Nursing Reference: Prevention Of Needlestick Injury Among Chinese Nurses Slide Transcript
Slide 1: Prevention of Needlestick Injuries Zhao X (China)
Slide 2: Introduction Each year more than 1.5 million NSIs happen among Chinese HCWs, an average of 4410 NSIs per day Near 80 percent of health workers in China have experience of NSI 17.9 percent have more than 5 times needlestick injuries Resource from: http://www.nursing.net.cn
Slide 3: Risks of Needlestick Injuries as many as 20 different pathogens are capable of transmission from patients or laboratory specimen to healthcare workers (HCWs) in the event of a NSI. Of these 20 pathogens, HIV, HBV, and HCV are the three most common diseases transmitted via NSI. A single exposure to HIV, HBV, or HCV in the context of a NSI places a HCW at average risks of infection of 0.3%, 6% to 30%, and 1.8%, respectively (CDC 2004; NIOSH 2000).
Slide 4: Hepatitis B Virus (HBV) In America 12, 000 HBV infections occurred in HCWs in 1985 500 HBV infection occurred in HCW in 1997 Intervention implemented: widespread immunizations of American HCWs for HBV But, there is a 6%-30% risk that an exposed, susceptible HCWs will become infected with HBV.
Slide 5: Hepatitis C Virus ( H C V) The precise number of HCWs who acquire HCV occupationally is not known in China. In the United States, HCWs exposed to blood in the workplace represent 2% to 4% of the total new HCV infections occurring annually. One study in the United States show that HCV transmission occurred only from hollow-bore needles compared with other sharps.
Slide 6: Human Immunodeficiency Virus ( H I V) The first case of HIV transmission from a patient to a healthcare worker was reported in 1986 Through December 2001, American Central for Disease Control and Prevention (CDC) had received voluntary reports of 57 documented and 138 possible episodes of HIV transmission to HCW in USA The average risk of HIV transmission after a percutaneous exposure is estimated to be approximately 0.3%
Slide 7: Cost of Needlestick Injuries Cost Direct costs: initial and follow-up treatment of exposed HCWs (it is estimated to range from ￥ 4000-2,4000 depending on the treatment provided) Indirect cost Emotional cost (fear, anxiety) lost time from work, etc
Slide 8: Epidemiologic Homeostasis Host Environment Agent
Slide 9: Epidemiology of needlestick injury Who? Where? When? How?
Slide 10: Who is at risk of injury?
Slide 11: Where do injuries occur?
Slide 12: How do injuries occur?
Slide 13: What device are involved in percutaneous injuries? Disposal syringes (32%) Suture needles (19%) Winged steel needles (12%) Scalpel blades (7%) Intravenous (IV) catheter stylets (6%) Phlebotomy needles (3%)
Slide 14: Hollow-bore needles (59%) !!!
Slide 15: Importance of hollow-bore needle injuries NIOSH (2000) point out that the risk of infection for a HCW in the event of a NSI depends on his or her immune status at the time of injury the pathogen involved the severity of the injury (e.g. how much blood was the worker exposed to?) whether or not effective treatment is available
Slide 16: •Devices requiring manipulation or disassembly after use is associated with a higher rate of injury
Slide 17: Prevention Strategies Hierarchy for prevention of needlestick injury First: eliminate and reduce the use of needles where possible. Using alternate routes for medication delivery and vaccination when available and safe for patient care. Second: isolate the hazards. Provide a rigid cover that allows the hands to remain behind the needle. Ensure that the safety feature is in effect before disassembly and remains in effect after disposal Be an integral part of the device Be simple and obvious in operation
Slide 18: How can you prevent needlestick injuries? Handle hypodermic needles and other sharps minimally after use and use extreme care whenever sharps are handled or passed. Use the \"hands-free\" technique (described below) when passing sharps during clinical procedures. Do not bend, break, or cut hypodermic needles before disposal. Do not recap needles. Dispose of hypodermic needles and other sharps properly.
