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Dr Paul Grime MBChB MSc MRCPI MFOM Chair, Safer Needles Network UK Consultant/Honorary Senior Lecturer in Occupational M

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

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Dr Paul Grime MBChB MSc MRCPI MFOM Chair, Safer Needles Network UK Consultant/Honorary Senior Lecturer in Occupational M

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

  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. Network’s Objective In January 2005, NHS Employers issued national guidance to reduce the risk needlestick injuries and for their prevention and management. The Network’s 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: Implementing 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. HCV 48% HIV 24% HBV 9% Percutaneous 78% Nurses 45% Doctors 37% 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

  11. 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 • 58% during procedure • 37% after procedure, before disposal or during/after disposal

  12. HIV UK: 5 definite since 1984 (4 have died) 12 probable World: 102 definite 217 probable HCV UK: 9 definite since 1997 World: 78+? Reported transmissions

  13. Prevention: Safe Systems of Work • Standard (Universal) Precautions • Don’t re-sheath • Don’t pass hand to hand • Dispose of sharps at point of use

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

  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 • www.pasa.nhs.uk

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

  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 Consider safer systems of work to prevent further incidents • Report: • HPA CFI • RIDDOR 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

  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

  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 Consider safer systems of work to prevent further incidents • Report: • HPA CFI • RIDDOR 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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