 2006

Membership

Trades unions – Unison, RCN, BMA

Clinicians and professional organisations – occupational health, infection control, perioperative care, risk management and anaesthetics

Manufacturers – ABHI

Interested parties – SCIEH, HPA, BDA, WAG

Observers – NHS Employers, PaSA, DH, HSE

Network Aims

Reduce number of needlestick injuries Preventative measuresSafer systems of workingProvision of safer needlesImproved training and educationUse of standard precautionsSafer disposal of sharpsPromotion of best practice

Network’s Objective

In January 2005, NHS Employers issued national guidance to reduce the risk needlestick injuries and for their prevention and management.

The Network’s principal objective is to facilitate implementation and compliance with the guidance so that NHS Trusts conduct proper risk assessment, surveillance and reporting procedures, training and education and make available safety devices.

Safer needles campaign

Coalition building, informing and influencing stakeholders

Media activity and raising awareness of the risks

Maintaining relationships with bodies who have a duty of care for employees and political campaigning

EPINet and HPA surveillance data

Monitoring the effectiveness of the national guidance through national audit

Website: needlestickforum.net Annual conferences and regional roadshows

What do we want?

The provision of training, education and medical devices incorporating safety engineered protection mechanisms which will lead to a significant reduction in the incidence of blood and body-fluid exposures. This can be achieved by:

 Implementing proper surveillance and reporting procedures

 Providing ongoing training and education, locally and nationally, of healthcare workers in preventative measures and safer working practices

 Making available medical devices incorporating safety engineered protection mechanisms to all healthcare workers in the workplace, where such devices will reduce the risk of blood and body-fluid exposure.

Health Service Circular and guidance to Trust Chief Executives andNHS Managers to minimise the incidence of sharps and NSI

Proper surveillance and reporting of NSI and monitoring of the reduction as a result of the introduction of safer needles

Sharps Injury: The hidden danger

Needle-stick Injury

• Definition, epidemiology, transmissions

• Prevention

– Safe systems of work

– Safety engineered devices

• Management of exposure incidents

Needle-stick and sharps injuries

Needle-stick injuries (NSIs), other sharp medical devices, bone, teeth (Percutaneous)

Splash (Muco-cutaneous)

Blood/Body fluid exposure

Potential for transmission of blood borne virus, e.g. HBV, HCV or HIV, or other transmissible agents

Health Protection Agency, Centre for Infections Surveillance of Occupational Exposure to Blood-Borne Viruses in Healthcare Workers:

Seven-year Report: 1st July 1997 to 30th June 2004

• HCV 48%

• HIV 24%

• HBV 9%

• Percutaneous 78%

• Nurses 45%

• Doctors 37%

• 58% during procedure

• 37% after procedure, before disposal or

during/after disposal

Health Protection Agency, Centre for Infections Surveillance of Occupational Exposure to Blood-Borne Viruses in Healthcare Workers:

Seven-year Report: 1st July 1997 to 30th June 2004

Reported transmissions

HIV

UK: 5 definite since 1984 (4 have died)

12 probable

World: 102 definite

217 probable

HCV

UK: 9 definite since 1997

World: 78+?

Prevention: Safe Systems of Work

• Standard (Universal) Precautions

• Don’t re-sheath

• Don’t pass hand to hand

• Dispose of sharps at point of use

Protective Equipment

– Gloves

– Cover cuts/abrasions with waterproof dressings

– Eye Protection

Prevention: Safe Systems of Work

Eye protection

Prevention: Safe Systems of Work

• Induction is not enough!

• Safety must be integral to organisational

culture & everyday practice

Prevention: Safety Engineered Devices

• Shielded/retractable

needles & cannulae

• Blunt suture

needles/cannulae

• Needle-free systems

• www.pasa.nhs.uk

• Local evaluation

• Cost in use

• US Needlestick Safety and Prevention

Act 2000

Prevention: Safety Engineered Devices

Management of Body Fluid Exposure IncidentsIncident

Assess the risk of BBV transmission.

Consider:

Circumstances of exposure:

•Percutaneous / Mucocutaneous

•High / Low risk

Source Patient Status:

•HIV•HCV•HBV

Exposed member of staff:•HBV immune status•Contraindications to PEP for HIV

Action to minimise the risk of BBV transmission:

•Hep B booster / HBIg•PEP for HIV

Report:•HPA CFI•RIDDOR

Consider safer systems of work to prevent further incidents

Follow up to confirm occupational BBV transmission has not occurred

Principles of Management of Needlestick Injury (BBFE)

• Assess risk of BBV transmission

• Action to minimise risk of BBV transmission

Assess risk of BBV transmission

Consider:

– Circumstances of exposure

– Source patient

– Exposed healthcare worker

Circumstances of the Exposure

• Percutaneous– Deep/superficial– Visible blood on the device– Solid/hollow bore needle– Volume of blood innoculated

• Muco-cutaneous

• 2-way exposure? (e.g. NSI during EPP)

Source Patient

• Known/unknown

• HIV, HBV, HCV

• Known Infection

• Co-infection

• Risk Factors

• Consent for testing

Source BBV risk factors

HIV HCV HBV

•Country of high prevalence e.g. Sub Saharan Africa•Gay Man•IVDU•Sexual partner with risk factor•Mother with risk factor

•IVDU•Country of high prevalence e.g. Egypt•Multiple blood transfusion before 1985

•IVDU•Gay man•Sexual partner with risk factor•Mother with risk factor

Exposed Healthcare Worker

• Hepatitis B immunity

• General Immunity

• Contraindications for PEP

Action to minimise the risk of BBV transmission

• Hepatitis B immunoglobulin

• HIV PEP

Reporting

• Local

• National e.g. HPA

• Legal requirements e.g. RIDDOR

Consider preventable factors

• Inform measures to continuously improve safety

Follow up to exclude BBV transmission

6 weeks HIV ab HCV RNA

12 weeks HIV ab HCV RNA

HCV ab

24/30 weeks HIV ab HCV ab

Management of Body Fluid Exposure IncidentsIncident

Assess the risk of BBV transmission.

Consider:

Circumstances of exposure:

•Percutaneous / Mucocutaneous

•High / Low risk

Source Patient Status:

•HIV•HCV•HBV

Exposed member of staff:•HBV immune status•Contraindications to PEP for HIV

Action to minimise the risk of BBV transmission:

•Hep B booster / HBIg•PEP for HIV

Report:•HPA CFI•RIDDOR

Consider safer systems of work to prevent further incidents

Follow up to confirm occupational BBV transmission has not occurred

Reference

Appendix 2:

Needlestick Injury: Prevention and Management

in The Management of Health, Safety and Welfare Issues for NHS Staff,

NHS Employers January 2005