POST 00708E : ACCIDENTAL NEEDLESTICK
Follow-up on Posts 00701E and 00706E
21 August 2004
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Amber Hogan (mailto:[email protected]) from the United States discusses
preventive measures of accidental needlesticks.
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Best practices for preventing exposures to contaminated sharps include the
institution of a hierarchy of controls which is more protective than what
the WHO recommends. These elements are fundamental to the practice of
industrial hygiene and community health throughout the world.
1. Substitution - if injections can be avoided and replaced with other
means of delivery - this, obviously (but less of an option with
immunization, more so with curative injections), is the best means of
prevention
2. Engineering Controls - this includes the use of safer medical devices
designed to reduce exposures to contaminated sharps - in the US, Canada,
Japan, EU, Australia and New Zealand - these are very viable options and
policies either exist or are being promulgated that support use of these
safer devices. Self-sheathing needles, retracting needles, etc.
3. Work Practices - that must be used in concert with engineering controls
(if available). This includes immediate disposal of contaminated sharps in
a container, proper injection technique, NOT recapping, no hands passing,
etc. These work practices are designed to protect not only the care giver,
but also the patient, and the community downstream. Standard precautions
are included here - assumption that all blood, all body fluids, all
contaminated devices have the presence of HCV, HIV, HBV, etc. (standard
precautions are more protective than universal precautions and were
instituted back in the 1990s by the CDC).
4. Personal Protective Equipment - gloves, eye protection, etc. (if
appropriate). PPE should be used always as a means of standard precautions,
and if any or all of the above can't be used.
Immunizations for flu, HBV, etc - are of course intrinsic to prevention
strategies, but not included in the hierarchy, as they are separate and
sure means of disease prevention.
Amber Hogan
Global Safety Policy
BD Corporate
Franklin Lakes, NJ - USA
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