______________________________ Infection Control for New York Health Care Professionals ‒ 2024 Update
b. All of the components are directly or indi- rectly exposed to the patient’s blood and cannot be used for another patient. c. Syringes and needles that intersect through any port in the IV system also become con- taminated and cannot be used for another patient or used to re-enter a non-patient specific multidose medication vial. d. Separation from the patient’s IV by distance, gravity and/or positive infusion pressure does not ensure that small amounts of blood are not present in these items. 4. Never enter a vial with a syringe or needle that has been used for a patient if the same medica- tion vial might be used for another patient. 5. Dedicate multidose vials to a single patient when- ever possible. If multidose vials are used for more than one patient, restrict the medication vials to a centralized medication area and do not bring them into the immediate patient treatment area (e.g., operating room, patient room/cubicle) 6. Never use peripheral capillary blood monitoring devices packaged as single patient use on more than one patient: a. Restrict use of peripheral capillary blood sampling devices to individual patients. b. Never reuse lancets. Use single-use lancets that permanently retract upon puncture whenever possible. III. Safe Injection Practices and Procedures Designed to Prevent Disease transmission from patient to healthcare worker. A. Refer to the updated OSHA guidelines, Needlestick Safety and Prevention Act [17]. https://www.govinfo. gov/content/pkg/BILLS-106hr5178enr/pdf/BILLS- 106hr5178enr.pdf IV. Evaluation/Surveillance of Exposure Incidents. A. Identification of who is at risk for exposure. B. Identification of what devices cause exposure. 1. ALL sharp devices can cause injury and disease transmission if not used and disposed of prop- erly. a. Devices with higher disease transmission risk (hollow bore). b. Devices with higher injury rates (“butterfly”- type IV catheters, devices with recoil action). c. Blood glucose monitoring devices (lancet platforms/pens). C. Identification of areas/settings where exposures occur.
D. Circumstances by which exposures occur. E. Post-exposure management (see Element VI). V. Engineering Controls. A. Use safer devices whenever possible to prevent sharps injuries: 1. Evaluate and select safer devices. 2. Passive vs. active safety features. Active features require the HCW to actively engage the safety feature while a passive safety feature requires no activation and happens automatically, such as a retractable syringe needle. 3. Mechanisms that provide continuous protection immediately, such as safe sharps devices/equip- ment, and following safe injection and disposal practices listed below. 4. Integrated safety equipment vs. accessory devices: a. Properly educate and train all staff on safety devices. b. Consider eliminating traditional or non- safety alternatives whenever possible. c. Explore engineering controls available for specific areas/settings. B. Use puncture-resistant containers for the disposal and transport of needles and other sharp objects: 1. Refer to published guidelines for the selection, evaluation, and use (e.g., placement) of sharps disposal containers. a. Review National Institute for Occupational Safety and Health guidelines from the CDC [18] C. Use splatter shields on medical equipment associated with risk prone procedures (e.g., locking centrifuge lids). VI. Work Practice Controls A. General practices: (Summary) 1-5. reviews hand hygiene from Element II, proper cleaning and disinfection in Element V, and donning and doffing of PPE in Element IV. 6. Preventing percutaneous exposures: a. Avoid unnecessary use of needles and other sharp objects. b. Use care in the handling and disposing of needles and other sharp objects B. Modify procedures to avoid injury: 1. Use forceps, suture holders, or other instruments for suturing. 2. Avoid holding tissue with fingers when suturing or cutting. 3. Avoid leaving exposed sharps of any kind on patient procedure/treatment work surfaces.
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