Needlestick/Sharps Injury and Disposal of Sharps Procedures

The University recognises its legal obligation to provide a safe work environment and that the risk of injury from sharp implements requires specific management and control. For the purpose of this policy, ‘sharps’ includes, syringes, needles, scalpels, razor blades, broken glass or any other sharp implement with the potential to cause a penetrating injury if not handled in a safe manner. Sharps are commonly used during research, undergraduate teaching and in clinical practice.

Sharps can potentially be contaminated with many different types of micro-organisms and whilst the risk from blood borne viruses e.g. Human immunodeficiency viruses (HIV), and Hepatitis B and C is generally well known, there are many other micro-organisms that are found in contaminants such as blood, faeces, sewerage, human or animal secretions. Therefore all sharps unless their origin is known, should be treated as contaminated.

Procedures/Guidelines

1.1 Disposal of sharps – Research and Teaching Areas

Work practices and the means for safe disposal of sharps is the responsibility of each Faculty or work area. Managers and supervisors have a responsibility for informing staff and students on these procedures.
Needles should not be resheathed, unless an appropriate re-capping device is available.         
Sharps (needles, scalpel blades, razor blades) are to be disposed of into approved impermeable sharps containers designated for the disposal of sharps. The containers must comply with AS/NZS 4261 eg. BUNZLE (needles only), or SHARPSAFE types and display the biohazard symbol.
Sharps containers must only be filled to 3/4 level or to the manufacturer's instruction.

1.2 Disposal of sharps found in non-teaching/clinical areas

If a ‘sharp’ is found on the campus, such as in grounds or ablution blocks then phone Security immediately, advising them of the location of the item.
Security phone: -  3020
Security staff carry 'sharps' disposal containers in their vehicles.  Do not pick up the 'sharps' item.  If the source of the broken glass or other sharp objects is not known,  assume that it could potentially be contaminated and call Security.
If you definitely know that the broken glass object is not contaminated it can be picked up by avoiding contact with the skin - use paper or a dustpan and brush. The glass or sharp object should be double wrapped carefully in paper and disposed of immediately.

2.0 Dealing with a 'needlestick or sharps' injury

Please note that a person who has an open wound/s is at greater risk from infectious agents.

If a person sustains a ‘needlestick/sharps’ injury: -

• Remove contaminated clothing
• Wash the injured area thoroughly with soap and water.  If the eye/s are involved, rinse with running water or saline
• Administer appropriate first aid for any bleeding or embedded object. Gain assistance from a first aid attendant as required
• Identify the source individual or the source of the sharp if possible and assess the risk status of the source individual
• All staff and students who sustain a sharps injury in which there is any risk of contamination must either attend the University Medical Centre or a General Practitioner for assessment, advice and if necessary counselling
• If a source individual is identified, they should be strongly encouraged to undergo blood testing
• Report the incident to your supervisor and complete a Confidential Needlestick/Sharps Injury or Exposure to Body Fluid Report Form as soon as practicable
• After hours – follow the above procedure, if needing assistance dial the emergency number 6488 2222.

Exposure Classifications and Risk Factors:

• The General Practitioner will assess the level of risk to determine further medical management. Please refer to Appendices 1 and 2. Advice is also available from The Needlestick Hotline on 1800 804 823.
• In the case of massive, definite or possible parenteral exposure, the health status of the source individual should be investigated. If the status of the source individual is unknown, the following blood tests should be undertaken from the source following appropriate counselling: HIV antibody, Hepatitis B surface Antigen and Hepatitis C antibody. Testing should not be performed if consent is refused
• The recipient should be assessed and examined to confirm the nature and seriousness of the exposure and counselled about the possibility of transmission of a blood-borne virus.
• Treatment for an exposure to possible or definite HIV, should commence as soon as possible after exposure. Immediate advice should be sought from the Immunology staff at Royal Perth Hospital, Sir Charles Gairdner Hospital or Infectious Diseases staff at Fremantle Hospital.
• Management of exposure to definite or possible Hepatitis B is dependant upon whether the recipient has been previously vaccinated for Hepatitis B or been previously infected with it. When the recipient has not been previously infected and is not immune, Hepatitis B immunoglobulin should be given within 72 hours of injury. Hepatitis B vaccination should also be commenced.
•  If the source is unable to be identified, follow up will depend on the type of exposure, the likelihood of the source being positive for a blood pathogen and the prevalence of blood borne infections in the community from which the needles or instruments come.
• The risk of tetanus should also be determined as the person may require either tetanus immunoglobulin, a course of adult diphtheria and tetanus (ADT) or an ADT booster.

Coverage for medical expenses:

Staff who sustain a ‘sharps injury’ from a contaminated or potentially contaminated source whilst undertaking work related duties, will be asked to lodge a workers’ compensation application to enable medical bills to be paid.  For injured students, either partial or full costs may be recoverable from Medicare. Refer Group Personal Accident Plan.  For further enquiries, please contact the Safety and Health on  6488 3938.

References

National Occupational Health and Safety Commission, National Code of Practice for the Control of Work-related Exposure to Hepatitis and HIV (Blood-borne) Viruses [NOHSC:2010 (2003) ].

