Balaji Hospital, Jodhpur

Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

1. Policy
Healthcare personnel are at risk for occupational exposure to blood borne pathogens, including Hepatitis
B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV). Exposures occur
through needle sticks or cuts from other sharp instruments contaminated with an infected patient's blood
or through contact of the eye, nose, mouth, or skin with a patient's blood. Important factors that influence
the overall risk for occupational exposures to blood borne pathogens include the number of infected
individuals in the patient population and the type and number of blood contacts. Most exposures do not
result in infection.

2. Purpose
To have in place a system for reporting exposures in order to quickly evaluate the risk of infection,
inform about treatments available to help prevent infection, monitor for side effects of treatments, and
determine if infection occurs. This may involve testing blood and offering appropriate post exposure
treatment.

3. Definition
Nil

4. Abbreviation
HBV Hepatitis B Virus

HCV Hepatitis C Virus

HIV Human Immunodeficiency Virus

5. Scope
Hospital Wide

6. Responsibility
Doctors, Nurses, Infection Control Nurse, Infection Control Team, Infection Control Committee

7. Distribution
Hospital Wide
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

8. Procedure

8.1 RISK OF INFECTION AFTER EXPOSURE

HBV

Healthcare personnel who have received Hepatitis B vaccine and developed immunity to the virus are at
virtually no risk for infection. For a susceptible person, the risk from a Single needle stick or cut
exposure to HBV-infected blood ranges from 6-30% and depends on the Hepatitis B ‘e’ antigen (HBeAg)
status of the source individual.

HCV

The average risk for infection after a needle sticks or cut exposure to HCV infected blood is
approximately 1.8%. The risk following a blood exposure to the eye, nose or mouth is unknown, but is
believed to be very small. However, HCV infection from blood splash to the eye has been reported.

HIV

The average risk of HIV infection after a needle stick or cut exposure to HIV-infected blood is 0.3%. The
risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be on average, 0.1%.
The risk after exposure of non-intact skin to HIV-infected blood is estimated to be less than 0.1%.

8.2 MANAGEMENT OF BLOOD & BODY FLUID EXPOSURE

1) Immediately following an exposure to blood:
a. Wash needle sticks and cuts with soap and water
b. Flush splashes to the nose, mouth, or skin with water
c. Irrigate eyes with clean water, saline, or sterile irritants
d. No scientific evidence shows that using antiseptics or squeezing the wound will reduce the
risk of transmission of a blood borne pathogen. Using a caustic agent such as bleach is not
recommended.
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

2) Report the exposure to the immediate Supervisor/HOD & Infection control department within
24hrs of exposure. Prompt reporting is essential because, in some cases, post exposure treatment
may be recommended and it should be started as soon as possible. If exposure occurs on:
a. Working days, report to Infection Control*.
b. Other times – report to Nursing Supervisor on duty. The Nursing Supervisor should hand
over the exposure details to Infection Control dept. on the next working day.
c. *While reporting, remember to bring the details of source patient.
3) Determine risk associated with exposure by
a. Type of fluid (e.g., blood, visibly bloody fluid, other potentially infectious fluid/tissue)
b. Type of exposure (i.e., percutaneous injury, mucous membrane or non-intact skin
exposure)
4) Evaluate exposure source
a. Assess the risk of infection using available information
b. Test known sources for HBsAg, anti-HCV & HIV antibody (consider rapid testing)
c. For unknown sources, assess risk of exposure to HBV, HCV or HIV infection
5) Evaluate the exposed person
a. Assess immune status for HBV infection
6) Post-exposure management for HBV
Vaccination & HBsAg positive Source Source
antibody response
HBsAg negative Unknown or not
status of exposed
available for testing
workers

