INJECTION SAFETY

AND
SHARP SAFETY

dr Errisa Maisuritadevi Mara., M.Sc., Sp.PK

IF ONE OF THE LINKS IN THE CHAIN OF INFECTION IS
BROKEN, INFECTION CAN BE PREVENTED.
 SAFETY AND INFECTION CONTROL

• Safety and infection control are two very important elements for
protecting both you and the patient when you are providing any aspect
of phlebotomy to prevent nosocomial infections (infections acquired
in a hospital or other medical setting).

• Keamanan dan Pengendalian infeksi adalah dua elemen yang sangat penting
untuk melindungi Anda dan pasien saat Anda memberikan aspek flebotomi
untuk mencegah infeksi nosokomial (infeksi yang didapat di rumah sakit
atau tempat medis lainnya).
 WHAT IS INJECTION SAFETY?

• Injection safety includes practices intended to prevent transmission of

infectious diseases between one patient and another, or between a patient
and healthcare provider, and also to prevent harms such as needlestick
injuries
• safe injection practices and related infection control is part of that
responsibility – it protects patients and health workers.
 WHAT IS A SAFE INJECTION

A safe injection, phlebotomy (drawing blood),

lancet procedure or intravenous device
insertion is one that:
• does not harm the recipient;
• does not expose the provider to any
avoidable risk;
• does not result in any waste that is
dangerous for other people.
(WHO, 2010)
 UNSAFE INJECTIONS

• Unsafe injections can result in transmission of a wide variety of pathogens.

• They can also cause non-infectious adverse events such as abscesses and toxic
reactions.
• Reuse of syringes or needles is common in many settings exposing patients either
directly (via contaminated equipment) or indirectly (via contaminated medication
vials).
 WHAT INFECTIONS CAN BE CAUSED BY
SHARP INJURIES?

• Sharps injuries can expose workers to a number of blood borne

pathogens that can cause serious or fatal infections.
• The pathogens that pose the most serious health risks are
 Hepatitis B virus (HBV)
 Hepatitis C virus (HCV)
 Human immunodeficiency virus (HIV)
32% of 40% of 5% of
new HBV infections new HCV infections new HIV infections
 PRACTICAL GUIDANCE ON PREPARING INJECTIONS

3 steps must be followed when preparing injections.

1. Keep the injection preparation area free of clutter so all surfaces can be easily
cleaned.
2. Before starting the injection session, and whenever there is contamination with
blood or body fluids, clean the preparation surfaces with 70% alcohol (isopropyl
alcohol or ethanol) and allow to dry.
3. Assemble all equipment needed for the injection:
– sterile single-use needles and syringes;
– reconstitution solution such as sterile water or specific diluent;
– alcohol swab or cotton wool;
– sharps container.
 IMPORTANT POINTS

• DO NOT allow the needle to touch any contaminated surface.

• DO NOT reuse a syringe, even if the needle is changed.
• DO NOT touch the diaphragm after disinfection with the 60–70% alcohol (isopropyl
alcohol or ethanol).
 GENERAL SAFETY PRACTICES INCLUDE:

1. Perform HAND HYGIENE (use soap and water or alcohol rub), and
wash carefully, including wrists and spaces between the fingers, for at
least 30 seconds.
2. GLOVES where appropriate
3. use PERSONAL PROTECTIVE EQUIPMENT.
4. SKIN PREPARATION AND DISINFECTION at the venepuncture site.
(WHO, 2010)
PRACTICAL GUIDANCE ON HAND HYGIENE
 PRACTICAL GUIDANCE ON HAND HYGIENE

BEFORE AFTER
• starting an injection session (i.e. • an injection session;
preparing injection material and • any direct contact with patients;
giving injections);
• removing gloves.
• coming into direct contact with
patients for health-care related
procedures;
• putting on gloves (first make sure
hands are
INDICATIONS AND PRECAUTIONS
FOR HAND HYGIENE
 HAND HYGIENE
LANGKAH CUCI TANGAN

• Rub
• Water
 PRACTICAL GUIDANCE ON
SKIN PREPARATION AND DISINFECTION

To DISINFECT skin, use the following steps :

1. Apply a 60–70% alcohol-based solution (isopropyl alcohol or ethanol) on a single-use
swab or cotton-wool ball. DO NOT use methanol or methyl-alcohol as these are
not safe for human use.
2. Wipe the area from the centre of the injection site working outwards, without going
over the same area.
3. Apply the solution for 30 seconds then allow it to dry completely.
 SKIN PREPARATION AND DISINFECTION
AT THE VENEPUNCTURE SITE.

• JANGAN menyentuh area injeksi setelah dilakukan disinfeksi.

• Jika recapping jarum tidak dapat dihindari, menggunakan teknik satu tangan (one-hand
scoop technique).

