POST 00706E : ACCIDENTAL NEEDLESTICK
Follow-up on Post 00701E
15 August 2004
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Two replies were received following Vladimir's Petrovic's posting (00701E).
The first is from Steve Wiersma (mailto:[email protected]) from WHO who
discusses the issue. The second came from Tina Norgard
(mailto:[email protected]) from Denmark who tells us about a new
generation of syringes, the retractable syringe.
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Vladimir Petrovic describes an unfortunate means of exposure to blood-borne
pathogens. Similar exposures occur in occupational settings and among
injection drug sharing populations among other groups. Unfortunately,
exposures such as this present multipe risks to blood-borne pathogens
including HIV, HBV and HCV, as well as other pathogens.
The public health approach towards a needle-stick injury should include a
complete risk assessment, referral for management of the injured person
(medical, psycho-social, etc), as well as implementation of prevention
strategies.
The WHO "Aide Memoire for the health care worker protection" (available at
http://www.injectionsafety.org ) covers many of these issues but is
addressed to a specific audience. The checklist contained in this document
covers
1) universal precautions (includes proper waste management),
2) hepatitis B immunization,
3) Personal protection, and
4) post-exposure management.
Each of these topics is relevant for the child who is injured by a medical
device in the situation described by Mr. Petrovic although specific advice
may be different for these cases (e.g. serological testing following
routine infant immunization is not recommended). In addition, post-exposure
options will vary depending the pathogen and resources available. Possible
options include provision of immunoglobin vaccine and antivirals. Decisions
may be improved by determination of source and victim serostatus for the
various pathogens, however, that is often difficult when exposure comes
from mixed medical waste.
In conclusion, most blood exposures are preventable and we need to continue
our efforts to make these events rare.
Steve Wiersma,
Medical Officer/Hepatitis Focal Point
Expanded Programme on Immunization
World Health Organization
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Mr Petrovic raises the issue of thrown away IDU syringes, which can then be
found at playgrounds, in parks etc. We would like to draw your attention to
a new generation of safety syringes, the socalled Retractable Syringes,
where the needles disappear into the barrel after use, thus preventing
re-use and preventing the fatal accidents referred to.
In the past such syringes were extremely expensive, with prices up to 50 US
cents a piece. However, the development of simpler manually retractable
syringes, has made it possible to put these on the market for around 8 - 10
cents a piece. Admittedly a price higher than a regular syringe, but taken
the costs of screening for and treatment of hepatitis and HIV, this may
prove to be a very viable investment. Safety Syringes are recommended by
WHO (see Guiding Principles to Ensure Injection Device Safety), and WHO
will have additional information about the cost effectiveness of
implemeting safety syringes.
If any members of TechNet are interested in receiving evaluation samples,
please do not hesitate to contact me, and please feel free to visit our
website www.emunio.dk for further information.
Tina Norgard
Emunio ApS
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