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Wednesday, November 7, 2007

Nursing Reference: Prevention Of Needlestick Injury Among Chinese Nurses

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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:

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  American Disease Control and Prevention Center (CDC)   American Occupational Safety & Health Administration  (OSHA) 

Slide 33: DISCUSSION Share your experience of needlestick injuries  Your experience might help others! 

Slide 34: Thank you for listening!

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