NSI Class

Hospital Infection Control Team
AIIMS, Rishikesh
Needle Stick Injury (NSI)
Mr. Ashok Kumar Sharma (ICN)
08/23/2023 1
Introduction
NSIs are common and to an extent

inevitable (situation that is unavoidable) in
health-care workers (HCWs) during
execution of their patient care services.
08/23/2023 3
Cont…
These events are of concern because of the risk
to transmit blood borne diseases through the
passage of the-
HepatitisB virus(HBV)
The hepatitis C virus (HCV), and
The Human Immunodeficiency Virus(HIV)
Due to NSIs, the risk of infections ranges
from as low as 0.2–0.5% for HIV to as high as
3–10% for HCV and 40% for HBV
08/23/2023 4
Blood Borne Viruses & NSI
08/23/2023 5
Definition
Needle stick injury (NSI) is defined as
percutaneous exposure where the skin is
breached by a needle or any sharp object
contaminated by blood or other bodily
fluid due to accidental pricks.
08/23/2023 6
Cont.....
 "Exposed Person" is a Healthcare Professional
who is potentially at risk of acquiring HIV infection
due to exposure to blood or potentially infectious
body fluids in his on her occupation.
 "Source Person" is the person who is (either
identified or not identified as) the possible source of
contamination through blood or potentially
infectious body fluids.
Determinants of NSIs
 Recapping of needles after use
 Overuse of injections and unnecessary sharps
 Lack of supplies: disposable syringes, safer needle
devices, and sharps-disposal containers
 Lack of access to and failure to use sharps containers
immediately after injection
 Inadequate or short staffing
 Lack of engineering controls such as safer needle devices
 Passing instruments from hand to hand in the operating
suite
 Lack of awareness of hazard and lack of training
Who are at Risk ?
 Nursing officer’s
 Doctor’s
 Student’s (Specially trainee)
 Laboratory Staff
 Housekeeping staff
 Patient itself
08/23/2023 9
What kinds of needles usually cause
needle stick injuries ?
Hypodermic needles
Blood collection needles
Suture needles
Needles used in intravenous delivery
systems
08/23/2023 12
When Needle-stick Injuries Occur ?
Needle-stick injuries are most often associated
with the following activities:-
Sudden patient movement during the
injection.
Recapping needles.
Transferring body fluid between
containers
Failing to dispose off used needles
properly in a puncture-proof safety box
08/23/2023 13
What happens with Recapping
08/23/2023 14
ONE HAND SCOOP TECHNIQUE
Cont….
The needle could miss the cap and stab the

hand holding it.
The needle could pierce the cap and stab the

hand holding it.
The poorly fitting cap could slip off a

recapped needle and stab the hand holding it.
08/23/2023 16
Cont….
 Needles left unattended
 Discarding sharps other than sharp container. Eg.
Garbage bags.
 Allowing the sharp container to overflow.
 Bending or breaking the needle.
 Transferring sharp from one person to another.
 Patient moving during procedure.
 When the HCW carrying the sharp all the way up to the
treatment room.
 Leaving the re-usable needles on the towel /sheets
/mattresses.
08/23/2023 17
Steps of Management:
• All percutaneous or mucocutaneous injuries in

NSI healthcare setting
• Wash under running tap water for

FIRST 3-5 minutes
AID • Do not squeeze or suck
INCIDEN • Inform immediate supervisor

T • Report to HICT /Emergency
REPORT
• Known: Tracing source viral markers
ROOT • Unknown: Nursing Supervisor of
CAUSE concerned area contacted to trace viral
markers of patients admitted for past
ANALYS 48 -72 hours or last documented
IS BMW collection from area
•
IMMUNIZATI • Hepatitis B
ON STATUS• Tetanus
OF HCW Toxoid
• Investigations under Needle

stick Injury Panel (NSI
EXPOS Panel)
ED • Includes CBC, LFT, HBsAg,
Anti HCV Ab, Anti HIV Ab,
Anti HBs Ab titre
Source
Anti HIV Ab • PEP: First dose preferably given within

reactive 2 hours of exposure
• Refer to ART Centre for full course of
OR
PEP after counselling
Unknown
• Check Anti HBs Ab titre of exposed

HBsAg • May wait upto 72 hours for titres
Positiv
e • If >10 m IU / ml: No Action
• < 10 m IU / ml: 0.06ml/kg HBIg
• Counselling and Follow-up

Anti
HCV • Neither Ig nor antiviral
Reactive agents recommended for
HCV PEP
Don’ts
08/23/2023 21
For Skin Exposure:
Remove gloves
If skin is broken after a needle stick/sharp instrument
If there is splash of blood or bodily fluid on
unbroken skin
Immediately wash wound & surrounding skin with

water.
Do not scrub
Do not use antiseptics or skin washes (e.g., bleach,
chlorine, alcohol)
08/23/2023 22
For Skin Exposure:
08/23/2023 23
For Eye Exposure:
08/23/2023 24
Whom to Report
Routine hours: Nodal officer NSI (Dr.