Unvaccinated HBIG y x 1 & Initiate Hepatitis B Initiate Hepatitis B

initiate HB vaccine series vaccine series
Vaccine series

Previously vaccinated

Known responder # No treatment No treatment No treatment

Known non responder HBIG x 1 and No treatment If known high-risk

 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

## initiate source, treat as if source

revaccination or were HBsAg +ve

HBIG x 2 Ï

Antibody response Test exposed No treatment Test exposed person for

unknown person for anti- anti-HBs
HBs
1. If adequate no
1. If adequate*no treatment is necessary.
treatment is
2. If inadequate,
necessary.
administer vaccine
2. If inadequate**, booster and recheck titre
in 1-2 months.
administer HBIG x
1 and vaccine
booster.

y Hepatitis B immuno globulin; dose is 0.06 mL/kg intramuscularly.

# A responder is a person with adequate levels of serum antibody to HBsAg

## A non-responder is a person with inadequate levels of serum antibody to HBsAg

Ï The option of giving one dose of HBIG and reinitiating the vaccine series is preferred for non-
responders who have not completed a second 3 dose vaccine series. For persons who previously
completed a second vaccine series but failed to respond 2 doses of HBIG are preferred.

(Source: CDC Guidelines, MMWR Sept 30, 2005/54(RR9);1-13).

7) Post-exposure management for HCV

 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

a. Perform baseline and follow-up testing for anti-HCV and Alanine Amino Transferase
(ALT) 4-6 months after exposure.
b. Perform HCV RNA at 4-6 weeks if earlier diagnosis of HCV infection desired.
c. Confirm repeatedly reactive anti-HCV enzyme immunoassays (EIAs) with supplemental
tests.
8) Post-exposure management for HIV
a. Perform HIV antibody testing for at least 6 months post exposure (e.g., at baseline, 6
weeks, 3months, and 6 months)
b. Perform HIV antibody testing if illness compatible with an acute retroviral syndrome
occurs.
c. Evaluate exposed persons taking PEP within 72 hrs. after exposure and monitor for drug
toxicity for at least 2 weeks.

8.3 TREATMENT FOR THE EXPOSURE

HBV

All healthcare personnel who have a reasonable chance of exposure to blood or body fluids should
receive Hepatitis B vaccine. Vaccination ideally should occur during the healthcare worker’s joining time.
Workers should be tested 1-2 months after the vaccine series is complete to make sure that vaccination
has provided immunity to HBV infection. If unvaccinated, then Hepatitis B vaccination is recommended
for any exposure regardless of the source person’s HBV status. HBIG and/or Hepatitis B vaccine may be
recommended depending on the source person’s infection status, HCW’S vaccination status and, if
vaccinated, HCW’S response to the vaccine.

HCV

There is no vaccine against hepatitis C. IG and antiviral agents are not recommended for Post Exposure
Prophylaxis (PEP) after exposure to HCV. In addition no guidelines exist for administration of therapy
during the acute phase of HCV infection. However, limited data from literature suggest that antiviral
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

therapy (Interferon or PegIFN+/-Ribavirin) might be beneficial when started early in the course of HCV
infection. When HCV infection is identified early, the person should be referred for medical management
to a specialist knowledgeable in this area.

HIV

There is no vaccine against HIV. PEP (Zidovudine, Lamivudine, Indinavir) is recommended for certain
occupational exposures that pose a risk of transmission.

CDC recommends a 4-week course of a combination of either two-antiretroviral drugs for most HIV
exposures, or three antiretroviral drugs for exposures that may pose a greater risk for transmitting HIV
(such as those involving a larger volume of blood with a larger amount of HIV or a concern about drug-
resistant HIV). These recommendations are intended to provide guidance to clinicians and may be
modified on a case-by-case basis.

