Circuit 1, station 9

Initial Action Plan for the Management of Needlestick Injuries:
1. Immediate Response Following Exposure
First Aid Application:
• In cases of accidental puncture wounds, apply immediate first aid by gently encouraging local bleeding. Do not attempt to suck the affected area.
• Cleanse the injured area thoroughly using mild soap and warm water. Do not vigorously scrub the area.
• For injuries involving mucosal surfaces, such as the mouth or conjunctiva, rinse the affected area with warm water or saline solution. Ensure that water used for mouth rinsing is not ingested. Avoid using bleach on the injury.
2. Assessment of the Injury
Determining Significance:
• Assess the injury to ascertain whether it qualifies as significant. A significant injury is characterised by both the type of injury sustained and the involvement of high-risk body fluids. Please refer to the definitions provided in Boxes 1 and 2 below for a clear understanding of high-risk injuries and body fluids.
For Health Care Workers:
• Report the injury to your supervisor.
• Notify the Occupational Health Department immediately. If the incident occurs outside of regular working hours, seek medical attention at the Accident & Emergency (A&E) department as soon as possible, preferably within one hour of the incident.
Supervisors:
• Reference Section 1 of the guideline titled “Management of Occupational Exposures to Bloodborne Viruses” for detailed guidance on roles and responsibilities.
High-Risk Injury:
• Percutaneous exposure (e.g. needlestick or other sharps injury)
• Mucous membrane exposure (e.g. eye)
• Human bite
Low-Risk Injury:
• Exposure on broken skin
• Splash on intact skin (Note: No known risk of Bloodborne Virus transmission from exposures to intact skin)
High-Risk Body Fluids:
• Blood
• Blood-stained low-risk fluid
• Semen
• Vaginal secretions
• Cerebrospinal fluid (CSF)
• Pericardial fluid
• Peritoneal fluid
• Pleural fluid
• Saliva associated with dentistry
• Amniotic fluid
• Breast milk
• Synovial fluid
• Unfixed tissues or organs
Low-Risk Body Fluids (unless blood-stained):
• Urine
• Vomit
• Saliva
• Faeces

Needle Stick Injury
Needle stick injuries are a major concern for healthcare professionals worldwide, and unfortunately, they are an occupational hazard that can’t be ignored. According to the Centres for Disease Control and Prevention (CDC), hospital-based healthcare personnel face approximately 385,000 sharps injuries annually, which translates to more than 1,000 injuries every day. This statistic highlights the alarming prevalence of needle stick injuries in the healthcare sector.
What is a Needle stick Injury?
A needle stick injury (NSI) is an accidental puncture or stab wound caused by a needle or other sharp object contaminated with someone else’s blood or bodily fluids. Those who work with needle-based equipment, particularly in hospital and dental clinic settings, are at the highest risk. These injuries can happen during the handling, dismantling, or disposal of needles, blades, or lancets and even hygiene workers who handle medical waste are at risk when needles are not disposed of properly.
Preventing NSIs is a challenge faced in virtually every medical workplace. In the dental industry, the routine use of sharp instruments and the presence of blood and saliva make this workplace particularly hazardous for blood-borne infections. It is important for workers to take precautions to prevent needle stick injuries and properly dispose of all sharp objects to protect themselves and others from harm.
Diseases Transmitted by Needle Stick Injuries
Needle stick injuries pose a risk of transmitting infectious blood-borne viruses such as Hepatitis B, Hepatitis C, and HIV from patients to healthcare workers. HIV/AIDS transmission is particularly prevalent in such cases.
The World Health Report 2002 estimates that of the 35 million healthcare workers worldwide, 2 million suffer from percutaneous exposure to infectious diseases annually. Furthermore, 37.6% of Hepatitis B, 39% of Hepatitis C, and 4.4% of Human Immunodeficiency Virus (HIV)/AIDS cases among healthcare workers are attributed to needle stick injuries.
Furthermore, in addition to the more commonly known viruses, needle stick injuries have transmitted many other rare diseases involving viruses, bacteria, fungi, and other microorganisms to healthcare workers, including:
• Blastomycosis • Mycoplasma caviae
• Brucellosis • Rocky Mountain spotted fever
• Cryptococcosis • Sporotrichosis
• Diphtheria • Staphylococcus aureus
• Cutaneous Gonorrhoea • Streptococcus pyogenes
• Herpes • Syphilis
• Malaria • Toxoplasmosis
• Mycobacteriosis • Tuberculosis
It’s crucial to exercise proper safety measures when handling needles to prevent needle stick injuries and the spread of infectious diseases.
How can Blood-borne diseases be transmitted?
Transmission can occur through percutaneous injury or contact with mucous membranes via drip or aerosolised body fluids. Even small amounts of infectious fluid are enough to spread diseases. If the contaminated needle punctures the skin, it can inject or transfer infected body fluids into the bloodstream, resulting in infection. As a result, it’s critical to take the necessary precautions to avoid needle stick injuries.
Furthermore, the risk of infection following exposure to infected blood varies by blood-borne pathogen.
Management of Needle Stick Injuries
The management of needle stick injuries involves various steps that healthcare workers must follow to prevent disease transmission. These steps include:
1. Immediate Action
The first step in managing a needle stick injury is to take immediate action. The injured person should:
• Stop the procedure immediately if possible and have another operator take over if available.
• Apply pressure to the injury site to prevent infectious fluid from entering the bloodstream.
• Drain some amount of blood from the injury site.
• If the nose, mouth, or eyes were exposed, flush them out with water.

