Inoculation Injury Management

1. Inoculation Injury Management Community Infection Prevention and Control Team 2011

2. Definition of Sharps �Sharps are anything that penetrates the skin to cause injury�

3. Types of Inoculation injuries Percutaneous Needles Instruments Teeth, bone Glass / ampoules Human bites and scratches

4. Types of Inoculation injuries Mucous membrane Contamination or splashing of the mucous membrane with blood or body fluids eyes, nose, mouth or conjunctiva with blood or body fluids Contamination or splashing with blood or body fluids of any open wound or skin lesion e.g. eczema

5. Inoculation Injuries in General Dental practice (Safer Needles Network 2006a) Large number of injuries occur during administration of anaesthesia However , many injuries occur after the injection has been carried out

6. Common Injuries in Dental Practice During needle re -sheathing / removal During Surgery decontamination During Instrument tray clearing Incorrect placement of syringes

7. Blood Borne Viruses Blood borne viruses (BBV) are viruses that some people carry in their blood and which may cause severe disease in certain people and few or no symptoms in others. The virus can spread to another person, whether the carrier of the virus is ill or not.

8. Blood borne Viruses Hepatitis B (HBV) Hepatitis C (HCV) H.I.V

9. Hepatitis B Virus (HBV) Blood-borne viral infection that can be prevented through vaccination. The hepatitis B virus (HBV) causes hepatitis (inflammation of the liver) Can also cause long-term liver damage

10. Hepatitis C (HCV) Virus that can cause long-lasting infection and can lead to liver disease. There is no vaccination to prevent HCV.

11. Human Immunodeficiency Virus Causes Acquired Immune Deficiency Syndrome (AIDS). HIV destroys the body's ability to fight infection by attacking the immune system. This results in infected individuals becoming susceptible to opportunistic infections.

12. Risk of BBV transmission

13. How much blood is required to transfer a blood-borne virus?

14. As little as 0.00004 ml from an infected patient A blue needle holds 0.1ml

15. Body Fluids High risk Blood Amniotic fluid Vaginal secretions Semen Breast milk Cerobrospinal fluid Peritoneal fluid Pericardial fluid Synovial fluid Saliva - dentistry

16. Increase risk of transmission depends on: How deep the injury is Visible blood present Needle from source patient�s artery/vein Terminal ill HIV related illness in source patient High Risk Activities: IV drug users Blood transfusion pre-1991 Residence in Sub Sahara Africa/Far East Detention in Prison since 1980 Male homosexual/bisexual Prostitutes HIV Sexual partners of listed Babies of high risk mothers

18. Sharps/ splash injury: prevention

19. Sharps/ splash injury: prevention

20. Sharps/ splash injury: prevention Never attempt to separate a needle and syringe; discard as one unit*. Store sharps containers at waist level or above, NEVER on the floor or above shoulder level, and ALWAYS out of reach of children and vulnerable adults. Use temporary closure mechanism when container not in use. Complete location sticker on sharps container and sign and date at assembly, locking and disposal.

21. Sharps/ splash injury: prevention If a needle and syringe must be separated, the appropriate slot on the sharps container should be used to remove the needle from the syringe. Needle forceps can also be used. If recapping a needle is absolutely unavoidable, a needle guard should be used. The one-handed technique can be used if staff are trained and competent to do so.

22. Policy and Procedure Each practice should have clear guidelines including : Inoculation injury management policy Flowchart for assessing and dealing with needlestick injury Programme for Hepatitis B immunisation Appropriate PPE

23. Scenario A dental nurse whilst cleaning instruments prior to autoclaving cuts her finger on a periodontal scaling instrument How will you manage this situation ?

24. Identify the wound Instigate basic first aid Assess the significance of the injury Risk assessment Hepatitis B status Report Seek expert guidance - Occupational health / A & E

25. Its 5 pm , Friday afternoon and leading to a bank holiday weekend. Following an inferior dental block a dentist accidentally sticks the needle into his thumb and notices blood accumulating under his glove . The patient is a 28 year old male on his second visit to the practice How will you manage this situation ?

26. As before but ensure All operative procedures are stopped

27. Individuals Exposed To Blood Borne Viruses in Health Care Settings Any person exposed to the risk of blood borne viruses in any healthcare setting (including a domiciliary care situation) should be assessed and managed according to the principles laid out in the guidance provided by Occupational Health or A & E department at Doncaster Royal Infirmary. Support will be available to the individual during and after the incident. This support can be accessed through several sources including line management, Human Resources or Occupational Health.

28. First Aid Percutaneous injury Aim to reduce bio burden Wash under running water Apply downstream pressure to help extrude infectious material Apply waterproof dressing Report and document incident to manager Seek advise from Occupational health Do not squeeze , suck or scrub area

29. First Aid Mucous Membrane Flush affected area with copious amounts of cold water Report and document incident to manager Seek advise from Occupational Health

30. information that may be required at Occupational Health or A&E

31. Details of injury Patient�s name Patient�s date of birth Any known history of BBV�s History of high risk activities

32.  Who should arrange for source patient blood testing?

33. Source patient testing should NOT be carried out by the injured member of staff Blood can only be taken & tested with consent Sample is saved and stored for 10 years

34. Post exposure prophylaxis (PEP) may be recommended if the injury is high risk and the source patient is known to be HIV positive