Sharps Injuries Refresher

A sharps injury is an incident, which causes a needle, blade such as a scalpel or other medical instruments to penetrate the skin. This is sometimes called a percutaneous injury. 

Dental care professionals that handle sharp items are prone to sharps injuries when carrying out work duties. 

This includes those who directly handle sharps, but also includes workers who may inadvertently be put at risk when sharps are not stored or disposed of correctly.

What is the risk?

The main risk from a sharps injury is the potential exposure to infections such as blood-borne viruses (BBV).

For example,

• Human immunodeficiency virus (HIV),
• Hepatitis B (HBV)
• Hepatitis C (HCV)

This can occur where the injury involves a sharp that is contaminated with blood or bodily fluid from a patient. 

Most sharps injuries are sustained during re-sheathing, dismantling, and the disposal of the anaesthetic needles, suture needles, matrix bands, and scalpels.

These are considered avoidable with good practice, such as the use of sharps safe devices, avoidance of re-sheathing of needles and careful disposal of sharps.

Guidance on safe use of sharps is covered in The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

Post Exposure Prophylaxis (PEP)

If there is a sharps injury, the practice must carry out a blood-borne virus risk assessment, and if the injury indicates there is a likelihood of exposure to one of the blood-borne viruses, then post exposure prophylaxis (PEP) is administered. This is performed by the occupational health service or local Accident Emergency Department.

The arrangements for PEP are outlined below:

• Hepatitis B Post Exposure Prophylaxis: HBV prophylaxis involves a booster HBV vaccine. Staff who are vaccine non-responders are offered (HBIG) immunoglobulin. HBV PEP should be administered preferably within 48 hours, but prophylaxis can be prescribed up to one week later.
• HCV Exposure Management: At the present time there is no effective prophylaxis or vaccine available against Hepatitis C. Blood samples are taken from the healthcare worker at baseline, 6, 12 and 24 weeks post the injury and analysed for evidence of infection with HCV (seroconversion). If the person becomes infected, they are offered antiviral drug treatment to clear the virus.
• HIV post Exposure Prophylaxis (PEP): PEP will not be offered if the source case is HIV negative, or following a risk assessment that indicates the risk of HIV infection is unlikely. Blood from an HIV positive source coming into contact with intact skin does not pose a risk for transmission of infection.
• If HIV PEP is required, ideally, it should be given within 1 hour to achieve the maximum preventive benefit, but it may still offer a degree of protection if given within 72 hours. The healthcare worker is normally recommended to commence on a starter pack of HIV PEP drugs. Most hospital laboratories should have the capacity to provide a source patient HIV test results within 8 to 24 hours. In cases where the source patient is found to be uninfected, the HCW can then stop the PEP drugs.
• If the source patient is found to be infected with HIV, then the HCW should complete the full 28 days course of PEP drugs. They are then followed up for a minimum of 12 weeks with blood tests to check that the prophylaxis has been effective, and they have not developed HIV infection.

The transmission of infection depends on a number of factors, including the person’s immune system.

We know the number of injuries each year is high, but only a small number are known to cause infections leading to serious illness.

However, the effects of the injury and anxiety about its potential consequences, including the adverse side effects of post-exposure prophylaxis, can have a significant personal impact on an injured employee.