FAQ

  • No symptoms of disease should be expected from the needle-stick exposure, upon a timely presentation.
  • The history should focus on the patient’s medical history, including immunizations and risk factors for both HIV and hepatitis.
  • Specific questions include the following:
    – Complete immunization record, including tetanus and hepatitis B
    – Previous occupational exposure to body fluids
    – Intravenous drug abuse
    – Sexual history
    – Body piercing or tattooing
    – Receiving blood and/or blood products
    – Any history of dialysis
    – Travel outside Thailand in the last year

Laboratory Studies

  • Source patient (if available)
    – HIV
    – Hepatitis B antigen
    – Hepatitis C antibody
    – Aspartate aminotransferase/alanine aminotransferase (AST/ALT) and alkaline phosphatase levels
  • Victim/health care worker
  • Hepatitis B surface antibody
  • HIV
  • Hepatitis C antibody testing at 2 weeks, 4 weeks, and 8 weeks
  • Pregnancy test (stat in woman)
  • CBC count with differential and platelets
  • Serum creatinine/BUN levels
  • Urinalysis with microscopic analysis
  • AST/ALT levels
  • Alkaline phosphatase level
  • Total bilirubin level  
  • Prior to initiating retrovirals

 

Prehospital Care

  • If the exposure is mucosal or the wound is large enough to irrigate, irrigate with copious amounts of saline or other clean fluid.

Emergency Department Care

Irrigate and clean wound.

The need for tetanus and/or hepatitis B prophylaxis is based on medical history. Health care providers should have been immunized against hepatitis B. Hepatitis A prophylaxis may (rarely) need to be considered depending on the source-patient situation.

The need for HIV or chemoprophylaxis (antiretrovirals) is based on an assessment of the risk by using the 3-step process

developed by the Centers for Disease Control and Prevention (CDC).

Step 1: Determine exposure code.

  • Is the source material blood, bloody fluid, other potentially infectious material, or an instrument contaminated with one of these substances? If not, there is no risk of HIV transmission? If yes, what type of exposure occurred?
  • If the exposure was to intact skin only, there is no risk of HIV transmission.
  • If the exposure was to mucous membrane or integrity-compromised skin, was the volume of fluid small (ie, few drops, short duration) or large (ie, several drops or major splash, long duration)? If small, the category is exposure code 1. If large, the category is exposure code 2.
  • If the exposure was percutaneous, was it a solid needle or a superficial scratch (ie, less severe)? If yes, the category is exposure code 2.
  • Was it from a large-bore hollow needle, a device with visible blood, or a needle used in a source patient’s artery or vein (ie, more severe)? If yes, the category is exposure code 3.

Step 2: Determine HIV status code.

What is the HIV status of the exposure source? If HIV negative, no postexposure prophylaxis is needed. If HIV positive, was the exposure low titer or high titer? Low-titer exposures are asymptomatic patients with high CD4 counts: These are HIV status code 1. High-titer exposures are patients with primary HIV infection, high or increasing viral load or low CD4 counts, or advanced acquired immunodeficiency syndrome (AIDS): These are HIV status code 2. If HIV status is unknown or the source is unknown, the HIV status code is unknown.

Postexposure prophylaxis recommendation

  • Exposure code 1 and HIV status code 1: Postexposure prophylaxis may not be warranted. Exposure type does not pose a known risk. The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of postexposure prophylaxis.
  • Exposure code 1 and HIV status code 2: Consider the basic regimen. Exposure type poses a negligible risk for HIV transmission. A high HIV titer in the source may justify consideration of postexposure prophylaxis. The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of postexposure prophylaxis.
  • Exposure code 2 and HIV status code 1: Recommend the basic regimen. Most HIV exposures are in this category. No increased risk for HIV transmission has been observed, but use of postexposure prophylaxis is appropriate.
  • Exposure code 2 and HIV status code 2: Recommend expanded regimen. Exposure type represents an increased HIV transmission risk.
  • Exposure code 3 and HIV status code 1 or 2: Recommend expanded regimen. Exposure type represents an increased HIV transmission risk.
  • HIV status code unknown: If the source or, in the case of an unknown source, the setting where the exposure occurred suggests possible risk for HIV exposure and the exposure code is 2 or 3, consider the postexposure prophylaxis basic regimen.

Step 3: Match exposure code with HIV status code to determine if any postexposure prophylaxis is indicated.

  • Basic regimen: 4 weeks of zidovudine (600 mg/d in 2-3 divided doses) and lamivudine (150 mg twice daily)
  • Expanded regimen: Basic regimen plus either indinavir (800 mg q8h) or nelfinavir (750 mg 3 times/d).
  • Interferon ribavirin prophylaxis decreases risk by 40%. Exposed workers should be counseled on the risks of disease transmission based upon their specific exposure.

Follow-up
Further Outpatient Care
Follow up with occupational health or infectious disease in 24-72 hours.
Discuss need for safe sex practices until follow-up laboratory testing is negative for HIV. Most now recommend a follow-up screen at 3 or 6 months.

As you known, safety syringes are priced higher than conventional (unsafe) syringes. But it is shortsighted —and erroneous—to simply compare the purchase price of the safety syringe to that of the conventional syringe.
A much more realistic approach should include the cost of tests to see if accidental needlestick injury victims acquire a bloodborne disease as a result of the injury. In addition, the cost of safe disposal of the syringe should be included.

