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Dr Paul Grime MBChB MSc MRCPI MFOM Chair, Safer Needles Network UK Consultant/Honorary Senior Lecturer in Occupational Medicine, Royal Free Hospital, London.

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Presentation on theme: "Dr Paul Grime MBChB MSc MRCPI MFOM Chair, Safer Needles Network UK Consultant/Honorary Senior Lecturer in Occupational Medicine, Royal Free Hospital, London."— Presentation transcript:

1 Dr Paul Grime MBChB MSc MRCPI MFOM Chair, Safer Needles Network UK Consultant/Honorary Senior Lecturer in Occupational Medicine, Royal Free Hospital, London. UK National NSI Conference 2006 – Ireland 22nd April 2006

2 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

3 Network Aims Reduce number of needlestick injuries Preventative measures Safer systems of working Provision of safer needles Improved training and education Use of standard precautions Safer disposal of sharps Promotion of best practice

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

5 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

6 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: I mplementing 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 and NHS 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

7 Sharps Injury: The hidden danger

8 Needle-stick Injury Definition, epidemiology, transmissions Prevention –Safe systems of work –Safety engineered devices Management of exposure incidents

9 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

10 Health Protection Agency, Centre for Infections Surveillance of Occupational Exposure to Blood-Borne Viruses in Healthcare Workers: Seven-year Report: 1 st July 1997 to 30th June 2004 HCV 48% HIV 24% HBV 9% Percutaneous 78% Nurses 45% Doctors 37%

11 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

12 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+?

13 Prevention: Safe Systems of Work Standard (Universal) Precautions Dont re-sheath Dont pass hand to hand Dispose of sharps at point of use

14 Protective Equipment –Gloves –Cover cuts/abrasions with waterproof dressings –Eye Protection Prevention: Safe Systems of Work

15 Eye protection

16 Prevention: Safe Systems of Work Induction is not enough! Safety must be integral to organisational culture & everyday practice

17 Prevention: Safety Engineered Devices Shielded/retractable needles & cannulae Blunt suture needles/cannulae Needle-free systems

18 Local evaluation Cost in use US Needlestick Safety and Prevention Act 2000 Prevention: Safety Engineered Devices

19 Management of Body Fluid Exposure Incidents Incident 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

20 Principles of Management of Needlestick Injury (BBFE) Assess risk of BBV transmission Action to minimise risk of BBV transmission

21 Assess risk of BBV transmission Consider: –Circumstances of exposure –Source patient –Exposed healthcare worker

22 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)

23 Source Patient Known/unknown HIV, HBV, HCV Known Infection Co-infection Risk Factors Consent for testing

24 Source BBV risk factors HIVHCVHBV 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

25 Exposed Healthcare Worker Hepatitis B immunity General Immunity Contraindications for PEP

26 Action to minimise the risk of BBV transmission Hepatitis B immunoglobulin HIV PEP

27 Reporting Local National e.g. HPA Legal requirements e.g. RIDDOR

28 Consider preventable factors Inform measures to continuously improve safety

29 Follow up to exclude BBV transmission 6 weeksHIV abHCV RNA 12 weeksHIV abHCV RNA HCV ab 24/30 weeksHIV abHCV ab

30 Management of Body Fluid Exposure Incidents Incident 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

31 Reference Appendix 2: Needlestick Injury: Prevention and Management in The Management of Health, Safety and Welfare Issues for NHS Staff, NHS Employers January 2005


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