Needlestick Injury and Sharp Injury Prevention

Introduction

A needlestick injury occurs when a needle or other sharp object accidentally punctures the skin, potentially exposing the individual to blood-borne pathogens such as HIV, hepatitis B (HBV), and hepatitis C (HCV). It’s a significant occupational hazard, especially for healthcare workers, lab technicians, and sanitation staff

Definition

A needlestick injury is a percutaneous piercing wound from a needle point, sharp instrument, or object.

Protocol for Needlestick or Sharp Injury

• Do not panic and do not ignore the exposure.
• Do not put the pricked finger in the mouth or squeeze.
• Do not use bleach, chlorine, alcohol, (povidone-iodine) or any antiseptic or detergent.
• Wash the site with soap and water immediately.
• The exposure should be assessed (type of fluid, type of needle, amount of blood on the needle, reviewing the patient’s record for serology, immunosuppressive condition, etc.).
• Report the incident to the head nurse or to the HICC department and to the medical officer.
• An Exposure Report Sheet should be completed.
• The exposure source should be evaluated, where the information pertaining to the patient must be mentioned:
• Status of the patient.
• Consent and testing of the patient for these diseases if the status is unknown.
• Evaluation of the exposed person’s status for HIV, HCV, and HBV antibodies.
• Start post-exposure prophylaxis (PEP) as soon as possible.
• Re-evaluate the exposed individual within 72 hours.
• Check the status of the source.

HIV

• If the source is determined to be HIV negative, PEP (ART drug regimen) can be discontinued.
• If the source is determined to be HIV positive, continue treatment for 4 weeks if tolerated.
• The exposed person should undergo HIV antibody testing at 0, 6, 12, and 24 weeks irrespective of the status of the index patient. If the test at 6 months is negative, no further testing is recommended.

HBV

• If the source is determined to be HBV negative, PEP can be discontinued.
• If antibodies present are more than 100 IU/L, no PEP is required.
• If antibodies are nil, a booster dose of hepatitis B immunoglobulin + HBV vaccine booster dose is given.

HCV

• If the source is determined to be negative, stop PEP.
• If the source is anti-HCV antibody positive, HCV core Ag (HCV Ag) and HCV RNA is detected (presence of HCV Ag and HCV RNA indicates a high viral load and the patient has HCV infection), start pegylated interferon plus ribavirin therapy.
• Re-evaluate the exposed person after 1 month, and then after 3 months.
• If the exposed person’s HBV and HCV are negative, document in the Hospital Health Record.

Key Prevention Strategies

1. Use Safety-Engineered Devices
   • Utilize needleless systems and retractable needles to minimize exposure.
   • Ensure proper training on safe device usage.
2. Proper Handling & Disposal
   • Never recap needles—use designated sharps containers.
   • Dispose of sharps immediately after use in puncture-resistant containers.
3. Follow Safe Work Practices
   • Plan procedures to minimize handling of sharps.
   • Avoid rushing and maintain awareness of surroundings.
4. Wear Personal Protective Equipment (PPE)
   • Use gloves, face shields, and gowns when handling sharps.
   • Ensure PPE is readily available in all clinical areas.
5. Undergo Proper Training
   • Regular education sessions on sharps safety.
   • Encourage reporting of near misses to improve protocols.
6. Report & Address Needlestick Hazards
   • Establish a bloodborne pathogen control program.
   • Investigate all sharps-related injuries to prevent recurrence.
7. Get Vaccinated
   • Ensure hepatitis B vaccination for all healthcare workers.
   • Follow post-exposure prophylaxis (PEP) protocols if needed.
8. Follow Post-Exposure Protocols
   • Wash needlestick injuries immediately with soap and water.
   • Flush splashes to the nose, mouth, or skin with water.
   • Irrigate eyes with sterile solutions.
   • Report the incident and seek medical evaluation promptly.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

Connect with “Nurses Lab Editorial Team”

I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.