1. Which of the following diseases has the highest risk of transmission via needlestick injury?
- a) HIV
- b) HCV
- c) HBV
- d) Asthma
- e) COVID 19
Comment - Hepatitis B virus is transmitted at between 6-30% via needlestick injuries. This is why vaccination is thought to be key. This is as compared to HIV 0.3% and HCV 1.3%. While the transmissibility of COVID 19 via needlestick injury is not known, it is thought to be low as it is a predominantly respiratory virus. Asthma is not an infectious disease.
2. What is the most common practice that leads to needlestick injuries in the health facilities?
- a) Throwing away sharps in normal garbage
- b) Recapping needles
- c) Letting sharps containers fill to the top before disposal
- d) Drawing blood from a patient in a poorly lit room
- e) Handing a sharp to a colleague after use
Comment - While the other factors may contribute to needlestick injuries, recapping of needles is the most common practice leading to needlestick injuries and accounts for up to 30% of all needlestick injuries.
3. When should a sharps container be sealed and disposed of:
- a) When it is full
- b) When it is a maximum of 3/4 full
- c) When it is a minimum of 1/3 full
- d) When it is a maximum of 2/3 full
- e) When a new sharps container is available
Comment - Many needlestick injuries occur when trying to place sharps in containers that are full and have sharps protruding out. It is therefore recommended to seal and dispose of sharps containers before they are full.
Clinical Scenario (Questions 4 and 5)
Mandela, a newly qualified nurse has been deployed to a small health facility handling all sorts of emergencies. Due to the current COVID 19 pandemic, they are understaffed and overworked. He was drawing blood from a patient for testing and attempted to recap the needle when he finished, because he was far from the sharps container and there were many other patients and nurses in the small room; he susbsequently sustained a needlestick injury.
4. What should Mandela do now that he has sustained a needlestick injury?
- a) Dispose of the sharps in the sharps container, take off his gloves and wash the site of the injury with soap and water without attempting to squeeze out any blood.
- b) Inform his supervisor or the Occupational Health and Safety Officer in his facility.
- c) In conjunction with his supervisor or the Occupational Health and Safety Officer, obtain consent from the source patient for testing of HIV, HBV and HCV.
- d) Get tested for HIV, HBV and HCV and start treatment as advised by the occupational health and safety officer/physician.
- e) All the above.
Comment - Needlestick injuries should always be reported to either the supervisor or Occupational Health and Safety Officer and testing and treatment should be sort immediately.
5. How can this facility prevent similar injuries in future?
- a) Obtain self-retracting needles where possible.
- b) Train Mandela and other health care personnel on proper use and management of sharps.
- c) Provide adequate staffing and improve their patient and work flow design.
- d) Place sharps containers at eye level and within easy reach of the health care workers.
- e) All the above.
Comment - -Prevention of needlestick/sharp injuries requires a hierarchical approach beginning with the elimination of the hazards when possible, appropriate engineering, administrative and work practice controls (such as proper training of staff, adequate work space and lighting), as well as the use of appropriate PPE.