Disease Control, Health Department of WA.  A management plan for medical practitioners for patients with HIV/AIDS in WA.  Produced by Disease Control with assistance from Health Promotion Services, HDWA.  1995.

Health Department of Western Australia, Sharps Injury and Body Substance Exposure Protocol, Operational Instruction, September 2000.

National Health and Medical Research Council. The Australian Immunisation Handbook, 9th Edition, 2008.

http://www.immunise.health.gov.au/

Appendix 1

EXPOSURE CLASSIFICATIONS

Non-Parenteral Exposure

• Intact skin visibly contaminated with blood or body fluid.

Doubtful Parenteral Exposure

• Intradermal (superficial) injury with a needle considered not to be contaminated with human blood or body fluid.
• A superficial wound not associated with visible bleeding produced by an instrument considered not to be contaminated with blood or body fluid.
• Prior wound or skin lesion contaminated with a body fluid other than blood and with no trace of blood, e.g. urine.

Possible Parenteral Exposure

• Intradermal (superficial) injury with a needle suspected as contaminated with human blood or body fluid.
• A wound not associated with visible bleeding produced by an instrument suspected as contaminated with human blood or body fluid.
• Prior (not fresh) wound or skin lesion suspected as contaminated with human blood or body fluid.
• Mucous membrane or conjunctival contact with human blood.

Definite Parenteral Exposure

• Skin penetration injury with a needle contaminated with human blood or body fluid.
• Injection of blood/body fluid not included under “massive exposure”.
• Laceration or similar wound which caused bleeding and is produced by an instrument that is visibly contaminated with blood or body fluid.
• In laboratory setting, any direct inoculation with human immunodeficiency virus tissue or material likely to contain HIV, Hepatitis B virus or Hepatitis C virus not included above.

Massive Exposure

• Transfusion of contaminated blood – not likely in Australia due to screening.
• Injection of large volume (> 1ml) of blood/body fluids.
• Parental exposure to laboratory specimens containing high titre of virus.

Appendix 2

Pre-Test Counselling Information Sheet

The purpose of pre and post test counselling is to fully inform the staff member of the psychological, legal and social implications of the possible outcomes of being tested for blood borne viruses.
These are what the affected person should understand:

What the HIV Antibody Test Means

• The HIV antibody test detects the antibody response to HIV following infection.  Seroconversion occurs in patients who have been exposed within six weeks to eight weeks, and virtually all patients are positive at six months.  Therefore appropriate retesting should be arranged at 6 weeks, 3 months and 6 months post exposure and understood in the pre-test counselling session.
• Following infection and HIV antibody positivity the patient may remain asymptomatic for several years.  During this time a predictable derangement of immune function occurs.
• AIDS as defined by opportunistic infection, malignancy or neurological disorders is a late manifestation of the immune deficiency. 

Hepatitis B and Hepatitis C Testing

• Hepatitis B and Hepatitis C can have a window period of four to six months from initial infection.  If testing is conducted during the window period a false negative may be obtained.  Repeat testing is therefore recommended at three and six months.
• If you have been Hepatitis B immunised, and baseline serology confirmed immunity (>10 IU/ml), then no further testing is required for Hepatitis B Virus (HBV).  It is no longer recommended that Hepatitis B booster vaccinations be given every 5 years.

What a positive result means in regard to:

Medical Aspects

• HIV, Hepatitis B and Hepatitis C antibody positive affected persons will be referred to a physician with expertise in HIV and Hepatitis medicine.  You will also be offered access to all available therapies for HIV and Hepatitis B infections.  In the case of Occupational Exposure, the recipient will be referred to a specialist physician.

Psychological Aspects

• It is important to anticipate how a patient is likely to react in the event of a positive HIV, Hepatitis B, Hepatitis C antibody test.  Adequate time and the correct setting should be planned to discuss the results of HIV, Hepatitis B and Hepatitis C antibody test, whether positive or negative.
• Therefore it is mandatory that no results, positive or negative will be given over the telephone or through an intermediary.  Results will be given face to face by appointment only.

Notification Requirements

• If the test is positive, the law requires that a notification be submitted to the Commissioner of Health.  If the patient is asymptomatic, then the notification is done by code using the first two letters of the first name and surname, date of birth, occupation and includes the status of the disease and possible mode of acquisition.  However, if the patient is AIDS-positive, the patient is to be notified by full name and address.  This information is used for epidemiological purposes and is maintained in the strictest confidence.

Social Aspects

• You need to know that there may be implications for your work, family, sexual activity, blood donation, etc.
• Insurance companies may ask if HIV antibody tests have been performed and if so, may request results of those tests.  Some insurance companies may take the performance of an HIV antibody test as evidence that the person has been at risk.

What a Negative Result Means

• A negative result indicates that the body has not made an antibody response to the HIV, Hepatitis B, or Hepatitis C virus.  It is important to emphasise that if you have recently been at risk the antibody test needs to be repeated at three and six months.  Subsequent testing should be guided by the possible risks that may be present.

Preventative Aspects

• HIV and  Hepatitis B are spread primarily through blood-to-blood contact, sexual intercourse, and vertically from mother-to-baby.  Risk factors must be assessed and modification of lifestyle implemented to reduce the risk.