Needle safety and post exposure follow-up

Needle safety

Healthcare workers who use or may be exposed to needles are at increased risk of needlestick injury. Such injuries can lead to serious or fatal infections with blood-borne pathogens, such as HBV, HCV, and HIV. Needlestick injuries account for most accidental exposures to blood. Used needles should never be recapped. After use, needles should be covered with the appropriate engineered safety device that is part of the needle assembly and disposed of in a biohazard sharps container.

Using safety needles

According to OSHA, the best practice for preventing needlestick injuries after phlebotomy is to use safety needles that are activated with one hand immediately after use. The US Food and Drug Administration (FDA), which is responsible for approving medical devices marketed and sold in the United States, recommends devices that provide a barrier between the hands and the needle, after use, in which the phlebotomist’s hands remain behind the needle at all times. Safety shields that can be activated before or immediately after removing of the needle from the vein and that remain in effect after disposal should also be an integral part of the device. Finally, these devices should be as simple as possible, requiring little or no training to use. Some examples of needle safety devices are as follows:

• One-handed vacuum tube needle: After the needle has been used and removed from the vein, the thumb holding the vacuum tube holder slides under the base of the pink safety device, causing it to snap over the contaminated needle. Or an orange needle shield on the holder is activated by pressing the device against a hard, flat surface.• Syringe needle safety devices: These devices have a spring-activated shield attached to a disposable syringe needle. After the venipuncture, the phlebotomist activates the device with the thumb holding the syringe, and a spring locks a protective plastic tip into place, protecting the needle. The needle can then be removed and discarded. The syringe is attached to the safety transfer device to deliver the collected blood into the appropriate vacuum tubes.
• Butterfly needle safety lock: After the venipuncture, the dominant hand holds the butterfly tail while the nondominant hand pulls back on the tubing, causing the needle to slide into the tubing and lock into place.
• Push-button butterfly safety device: With the needle still in the arm, the medical assistant grasps the tail of the butterfly with the dominant hand while the nondominant hand presses the button just below the wings, causing the needle to retract into the butterfly body as it leaves the vein.
• Needle-blunting butterfly set: A third wing is rotated after collection and before removal of the needle from the vein. As the third wing is rotated, it moves the blunt needle down the shaft before it is removed from the patient.
• OSHA requires employers to establish and maintain a sharps injury log for recording injuries from contaminated sharps. This log should contain information about the device involved in the incident and the department or work area where the incident occurred, in addition to an explanation of the incident. Employee confidentiality must be maintained.

Protect against needlestick injuries

OSHA’s Bloodborne Pathogens Standard emphasizes that phlebotomists should have direct input on the type of safety needles they will be using. The following steps should be taken to protect against needlestick injuries:

• Help your employer evaluate and select devices with safety features.
• Use devices with safety features provided by your employer.
• Never recap a contaminated needle except with a safety device.
• Plan for safe handling and disposal before beginning any procedure using needles.
• Dispose of used needles and needle holders promptly in appropriate biohazard sharps containers.
• Report all needlestick and other sharps-related injuries promptly to ensure that you receive appropriate follow-up care.
• Tell your employer about hazards from needles that you observe in your work environment.
• Participate in bloodborne pathogen training, and follow recommended infection prevention practices, including vaccination against hepatitis B virus (HBV).

Post exposure needlestick follow-up

An accidental needlestick is a medical emergency. Effective management of an accidental sharps exposure includes the following measures:

• Immediately after injury, the wound is inspected and washed for 10 minutes with soap, 10% iodine solution, or chlorine-based antiseptic.
• The injury is reported to the supervisor, and an incident report is completed.
• The employee is referred to a provider for confidential assessment and follow-up. Baseline testing for HBV, HCV, and HIV is recommended for both the employee and the source individual:
• HBV: If the employee has been immunized for HBV and has a positive post immunization titer, there is no risk of acquiring HBV, and no source testing is needed. If the employee has not been immunized or the post immunization titer is negative, source testing for infection with HBV is recommended if the source is known and can be located. If the source patient tests positive for HBV, the employee should receive HBV immune globulin (HBIG), and a series of HBV immunizations should be initiated. If the source tests negative, no treatment is indicated. If the source patient cannot be tested, the employee should be treated as if the source patient were positive for HBV.
• HCV: The source should also be tested for HCV. If the source is positive, the employee should be monitored for signs and symptoms of hepatitis for 6 months. No postexposure prophylaxis is recommended for HCV infection.
• HIV: For HIV exposure, most employers recommend a 4-week regimen of antiretroviral drugs. To best protect the victim, antiretroviral therapy should be administered within hours of exposure. Early HIV drug therapy is now recommended for anyone who may be at risk of infection. Because these medications have side effects, the employee is the one who decides whether the medications are started. If the source is found to be negative, antiretroviral therapy can be discontinued.
• Interim testing may be performed if the healthcare worker experiences symptoms of acute HIV exposure or hepatitis. For HIV, antibody testing should be repeated at 6 weeks, 12 weeks, and 6 months if the source was HIV positive or the source’s status remains unknown. Confidential follow-up care must include provisions for emotional support and counseling for the healthcare worker.