2. Identify the Portal of Entry
It is crucial to identify the portal of entry for disease transmission. The portal of entry could be through the cutaneous membrane, percutaneous, mucous membrane, or any exposed injury. This information can help determine the necessary treatment and prophylaxis.
3. Determine the Risk of Exposure
The risk of exposure to blood borne pathogens depends on various factors, including the type of exposure, the body fluid involved, and the infectious status of the source patient. Therefore, it is crucial to determine the risk of exposure before taking any further action.
4. Follow CDC Guidelines
The Centres for Disease Control and Prevention (CDC) has issued guidelines on how to manage needle stick injuries. The guidelines vary depending on the type of exposure and the source patient’s infectious status.
Hepatitis B:
If the exposed person has completed a full course of hepatitis B vaccination and their anti-HBS level is above 100 IU/ml, then no further action is necessary. If not, the individual should start the vaccination course and receive hepatitis B immunoglobulin (HBIG) if the exposure was significant.
Hepatitis C:
Unfortunately, there is no specific prophylaxis or vaccination available for hepatitis C. Exposed healthcare workers should be managed based on the source’s status and should follow up with blood work to monitor disease status.
HIV:
HIV is a virus that attacks the immune system and is transmitted through bodily fluids such as blood, semen, vaginal secretions, and breast milk. If there is a risk of exposure to HIV, it is essential to obtain prophylaxis as soon as possible, ideally within one hour. The risk of seroconversion following a single percutaneous exposure to HIV is low, but PEP should still be considered whenever there has been exposure to a material known to be or strongly suspected of being infected with HIV.
Post-exposure prophylaxis (PEP) for HIV consists of a 28-day course of two to three antiretroviral drugs. (Truvada QD (Tenofovir 300mg + Emtricitabine 200mg) + Raltegravir 400mg BID). Initiating the regimen as soon as possible is essential since effectiveness is unknown after 72 hours. PEP should not be offered following contact through any route of urine, vomitus, saliva, and faeces unless they are visibly blood-stained.
5. Reporting
It is essential to report any needle stick injury immediately to the appropriate personnel. Healthcare workers must report the incident to their supervisor or infection control department. Accurate and prompt reporting is critical for the effective management of needle stick injuries.
6. Prevention
The best way to manage needle stick injuries is to avoid them in the first place. To reduce the risk of needle stick injuries, healthcare workers should use safety devices, properly dispose of needles, implement safe work practices, and be trained in safe needle-handling techniques.
Conclusion
Healthcare workers should take immediate and appropriate steps after an NSI to minimise the risk of transmission of blood-borne infections.