Mukesh Bairwa), Department of
Medicine/OPD of medicine with OPD Slip.
After that also report to Hospital Infection
Control Team, Department of Microbiology
level 4th Medical college building
Post routine hours: (evening/night/holiday):

Consult doctor/Resident on duty in Emergency area
(Contact No 0312040)
08/23/2023 26
Fill Incident Form if any NSI
occur in your area and send it
to HICT through email.
([email protected])
How Can You Protect Yourself ?
WHO recommends that all HCWs should be

vaccinated against hepatitis B
Plan safe handling and disposal of needles

before using them.
If you have to transport the safety box to
another room or to a disposal site, carry it
carefully holding it at the top, above the level
of the needles.
08/23/2023 28
Use puncture proof disposal
bins
Empty sharp container when they are
3/4th full
Cont…
Never re-cap needles-

Place them uncapped in to a sharps container
immediately.
Never open a safety box.

Store in a safe and secure place until it is ready for final
disposal
Never fill a safety box more than three-quarters full.
08/23/2023 31
Cont…
• Ensure that all staff in your area are educated on the
risks of needle stick injuries and given appropriate
training. (housekeeping and sanitation workers)
 Take time to explain risks, especially if you observe

risky or dangerous procedures or behaviors among
your colleagues.
Ensure waste is disposed off properly with in the

facility.
08/23/2023 32
Unsafe practices
08/23/2023 33
Safe practices
08/23/2023 35
First aid following blood splash on eyes – which is correct
statement
1. Rub and squeeze the eye thoroughly
2. Wash the eyes with running tap water for at

least 5 minutes
3. Just wipe the eyes with a towel
36
Which first aid measure should be
undertaken following accidental
exposure to blood/fluid?
A. Place the pricked finger into the mouth

B. Squeeze blood from wound
C. Use bleach, alcohol, iodine, antiseptic,
detergent, etc.
D. Wash exposed site thoroughly with
running water
37
The best protection will be achieved if first
dose of PEP for HIV is taken within-
A. 2 hours of exposure
B. 6 hours of exposure
C. 12 hours of exposure
D. 72 hours of exposure
38
What should be done if the source is
positive or unidentified for Hepatitis C?
1. There is no vaccine or drug available

for prevention of transmission
2. Take vaccine for Hepatitis C
3. Take drugs for prevention of
transmission of Hepatitis C
39
Take Home message
•Vaccination against Hepatitis B.
Treat all patients as potentially infectious.
Getting acquainted to Hospital protocol
for NSI.
Follow safe injection practices.
Avoid recapping of needles.
Spread awareness.
Don’t ignore if any NSI occur.
08/23/2023 40
Thank you
08/23/2023 41

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Hospital Infection Control Team

Needle Stick Injury (NSI)

Mr. Ashok Kumar Sharma (ICN)

NSIs are common and to an extent

The needle could miss the cap and stab the

The needle could pierce the cap and stab the

The poorly fitting cap could slip off a

• All percutaneous or mucocutaneous injuries in

• Wash under running tap water for

INCIDEN • Inform immediate supervisor

• Investigations under Needle

Anti HIV Ab • PEP: First dose preferably given within

• Check Anti HBs Ab titre of exposed

• Counselling and Follow-up

Immediately wash wound & surrounding skin with

Routine hours: Nodal officer NSI (Dr.

Post routine hours: (evening/night/holiday):

WHO recommends that all HCWs should be

Plan safe handling and disposal of needles

Never re-cap needles-

Never open a safety box.

Never fill a safety box more than three-quarters full.

 Take time to explain risks, especially if you observe

Ensure waste is disposed off properly with in the

1. Rub and squeeze the eye thoroughly

2. Wash the eyes with running tap water for at

3. Just wipe the eyes with a towel

A. Place the pricked finger into the mouth

1. There is no vaccine or drug available

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