8.4 PREVENTION OF OCCUPATIONAL INFECTIONS WITH HBV, HCV, HIV

Hepatitis B virus is largely preventable through vaccination. For HBV, HCV, and HIV, however,
preventing occupational exposures to blood can prevent occupational infections with HBV, HCV, and
HIV. This includes using appropriate barriers such as gown, gloves and eye protection as appropriate,
safely handling needles and other sharp instruments, and using devices with safety features.
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

Start

FO-INFD-001
Blood and Body Fluid Exposure

Wash the exposed site immediatly and inform to immediate

HCW supervisor and infection control department as soon as
possible (within 24hrs of exposure)

ICN Risk assesment and documentation

Blood and Body fluid

Follow up exposure form

Whether
Suspected HCV/ Yes A
HIV

No

Source HB Source Initiate

Whether
+ve/ Source HB -ve/ Yes vaccination
Yes HCW No No
Unknown HB +ve Unknown series
vaccinated

Yes No

* HBIGX1 and initiate

Yes Anti HBS testing HB vaccine series
* Hepatitis B
Immunoglobulin
.06ml/kg
intramuscularly

<10 ml * HBIG X1 and vaccine

Yes booster
U/mL

No Anti-HBs testing
No (1-2 months)

Follow -up Discontinued

End
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

Source Source
HCV +ve HIV +ve

Yes Yes

HIV ab testing: HCW [Baseline] Zidovudine,

HCW: Start PEP for 1 month Lamivudine
Anti HCV ,ALT[ Baseline,4-6 ( with in 24 hrs of exposure) & Indinavir
months] HCV-RNA [4-6 wks]

HCW:
Anti HCV HIV Ab testing
+Ve (6 weeks, 3 months, 6 months)

Yes HIV +Ve

Interferon
Start PEP and No
Ribavirin
No

Yes

Counselling,
No
Follow up as necessary No

End
8.5
NEEDLE STICK INJURY PROTOCOL
Needle stick injuries are as a result of following:

 Unsafe injection practices

 During mutilation
 During recapping of needles
 During suturing
 Movement of patient
 Collection & Transportation of Biomedical Waste or through accidental prick from needles fallen on floor
Steps to be followed after the prick (First Aid)

 Remove the offending needle immediately

 Encourage the wound to bleed as much as possible as this will “Wash out” a certain number of
microorganisms. Squeezing the affected area can help this.
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

 Wash the part with soap and water immediately

 Apply antiseptic hand rub
 Apply sterile water proof dressing
The above-mentioned 5 steps are to be followed for all the cases. Further if the needle was used for a
patient inform immediately to Shift in charge and during emergency hours directly to ICN / Nursing
Supervisor.

Infection control Nurse shall assess that needle stick injury is percutaneous or mucocutaneous

Kindly refer the attached procedural steps (reporting form) for the reporting of the needle stick injury.

Reporting of the all Needle stick injury data shall be done through infection control nurse on monthly
basis to relevant committees.

Staff handling bio-medical waste shall be provided with personal protective equipment (PPE), for
example, gloves and masks, protective glasses, gowns, etc. The staff shall use PPE while handling the

waste.
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury

REPORT THE INCIDENT

In all healthcare settings, an occupational exposure must be reported without delay:

 Report immediately to the duty manager responsible for the area in

which the incident occurred (i.e. Nurse in charge or duty Departmental
Manager). If the source patient is known, you must provide the source
patient details and location when reporting the incident.
 Then report to Occupational Health (or A & E if out of hours) as soon as possible
and within the hour. (Contact details below). In hours: attend or telephone ICN;
out of hours: attend A & E. If the source patient is known, bring the source
patient details with you when reporting.
WORKING HOURS ATTEND OR PHONE OCCUPATIONAL HEALTH

Mon – Sunday Tel No.- 09461383171, 0291-2713000

OUTSIDE NORMAL HOURS ATTEND ACCIDENT & EMERGENCY

Complete an Accident/Incident form as soon as
possible after the incident

9.References
CDC Guidelines

10. Records and Formats

NEEDLE STICK INJURY FORM

 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury
 Balaji Hospital, Jodhpur
Issue No: 01
Balaji/HIC/01/00 Issue date:
Revision No: - 00
Revision date: - 00
Policy for Needle stick injury