Bloodborne diseases are transmitted from one person to another in different ways. Unfortunately, a very efficient method of transmission is with a syringe that is reused or that causes an accidental needlestick injury (NSI). In either case, blood from a patient (which may contain one or more of a host of bloodborne pathogens such as hepatitis or HIV) can contaminate the bloodstream of either another patient or someone else (such as a healthcare worker), often transmitting a serious—perhaps fatal—disease.

Upon the completion of an injection with a safety syringe, the needle is controllable and instantly retracted  from the patient into the barrel of the syringe. When this happens, the syringe is rendered non-reusable, and the contaminated needle is not available to prick the medical worker.

Most of the HIV/AIDS pandemic traditionally has been attributed to sexual transmission. However, several recent thought-provoking articles in medical journals have presented evidence that much of the transmission actually is caused by dirty needles.[1] Healthcare workers in the U.S. suffer an estimated 600,000 to 800,000 accidental needlestick injuries each year.[2] This amounts to one NSI for about every 6,000 injections given with a conventional syringe.

Whenever a syringe is reused, or when a healthcare worker suffers an accidental NSI, it is imperative that tests be conducted to determine whether or not a bloodborne disease has been contracted. And often the tests must be repeated, because it may take several months before some pathogens can be detected. HIV sometimes lies dormant in the human body for up to three years. Such tests are expensive: in the U.S., the cost is approximately $3,000.[3]

In instances where a bloodborne disease indeed has been contracted, treatment can be very expensive.Victims of NSI are usually frontline healthcare workers: doctors and nurses that the world can ill afford to lose. And, of course, there is no way to monetarily quantify human emotions such as fear and anxiety or potential damage to relationships.

Disposal costs must also be taken into account. This includes the cost of the sharps disposal box plus the cost of transportation to the incineration site and the cost of incineration. For a conventional (unsafe) syringe, the disposal cost is approximately $0.18 each. Activated   safety syringes “nest” or pack together much more efficiently  than conventional syringes. Any sharps disposal box will hold at least two times as many activated (retracted) safety syringes as conventional syringes.

The actual (or true) cost of a syringe can be calculated as follows:
purchase price + testing cost + disposal cost = actual cost of a syringe
Even if the purchase price of a safety syringe were about two times as much as the purchase price of a conventional syringe, the actual cost of the conventional syringe would still be more expensive
When these costs are taken into account, it actually is much less expensive to use a truly effective safety syringe than to use a conventional syringe (or one of the marginal so-called “safety” syringes that do not do an effective job of preventing both reuse and NSI). It not only makes good sense to use the safest product, it also makes good economic sense.

References

[1] David Gisselquist et al., “Let It Be Sexual: How the Health Care Transmission of AIDS in Africa was Ignored,” International Journal of STD & AIDS 2003; 14: 148-161. Also Devon D. Brewer et al., “Mounting Anomalies in the Epidemiology of HIV in Africa: Cry the Beloved Paradigm,” in the same issue, pages 144-147.

[2] NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings, Publication No. 2000-108, CDC/NIOSH/DHHS, November 1999, p. 2, available online at http://www.cdc.gov/niosh/pdfs/2000-108.pdf.

[3] Irene B. Hatcher, “Reducing Sharps Injuries Among Health Care Workers: A Sharps Container Quality Improvement Project,” The Joint Commission Journal on Quality Improvement, July 2004 (vol. 28, no. 9), p. 413. Also William Carlsen, “Safer Needles Save Money, Report Says,” San Francisco Chronicle, December 18, 1998, p. A-1, available online at http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/1998/12/18/MN44912.DTL. Also “Market for Needle-free Injection Devices and Safety Syringes to Shoot Up to $2.49 Billion by 2009,” PR Newswire, February 7, 2006. Also Ron Stoker, “Anatomy of a Needlestick Injury,” Business Briefing: Global Healthcare – Advanced Medical Technologies 2004, p. 34, available online at http://www.touchbriefings.com/pdf/950/stoker.pdf.

In year 2000, the FDA approved a safety syringe to minimize the risk for accidental transmission of blood-borne pathogens and other infectious agents via needlestick injuries.

How important of needestick injuries?– Statistics from the Centers for Disease Control and Prevention show that nearly 1 million US healthcare workers suffer from accidental needlestick injuries every year. Up to 90% of cases remain unreported, causing the occupational transmission of more than 20 blood-borne pathogens and other infectious agents.

Moreover, data from the World Health Organization suggest that needlestick injuries account for 40% of hepatitis B and hepatitis C virus infections and 2.5% of HIV/AIDS infections among healthcare workers. The safety syringe features one-handed operation ,after single use, the plunge will be locked with the needle and draw the needle in barrel.

The plunger can be broken easily after draw the needle in barrel. By this design principle, this product is real safety, thereby creating additional protection from accidental exposure.

More than 20 bloodborne pathogens that can be transmitted by an accidental needlestick injury. But the diseases that important and can be fatal are:

  • HIV
  • Hepatitis B
  • Hepatitis C
  • Hepatitis D
  • Tetanus
  1. The use of our product which has simple structure is exactly the same as traditional syringe.
  2. The syringe needle will be drawn back to the tube which ensures the security function.
  3. After single use, the plunge will be locked with the needle. And draw the needle in barrel. The plunger can be broken easily after draw the needle in barrel, by this design principle, this product is real safety, do not injure medical workers.
  4. This design doesn’t need extra power to push the plunge to bottom of barrel until it locked. So the needles not shaking when inject in the muscle, then, no more pain than conventional syringe.
  5. The remaining amount of liquid medicine is as the same as the normal syringe, or less than that of normal syringe.
  6. Safe and easy disposal after only one use.