Sharps Injuries

The dental practice is required to have a written policy for the management of sharps.

Management Of Blood Borne Virus Infections From Sharps

Body fluid exposure incidents include sharps injuries, such as lacerations and puncture wounds, and splashes/splatter of body fluids to non-intact skin, eyes, mouth and mucous membranes.#

Such incidents carry the risk of exposure and potential infection with blood borne viruses for example HIV, Hepatitis B (HBV) and Hepatitis C (HCV).

Most needle stick injuries are sustained during re-sheathing, dismantling and disposal of the needle. These are considered avoidable with good practice such as the use of sharps safe devices, avoidance of re-sheathing of needles and careful disposal of sharps.

Guidance on safe use of sharps is covered in “The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013” that came into force in May 2013. The regulations also introduced a duty on healthcare workers to promptly report any sharps injury to their employer.

Post Exposure Prophylaxis (PEP)

If the risk assessment of the injury indicates there is likelihood of exposure to one the blood borne viruses then post exposure prophylaxis (PEP) is administered. This is performed by the occupational health service or local Accident Emergency Department.

The arrangements for PEP are outlined below:

  • Hepatitis B Post Exposure Prophylaxis: HBV prophylaxis involves a booster HBV vaccine. Staff who are vaccine non-responders are offered (HBIG) immunoglobulin. HBV PEP should be administered preferably within 48 hours, but prophylaxis can be prescribed up to one week later.
  • HCV Exposure Management: At the present time there is no effective prophylaxis or vaccine available against Hepatitis C. Blood samples are taken from the healthcare worker at baseline, 6, 12 and 24 weeks post the injury and analysed for evidence of infection with HCV (seroconversion). If the person becomes infected they are offered antiviral drug treatment to clear the virus.
  • HIV post Exposure Prophylaxis (PEP): PEP will not be offered if the source case is HIV negative, or following a risk assessment that indicates the risk of HIV infection is unlikely. Blood from an HIV positive source coming into contact with intact skin does not pose a risk for transmission of infection.

If HIV PEP is required ideally it should be given within 1 hour to achieve maximum preventive benefits but it may still offer a degree of protection if given within 72 hours. The healthcare worker is normally recommended to commence on a starter pack of HIV PEP drugs. Most hospital laboratories should have the capacity to provide a source patient HIV test result within 8 to 24 hours. In cases were the source patient is found to be uninfected, the HCW can then stop the PEP drugs.

If the source patient is found to be infected with HIV, then the HCW should complete the full 28 days course of PEP drugs. They are then followed up for a minimum of 12 weeks with blood tests to check that the prophylaxis has been effective and they have not developed HIV infection.

What To Do In The Event Of A Sharps Injury

The dental practice is required to have a written policy for the management of sharps, and significant splashes into the eye or on broken skin.

 


Encourage Bleeding: Do NOT suck the wound.


Wash the wound with plenty of soap and running water, do not scrub.


Dry the wound and cover with a waterproof dressing


Report


Check patients medical history


Contact Occupational Health


Complete accident report

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