Puncture Wounds by Hypodermic Needles A SAFETY TALK FOR DISCUSSION LEADERS This safety talk is designed for discussion leaders to use in preparing safety meetings. Set a specific time and date for your safety meeting. Publicize your meeting so everyone involved will be sure to attend. Review this safety talk before the meeting and become familiar with its content. Make notes about the points made in this talk that pertain to your workplace. You should be able to present the material in your own words and lead the discussion without reading it. Seating space is not absolutely necessary, but arrangements should be made so that those attending can easily see and hear the presentation. Collect whatever materials and props you will need ahead of time. Try to use equipment in your workplace to demonstrate your points. DURING THE MEETING Give the safety talk in your own words. Use the printed talk merely as a guide. The purpose of a safety meeting is to initiate discussion of safety problems and provide solutions to those problems. Encourage employees to discuss hazards or potential hazards the encounter on the job. Ask them to suggest ways to improve safety in their area. Don't let the meeting turn into a gripe session about unrelated topics. As discussion leader, its your job to make sure the topic is safety. Discussing other topics wastes time and can ruin the effectiveness of your safety meeting. At the end of the meeting, ask employees to sign a sheet on the back of this talk as a record that they attended the safety meeting. Keep this talk on file for your records. Puncture Wounds by Hypodermic Needles NOTE TO DISCUSSION LEADER: Before your meeting, you may want to visit each nursing unit nd check for the following items: ù A needle cutter that is working and has a lid which fastens securely ù A special container (not full) for disposal of used syringes ù A special, labeled waste container for glass The results of this inspection may interest your group. Point out that nurses especially are responsible for seeing that these items are used. Consider these incidents: ù A nurse carries some used needles in her pocket because she does not want to go back to the nurses' station right away to dispose of them. She reaches into her pocket and receives a serious puncture wound because the cap came off one of the needles. ù A hospital housekeeper is in a hurry and does not handle the plastic refuse bag with care. He is stuck by a discarded needle, which has punctured the bag. When did either of these employees last have a tetanus booster? Probably neither of them remembers. Everyone who has worked in a hospital or nursing home and surely every hospital supervisor has heard similar stories. We are here to discuss the problem of puncture wounds, what to do if you receive one and, most importantly, what you can do to prevent them. Puncture wounds are different from lacerations because they bleed only a little and the wounds often "seal over" and appear to be healed. Therefore, puncture wounds are easy to disregard. However, serious problems can result from puncture wounds. Let's discuss a few of the diseases which can occur after being "stuck" accidentally with a "dirty" needle. ù Tetanus or "lockjaw." This disease is fatal and symptoms may not appear until six weeks after the puncture wound is received. Immunizations against tetanus should be kept up to date and should be received as follows: initial series of two injections, four weeks apart, followed by a booster in one year; and a routine booster every eight to ten years and a booster injection following an injury if the most recent booster is not within five years of the injury. Remember, tetanus is rare, but when it does occur, it is almost always fatal! No preventive measures are wasted. ù Hepatitis. This is an infectious disease which causes inflammation of the liver and can result in permanent liver damage if the case is severe. ù Syphilis. This venereal disease, usually transmitted only by sexual contact, can be transmitted by needle if only a small amount of time elapses between the "sticking" of the infected patient and the "sticking" of the employee with the same needle. The "guilty" organism, treponema pallidum, lives only briefly outside the body. Operating room personnel are probably the most concerned with contracting syphilis by way of a needle. The following rules should prevent most puncture wounds: ù Disposable needles, including those in IV sets, should be cut off at the hubs immediately after use by a special needle cutter equipped with a receptacle for used needles. Used needles should never be carried in pockets and should not remain on med carts or in med rooms long after use. ù Needles "frozen" to syringes should be disposed of in the same manner as dirty needles. ù Needles should never be disposed of in a wastebasket; however, housekeepers should be careful when emptying waste receptacles because needles, broken glass or knife blades may be present. ù Sharp instruments, such as knife blades, should be placed in special containers immediately after use and then they should be disposed of or taken to be sterilized. ù Linens should be checked for needles before being taken to the laundry, and laundry personnel should recheck and handle linens carefully to avoid injury. Broken glass should be swept up immediately. Never pick up broken glass with your hands. NOTE TO DISCUSSION LEADER: Discuss at this time the observation you made at the various nursing units. If, in spite of the best precautions, you happen to be the victim of a puncture wound, take immediate action: ù Wash the wound and surrounding area with an iodophor solution. ù Report the injury to your supervisor. An incident report form should be completed in order to provide information that will be helpful in preventing similar accidents. You may want to get an injection of gamma globulin, which provides some protection against hepatitis, but is no guarantee. ù Be alert for symptoms, especially those of hepatitis, such as fatigue, nausea and sometimes vomiting, lack of appetite, swollen glands and sore throat. Smokers with hepatitis may develop a distaste for tobacco. Yellowing of the skin and eyes can be present. Treatment of hepatitis involves several weeks of rest, usually at home, taking vitamins and following a special diet. ù Several weeks after the injury you may want to have a blood test to assure that you have not contracted syphilis. Puncture wounds have a way of happening to the most unsuspecting people in hospitals. To insure that they aren't a problem and to provide everyone with a safe working environment, we need to be alert to all hazards that may result in puncture wounds, and then take action to eliminate them. Puncture wounds are a serious matter. Do your best not to get the "point!"  .