Needlestick Injury + Prevention Info

[NRSKarenRN, BSN, RN]

needle-stick guideline: emedicine emergency medicine

the need for hiv or chemoprophylaxis (antiretrovirals) is based on an assessment of the risk by using the 3-step process developed by the centers for disease control and prevention (cdc).[color=#004276]5

• step 1: determine exposure code.
  
  • is the source material blood, bloody fluid, other potentially infectious material, or an instrument contaminated with one of these substances? if not, there is no risk of hiv transmission? if yes, what type of exposure occurred?
    
  • if the exposure was to intact skin only, there is no risk of hiv transmission.
    
  • if the exposure was to mucous membrane or integrity-compromised skin, was the volume of fluid small (ie, few drops, short duration) or large (ie, several drops or major splash, long duration)? if small, the category is exposure code 1. if large, the category is exposure code 2.
    
  • if the exposure was percutaneous, was it a solid needle or a superficial scratch (ie, less severe)? if yes, the category is exposure code 2.
    
  • was it from a large-bore hollow needle, a device with visible blood, or a needle used in a source patient's artery or vein (ie, more severe)? if yes, the category is exposure code 3.
    

  [*]step 2: determine hiv status code.

  • what is the hiv status of the exposure source? if hiv negative, no postexposure prophylaxis is needed. if hiv positive, was the exposure low titer or high titer? low-titer exposures are asymptomatic patients with high cd4 counts: these are hiv status code 1. high-titer exposures are patients with primary hiv infection, high or increasing viral load or low cd4 counts, or advanced acquired immunodeficiency syndrome (aids): these are hiv status code 2. if hiv status is unknown or the source is unknown, the hiv status code is unknown.
    

  [*]step 3: match exposure code with hiv status code to determine if any postexposure prophylaxis is indicated.

  • postexposure prophylaxis recommendation
    
    • exposure code 1 and hiv status code 1: postexposure prophylaxis may not be warranted. exposure type does not pose a known risk. the exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of postexposure prophylaxis.
      
    • exposure code 1 and hiv status code 2: consider the basic regimen. exposure type poses a negligible risk for hiv transmission. a high hiv titer in the source may justify consideration of postexposure prophylaxis. the exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of postexposure prophylaxis.
      
    • exposure code 2 and hiv status code 1: recommend the basic regimen. most hiv exposures are in this category. no increased risk for hiv transmission has been observed, but use of postexposure prophylaxis is appropriate.
      
    • exposure code 2 and hiv status code 2: recommend expanded regimen. exposure type represents an increased hiv transmission risk.
      
    • exposure code 3 and hiv status code 1 or 2: recommend expanded regimen. exposure type represents an increased hiv transmission risk.
      
    • hiv status code unknown: if the source or, in the case of an unknown source, the setting where the exposure occurred suggests possible risk for hiv exposure and the exposure code is 2 or 3, consider the postexposure prophylaxis basic regimen.
      

ana backgrounder: needlestick and sharps injuries [pdf]

ana: safe needles save lives

[color=#1111cc]ana needlestick prevention guide [pdf] - ana needlestick guide v5

canada: osh answers: needlestick injuries

osha: safety and health topics: bloodborne pathogens and needlestick ...

osha's bloodborne pathogen standard (29 cfr 1910.1030)

in 2000, the bbp standard was amended to include the needlestick safety and prevention act which additionally required employers to use or provide safer devices and engineering controls, document nsi in a separate injury log--in addition to the osha 300 log, and involve frontline employees in device evaluation and selection

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osha's needlestick prevention act

osha/infection control annual update training - 2008

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pamphlet prevent needlestick injuries

[P_RN, ADN, RN]

Excellent Karen.