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INOCULATION
INJURIES
A Training Pack for Health Care
Professionals
Sponsored by Daniels Healthcare
Issue 1 October 1999
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INOCULATION INJURIES
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Minimizing the risk
Prevention Strategies
Treatment Protocols
Paul Hateley
Lead Nurse
Infection Control
St. Bartholomew’s Hospital
London
Rona McMillan
Clinical Nurse Specialist
Infection Control
St. Bartholomew’s Hospital
London
MINIMISING
THE
RISK
Every employee has a legal responsibility under the Health
and Safety at Work Act (1974), to take care of both their
own and others Health and Safety.
All health care workers have a legal requirement to
identify the hazards and assess the risks relevant to Health
and Safety.
Identified risks must be reduced as far as is reasonably
practical by introducing suitable safety measures.
Health and Safety at Work Act,(1974)
THE RISKS
Contaminated blood / body
stained fluid
• Through skin
• Onto broken skin
• Onto mucous membranes
Body fluids that may contain
HIV and/or Hepatitis B and/or C
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Blood
Blood stained body fluids
Semen
Vaginal secretions
Tissues
CSF, amniotic, pericardial, pleural fluids
Body fluids that are unlikely to contain
pathogenic organisms:
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Tears
Nasal secretions
Sweat
Saliva
What is risk assessment?
Assessment of the risk to the
health and safety of employees
to which they are exposed
while at work
For risk assessments to be
effective they need to be:
• Systematic
• An ongoing process monitoring,
reviewing and modifying
Assess body fluid risk of
task to be undertaken
No risk of splashing
No protective clothing
Blood/blood stained
body fluid but low
risk of splashing
Disposable gloves & aprons
Blood/blood stained
body fluid and high
risk of splashing
Gloves, waterproof gown & eye
protection
(Adapted from EAGA 1998)
When undertaking
risk assessment:
• Identify hazards / risks
Acts / regulations that must be complied with
will help identify hazards
• Evaluate extent hazards / risks
Take into account existing control measures
• Assess the population of staff affected and
consequence of the risks
• Risk assessment must be recorded
Occupational transmission of infection to
health care workers
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Through skin
Onto broken skin
Onto mucous membranes
Direct contact with infective material
By droplet spread
Risk of health care workers acquiring HIV
and HBV occupationally
• HIV
0.37%
• HBV
20 - 40%
following exposure to contaminated blood
(Alder, 1997)
HIV Transmission:
Global summary, June 1996
Type of exposure
Blood transfusion
Perinatal
Sexual intercourse
vaginal
anal
Injecting drug use (sharing works etc)
Heath care (inoculation injury etc)
% of global total
3-5
5-10
70-80
60-70
5-10
5-10
<0.01
(Friedman Kien AE, Cockerell CJ 1997)
Prevention
Strategies
Sharps safety
Prevention of inoculation injury
• Never re-sheath used needles
• Take a sharps container with you and
dispose of sharps at the point of use
• Never fill a sharps bin to more than 75% of
its capacity
• Ensure you take responsibility for your own
sharps
Body substance isolation
(BSI)
Devised by Lynch and Jackson in 1984
Purpose of BSI
• Reduce risk of cross-infection to patients
• Protect health care workers from acquiring infections
occupationally
• Simplify infection control procedures
• reduce cost of the prevention of hospital acquired
infections
(Jackson & Lynch, 1992)
Basic elements of BSI
• Gloves are worn for anticipated contact with body
substances (blood, urine, faeces, wound drainage etc). To
be put on just before contact with body substances
• Protect clothing if soiling with body substances is
anticipated
• Eye and face protection as appropriate
• handwashing
• Careful use and disposal of sharps
• Waste contaminated with body substances segregated as
clinical waste
In addition
• All specimens categorised the same way
• All linen is treated the same way
Conclusion
• BSI effective infection control strategy
• Senior management support required
for successful implementation
• Multidisciplinary agreement
• Ongoing education
• Compliance studies / audits
Treatment
Protocols
Inoculation injury
Prevention is better than cure
Should an injury occur:
• Encourage bleeding / irrigation
• OHD / Virologist
• Hepatitis B status
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vaccine
immunoglobin
No Hepatitis C vaccine
Serum storage (Hep B, C and HIV)
Staff? Test later
Patient - if known - ? Test with ‘informed’ consent
Report incident / documentation
Prophylactic therapy
Dual / triple
• High risk - double
• Known HIV - triple
• Pregnancy - mono only
Drug regimens
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AZT - zidovudine
3TC - Lamivudine
Indinavir
AZT - pregnancy second and third trimester
- no foetal damage
Drug therapies
Triple therapy suppresses the viral
load, thus increases the CD4 count.
Lamivudine is not recommended for
monotherapy
Side effects
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Rare in short courses
Dose related
Nausea / vomiting
Fever
Myalgia
Fatigue
Anaemia
Leucopenia
Parasthesia
Insomnia
Rashes
Understand
the
options
and
decide
beforehand!