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Ouch! Managing Sharps Injuries to Avoid Infection

Physicians sustain sharps injuries and needlestick exposures more frequently than other healthcare workers, and surveys shows they are not likely to report their injuries. A survey of 336 dermatologists found that 85% of dermatologists reported a sharps injury within the last year, but 64% of respondents noted that the injury went unreported. Another survey of dermatology residents found that 45% responded that they did not report needlestick injuries. This is notable because injury reporting by clinical personnel and appropriate management can reduce the risk of blood-borne disease transmission. The Centers for Disease Control and Prevention (CDC) has recommendations designed to minimize risks related to occupational exposures to HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) in the dermatology office. In addition, there are sharps that are engineered to reduce injury. A recent report reviewed the guidelines and recommendations to reinforce their use by dermatologists.

The report was a reminder of the following guidelines for HIV exposure:
• HIV transmission risk after a percutaneous (skin cut or puncture) exposure is approximately three times higher than a mucous membrane (splash) exposure.
• After an occupational exposure, the source patient should be tested for HIV with a combined
antibody and antigen test performed on blood or saliva.
• HIV postexposure prophylaxis (PEP) should be started immediately, preferably within hours of exposure.

For HBV:
• Transmission risk is related to the degree of contact with blood and the hepatitis B e antigen (HBeAg) status of the source patient.
• Health care workers should have an up-to-date HBV vaccination.
• If an injury occurs HBV re-vaccination should be administered to stimulate the immune response.

For HCV:
• Approximately 75% of all HCV exposures for health care personnel are percutaneous; mostly needlesticks and cuts from sharp instruments.
• If an accident occurs, baseline HCV antibody and RNA tests should be obtained from both the source patient and the exposed health care provider within 48 hours.
• If the result of either test of the source patient is positive, follow-up testing of the provider at 4- to 6-week intervals is indicated for 6 months.

This report offers an algorithm to follow to make sure health workers get optimal care within the appropriate time after any exposure.


Byline: Martha L. Sikes, MS, RPh, PA-C

Posted: December 4, 2017

Source: JAAD
Adapted from the original article.

[Image: Shutterstock]

Summary: Dermatology providers should be aware of how to manage sharps and/or needlestick injuries.
Key words: sharps, needlestick, HIV, HBV, HCV, sdpa, society of dermatology physician assistants

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