Health Care Worker Needlestick Protocol
 

Health Care Worker needlestick injuries are an unfortunate reality.  Accidental exposure to blood from a used needle requires a follow-up protocol for the protection of the Health Care Worker as well as the Employer.
 
Infections that may be acquired from exposure to blood and body fluids are Hepatitis B, Hepatitis C, and the Aids Virus (HIV.)  The risk of actual infection is dependant upon the health status of the source as well as the type and severity of the exposure.  The overall risk of acquiring HIV is very low, 0.3%.  The risk of acquiring HBV is 5-40%, relating to the health of the source and the severity of the exposure.
 
Prevention
Vaccinate your employees.  If you are already immune to Hepatitis B (from vaccination or previous infection) there is no risk of infection.  Currently, there is no vaccination available to prevent Hepatitis C or HIV infection.  If infection is to occur, it typically takes place within the first 6 months of exposure.
 
Provide your employees with needle guards or re-capping gadgets and always encourage the “scoop” method to recap used needles.  Sharps should be removed first from a used tray of instruments.  Provide heavy rubber gloves for any instrument scrubbing.
 
First Aid
Encourage bleeding from the wound and wash the area with soapy water, disinfectant, scrub solution or water.
 
Reporting
All workplace needlesticks or exposures are to be reported to the Employer immediately.  An Exposure Incident Form is to be filled out (attached.)  A copy is to be kept in the employee’s confidential record and one given to the employee’s consulting physician.
 
The Employer (Dentist) is to explain to the Source (Patient) what has happened and ask permission to draw blood (or send to the local hospital for a blood draw.)  Both the Health Care Worker and the Source will need a Hepatitis B status, Hepatitis C status, and an HIV test.  These will require consent or written refusal from both the Employee and the Source.  All testing is paid for by the Employer.
 
If the Source is confirmed to be HIV positive, the exposed Health Care Worker will be counseled and offered Post-Exposure Prophylaxis (PEP.)  PEP drugs have been found to be most effective when given within 72 hours of exposure.  The CDC recommends AZT in combination with other specified anti-viral drugs be given to exposed employees who have sustained certain high risk exposures.  These include injuries involving a contaminated needle or instrument as well as a large amount of blood.
 
If the Source was found positive for HIV and/or Hepatitis C, the exposed employee will need regular follow-up, usually several visits over the following months depending on the situation.
 
If the Source was found negative for both HIV and Hepatitis C, the exposed employee will only need a single follow-up, six months after the exposure.

 EXPOSURE INCIDENT FORM, page 1

EXPOSURE INCIDENT FORM, page 2
 
Holly Wales, Corporate Manager

References:
NSU Health Systems, Blood Borne Pathogen Exposure Fact Sheet, 2/2/09
www.OSHA.gov, Exposure Incident Report, Ch 19 Bloodborne Pathogens