• JANGAN gunakan spuit, jarum atau lancet untuk lebih dari satu pasien.
• Buang jarum suntik bekas dan segera semprot ke wadah tajam.
• Tutup wadah dg tutup tamper-proof.

• Jika terjadi kecelakaan apa pun yang terkait dengan jarum atau cedera tajam mulailah
Post-Exposure Prophylaxis (PEP) sesegera mungkin dan segera laporkan kejadian.
 PENGGUNAAN ALAT PELINGDUNG DIRI (APD)

• Sarung tangan
•  Clean, non-sterile examination gloves

Recommendation on personal protection

 Health workers should wear well-fitting, non-
sterile gloves when taking blood;
 they should also carry out hand hygiene before
and after each patient procedure, before putting
on and after removing gloves.
 INDICATIONS FOR GLOVE
USE IN INJECTION PRACTICE
CARA MELEPAS SARUNG TANGAN
INFECTION PREVENTION AND CONTROL
PRACTICES
 SAFE WASTE AND SHARPS DISPOSAL
Safely Handling Sharps
 Practical guidance on
prevention of sharps injuries
• do not bend, break, manipulate or manually remove needles before disposal;
• avoid recapping needles, but if a needle must be recapped, use a single-handed
scoop technique;
• discard used sharps and glass ampoules immediately after use in the location
where they were used, disposing of them into a robust sharps container that is
leak and puncture resistant;
• place the sharps container within arm’s reach (preferably in a secured area) to
allow for easy disposal of sharps;
• seal and replace sharps container when the container is three quarters full.
 RECAPPING THE LEADING CAUSE OF
INJURY
Recapping can account for 25 to 30 percent of all needle
stick injuries of nursing and laboratory staff. Often, it is
the single most common cause
It is extremely dangerous to hold a needle in one hand
and attempt to cover it with a small cap held in the other
hand.
Injuries occur three different ways:
• The needle misses the cap and accidentally enters the
hand holding it.
• the needle pierces the cap and enters the hand
holding it.
• the poorly fitting cap slips off of a recapped needle
and the needle stabs the hand.
 RECAPPING PROCEDURE
Video Phlebotomy\Lab safety\The One-hand Scoop Technique and Discard Used Needles
Safely [720p].mp4
Practical guidance on waste management
• transport and store sharps containers in a secure area before final
disposal;
• close, seal and dispose of sharps containers when the containers are
three quarters full; assign responsibility in written policy for monitoring
the fill level of sharps containers and replacing them when three
quarters full;
• discard waste that is not categorised as sharp or infectious in
appropriate colour-coded bags;
• ensure that infectious waste bags and sharps containers are closed
before they are transported for treatment or disposal.
DISPOSAL OF NEEDLES
• Needle stick injuries commonly occur
when workers dispose of needles.
• They occur when staff use special
containers for needles and sharps.
• They also occur when needles are
disposed of improperly in regular
garbage or lost in the workplace.
SHARPS DISPOSAL
device
SHARPS DISPOSAL
SHARPS DISPOSAL
device
Selamat Belajar
Needlestick Injuries
PROBABILITY OF INFECTION
AFTER A NSI

Rate of Hollow needle Minimal

blood
HBV 22 – 31% 0.0004 ml

HCV 0 - 7% Not known

HIV 0.3 - 0.4% 0.1 ml

 ACCIDENTS OCCUR AT EVERY STEP:
 while carrying the needle to the disposal
container, especially when the needle is
uncapped and mixed with other trash.
 while placing the needle into the disposal
container, especially if the container is
overfilled.
 while emptying disposal containers instead of
sealing them for disposal.
 DO’S FOR BENCHWORKERS

• GET IMMUNIZED AGAINST HBV

• DISPOSE YOUR OWN SHARPS.
• TAKE RESPONSIBILITY
• USE GLOVES & FORCEPS.
• USE SHARPS CONTAINER.
• USE NEW TECHNIQUES.
• BE AWARE ABOUT NSI
 DON’TS FOR BENCHWORKERS

• NEGLECT ANTI HBSAg TITER

• RECAP, REUSE.
• BEND, BREAK.
• PASS, FLING SHARPS.
• EMPTY SHARPS IN WRONG WASTE
BAGS.
• MISPLASE SHARPS.
• USE BARE HANDS.
 Post injury / exposure
protocol

 Don’t PANIC !!!

 Don’t squeeze the injured site
 Wash with soap and water immediately
 Report to the casualty & provide,

(i) Full history of injury or exposure

(ii) History of Hepatitis B immunization
(iii) Blood for testing
MANAGEMENT OF EXPOSED PERSON
1 st step: Management of exposed site - First Aid
Cont…..
First-aid care of the exposure site
Selamat Belajar