3.2.05 Stab and cut injuries in hospital

1 Aim and purpose

Procedure for stab wounds and cuts (reporting route), care, tracing and corrective measures.

Protection of employees against parenterally transmitted diseases, in particular hepatitis B, hepatitis C and HIV. Ensuring insurance cover via the accident insurance provider.

2 Scope of application

All clinics and laboratories of the KRANKENHAUS. Affected occupational groups are in particular nursing staff, medical staff, MTAs and cleaning staff.

3 Description of the procedure

Needlestick injuries and cuts with contaminated instruments and contact with blood and mucous membranes are not trivial. They are the most common causes of hepatitis B infections among hospital staff and can also lead to hepatitis C and HIV infections.

3.1 Precautionary measures

3.1.1 Active hepatitis B vaccination

- Exposed employees of the KRANKENHAUS receive the vaccination free of charge at the company medical examination centre.

- The companies themselves are responsible for vaccinating the employees of external companies.

- Although there are currently no vaccinations against hepatitis C and HIV, the following measures are available:

3.1.2 Post-exposure HIV prophylaxis with medication

In the case of injuries with instruments that have been used on people who are definitely infected with HIV. Start prophylaxis immediately, if possible up to 2 hours after injury, Annexes 3,4,5.

3.1.3 Early treatment of hepatitis C

In the case of injuries with instruments that have certainly been used on people infected with hepatitis C, an attempt can be made as early as 4 weeks after the injury to detect hepatitis C viruses in the injured person so that treatment can be started as early as possible.

3.1.4 Instruction of personnel

Staff should receive annual training in the handling of infectious material.

3.2 Measures to prevent stab wounds and cuts

- Wear protective gloves

- Only dispose of cannulas in the puncture-proof containers provided, never put them back into the protective cover, do not overfill the container,

- Only touch the outer edge of the waste bin, never reach into it,

- Do not fill waste and laundry bags to the maximum, do not reach into them, do not squeeze them, close them securely, only touch them at the top or bottom corners, do not carry them on your body but pull them behind you.

- Use safety syringes.

3.3 Immediate measures

For stab wounds, cuts and blood contact

- Promote blood flow by applying pressure to the surrounding tissue (for at least one minute),

- Cleaning and disinfection of the wound with virus-inactivating disinfectants,

- or thorough rinsing of the contaminated skin and mucous membrane areas with water (eye) or 20-30%iger alcoholic solution (oral mucosa).

- Immediately visit the company medical examination centre (Tel.: ): - Mon.-Thurs., Fri. o'clock - or trauma surgery at other times (Tel.: ), as any HIV prophylaxis must be started as soon as possible.

3.4 Further supply

3.4.1 On the day of injury (in BU or trauma surgery):

- Completion of the questionnaire, Annex 5

- Blood collection for hepatitis B, hepatitis C and HIV serologies,

- Anamnestic clarification of the hepatitis B immune status and, if necessary, passive and/or active immunisation, Appendix 2.

- Checking the tetanus protection

- Drug-based post-exposure HIV prophylaxis Appendices 3, 4, 5.

- Preparation of the accident report for the responsible employers' liability insurance association, Annex 1, or the service accident report (Annex 6).

3.4.2 4 weeks after injury (in the BU)

Blood sample for possible hepatitis C virus detection (PCR) in the case of a positive hepatitis C index person.

3.4.3 6 weeks after injury (in the BU):

- Control of HIV serology.

- Control of hepatitis B serology depending on the immune status of the injured person.

- Control of hepatitis C serology depending on the infectivity of the index person.

3.4.4 12 weeks after the injury (in the BU):

Control of HIV and hepatitis C serology.

3.4.5 ½ year after the injury (in the BU):

Control of HIV and hepatitis C serology.

3.5 Occupational health check-up

Only persons who are monitored by special occupational medical check-ups may be employed in work areas with an increased risk of infection.

This also applies to cleaning personnel from external companies

3.6 Statutory accident insurance

Every employee is insured against the consequences of accidents at work and occupational illnesses with the employers' liability insurance association. For employees of the KRANKENHAUS, this is the Hamburg State Accident Insurance Fund.

Employees of external companies are insured with other employers' liability insurance associations and must report accidents at work to the employers' liability insurance association responsible for them so that the treatment costs can be covered.

4 Responsibility, qualification

- D-Arzt-authorised, i.e. responsible for occupational accidents, is the trauma surgery department. During the BU's opening hours, the BU is the first point of contact, at other times it is the trauma surgery department.

- The accident report must be signed by the managing director or head of institute or department, the works council and the safety officer.

5 Documentation

Documentation of accidents at work is mandatory and is carried out via the medical accident report, the employer's accident report (Annex 1) and the occupational accident report (Annex 6). The form sets for accident reports, occupational illnesses and service accident reports can be obtained from -FA-.

6 Notes and comments

- Outside of the BU's opening hours, post-exposure HIV prophylaxis is started by the trauma surgery department. The BU is responsible for recommending the exact medication in consultation with the infectiologists.

- A presentation in the BU on the next working day is urgently required for the continuation of the HIV PEP.

7 Applicable documents

Occupational Safety Act (ASIG), Occupational Health and Safety Act (ArbSchG), Biological Substances Ordinance (BioStoffV), statutory accident prevention regulations GUV 0.5 and GUV 0.6. accident insurance law (SGB § 7), German-Austrian recommendations on HIV-PEP (Epidemiological Bulletin of the RKI 21/98)

8 Terms

Index person: The patient with whom the blood contact took place.
HIV PEP:Prophylaxis after blood contact with the blood of an HIV-positive patient

Attachments

• Accident report