Slide 19: Recapping? Many accidental needlestick injuries occur when staff are recapping needles. Recapping is a dangerous practice: If at all possible, dispose of needles immediately without recapping them. If it does become necessary for you to recap a needle (for example, to avoid carrying an unprotected sharp when immediate disposal is not possible), do not bend or break the needle and do not remove a hypodermic needle from the syringe by hand.
Slide 20: Recapping: The \"one-hand\" technique Step 1 Place the cap on a flat surface, then remove your hand from the cap. Step 2 With one hand, hold the syringe and use the needle to \"scoop up\" the cap. Step 3 When the cap covers the needle completely, use the other
Slide 21: Handling sharps During a clinical procedure When passing sharps, especially when there is sudden motion by staff members carrying unprotected sharps when clients move suddenly during injections when sharps are left lying in areas where they are unexpected (such as on surgical drapes). Giving verbal announcements when passing sharps Avoiding hand-to-hand passage of sharp instruments by using a basin or neutral zone Ensuring cooperation from patients Dispose a contaminated needle immediately after use
Slide 22: Safe passing of sharp instruments Uncapped or otherwise unprotected sharps should never be passed directly from one person to another. In the operating theater or procedure room, pass sharp instruments in such a way that the surgeon and assistant are never touching the item at the same time. This way of passing sharps is known as the \"hands-free\" technique:
Slide 23: \"hands-free\" technique: First step: The assistant places the instrument in a sterile kidney basin or in a designated \"safe zone\" in the sterile field. Second step: The assistant tells the service provider that the instrument is in the kidney basin or safe zone. Third step: The service provider picks up the instrument, uses it, and returns it to the basin or safe zone.
Slide 24: When giving injections……… Unexpected client motion at the time of injection can lead to accidental needlestick injuries. Therefore, always warn clients when you are about to give them an injection. To protect clients, always use proper client preparation when giving an injection, and be sure that you handle IV fluids and multidose vials correctly.
Slide 25: If you are a head nurse in the unit, what you can do to prevent NSI? Educating your staff A reduction in the use of invasive procedures (as much as possible) A secure work environment An adequate staff-to-patient ratio
Slide 26: If you are a head nurse in the unit, what you can do to prevent NSI? Risk-taking personality profile Perceived poor safety climate in the workplace Perceived conflict of interest between providing optimal patient care and protecting staff themselves HCWs most readily change their risk behaviors when they thinks They are at risk The risk is significant Behavior change will make a difference The change is worth the effort
Slide 27: Introduction of safety devices Vanish point syringe Work principle How to use it appropriately Cost
Slide 28: Introduction of safety devices Sharps Container Work principle How to use it appropriately Cost
Slide 29: Post-exposure Treatment Source patient details Risk assessment Action plan Introduction of Nottingham Report Form Following Contamination from Blood or Body Fluids
Slide 30: Post-exposure treatment Available data from animal studies (Ferreiro & Sepkowitz 2001) indicated that systemic infection after a NSI does not occur immediately if antiviral therapy is delivered expeditiously, establishment of infection may be prevented. Therefore, If you are injured by contaminated needle, ensure effective treatment to be available as soon as possible
Slide 31: Useful information after exposure Disease Control and Prevention Center of Yannan Province Telephone number: 0871-3611773 (available: 8am-11am, 2:30pm-5:30pm) Health Education Institution of Yannan Province Telephone number: 0871-5377136 (available: 24hours) Disease Control and Prevention Center of Kunming Telephone number: 0871-4108357 (available: 8am-11am, 2:30pm-5:30pm)
Slide 32: Useful websites Disease Control and Prevention Center of the People’s Republic of China http://www.chinacdc.net.cn/n272442/n272530/index.html American Disease Control and Prevention Center (CDC) http://www.cdc.gov/ American Occupational Safety & Health Administration (OSHA) http://www.osha.gov/
Slide 33: DISCUSSION Share your experience of needlestick injuries Your experience might help others!
Slide 34: Thank you for listening!
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