Question

Case Study: Policy planning for occupational health and exposure control

Evaluating policy measures to protect healthcare workers from bloodborne pathogens: Universal Precautions, Post-exposure follow-up, and Exposure control planning.

During the evening tour of duty on the weekend, an ICN Nurse sustained a needlestick injury (nsi), a deep wound, after starting an IV on a patient. The sharps container was on the injection trolley being used for the patient in the next bed and the nurse was stuck while walking to the sharps container. The source patient was in the hospital for pneumonia secondary to AIDS and being treated with antiretrovirals. It is unknown whether the source patient has hepatitis B or C virus infection. The nurse had not been immunized against hepatitis B.

The Policy:

Institutional/Hospital The policy for post-exposure prophylaxis states that the employer will provide PEP within 24 hours. In practice at this hospital, when a nsi occurs on a weekend, the nurse is told to return on Monday for evaluation when the occupational health office is open.

There is a health and safety committee but they do not include representatives form patient care areas only 2 union representatives who work in radiology and the lab and the committee does not consider exposure control or review the needlestick injuries that occur.

Provincial All workers must be immunized against hepatitis B. Sharps containers must be available in all patient care areas.

National Universal precautions are required. All health care workers must receive immunization against hepatitis B preservice.   

There is no occupational health agency in the government or within the ministry of health.  

Answer each questions from the perceptive of each role.

You are the:  

1. Nurse with the injury

2. The union steward
3. The President of the National Nurses Association
4. The chief matron of the hospital

5. Director of infection control for the hospital

1. What questions would you ask the nurses about the nature of the needlestick injury? What would you recommend about PEP for the nurse?
2. What other policies would you review in this case? How/where would you get the information about the policy?
3. What goals/recommendations do you have for this hospital? For the health and safety committee?
4. What recommendations for policy in the hospital, province and national department of health?
5. What steps would you take to achieve these goals? Timeline?

Answer 1

Needle stick injury is an occupational health hazard for health workers who are in direct contact with the patients. It defines as an accidental injury caused by the needles,and syringes. There is a risk for blood borne infections like Hepatitis B and HIV viral infection. Sharps includes needles,scissors,clamps,pins,staples,cutters,lancets,metal wire.

The common questions to What questions would you ask the nurses about the nature of the needlestick injury includes : the types of sharp exists int he hospital, what is needle stick injury, what are the health hazards occurs secondary to needle stick injury, reasons of NSI, ways to prevent NSI.

Post exposure prophylaxis refers to the protocol maintained to minimize the risk of infection following needle stick injury. Start PEP within 2 hours of exposure and needs to be continued for 4 weeks. Report exposure to the inflection control unit and start 2 drug regimen at the earliest. HIV testing soon after an occupational exposure to establish a baseline data. Periodical monitoring and evaluating signs of infections like fever,flu like symptoms, pharyngitis,eruptions in skin. Exposed person should avoid breast feeding,blood donation, tissue donation for the first 6-12 weeks after exposure. Repeat laboratory investigations at a period of 3 months and again at 6 months. Each hospital have policy of disposing sharps in a needle proof containers. The most common cause of NSI in hospitals are due to employees failure to adopt with safety precautions, not adhering to the safety protocol, mishandling of sharp devices.

Recommendation includes initiating a risk assessment plan to determine the exposure code, the current status of the patient like positive for HIV/viral hepatitis, Decision in making post exposure prophylaxis,. Educating employees to adhere with policies reduces the risk for needle stick injury.

Steps to reduce the needle stick injury includes avoid recapping needles, practicing safety precautions, keep needle proof resistant container in easy access.