Republic of the Philippines Doc. No.

PROVINCE OF DAVAO OCCIDENTAL Rev. No.

DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

POLICY ON THE PREVENTION AND TREATMENT OF

NEEDLESTICK INJURIES AND SAFE DISPOSAL OF NEEDLES

INTRODUCTION

A needle stick injury (NSI) is an accidental skin-penetrating stab wound from a

hollow-bore needle containing another person's blood or body fluid. Healthcare
workers are at an occupational risk of exposure to blood-borne pathogens following
NSIs and sharps injuries (SIs). A thorough understanding of the safe practices while
handling needles and sharps and its proper disposal is crucial for healthcare workers
to create a risk-free work place environment.

Biohazardous waste must be scrupulously handled and disposed of to ensure the

safety of medical personnel and patients. The most at-risk for sharps-related injuries
are those who handle the implements directly. However, when sharps bins aren’t used
appropriately, incidents and injuries involving tangential personnel (janitorial
workers, administrators) and even patients can occur.

RATIONALE

Globally, needle stick injuries (NSI) are the most common source of occupational
exposures to blood and the primary cause of bloodborne infections of healthcare
workers (HCW). These workers incur 2 million NSI that result in Hepatitis B, C, and
HIV infections per year.

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

In the Philippines, 68% of the institutions have current data pertaining to NSI and
have existing policies and guidelines regarding reporting of NSI. Thirty- two percent
(32%) said that recapping of needles was the primary cause of NSIs.

PURPOSE
 To minimize the risks of transmission of hazardous sources.
 To promote awareness safe management of sharps and occupational exposure.
 To provide a framework for the education of healthcare workers in the safe
handling of sharps.
 To equip the staff on the proper course of action in cases of exposure to blood
and blood-stained fluids by sharps and needle prick injuries.

ROLES AND RESPONSIBILITIES

1. The staff has a responsibility to ensure they follow instructions, in accordance with
policy, and not place themselves or others in danger.

2. Each individual has an obligation to adhere to these recommendations and comply

with best practice.

3. It is the responsibility of the injured employee to report to the Supervisor and to

Hospital Infection Control Committee Nurse/ Chairman and follow-up his own
treatment.

4. ER Staff must ensure that entries in the OVR (occurrence/variance report) form are
completed.

5. It shall be the responsibility of the Medical Technologist on Duty to obtain samples

for baseline testing of the healthcare worker after a needle stick injury and the
subsequent testings thereto.

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

6. The hospital administrator shall assist the healthcare worker with the
recommendations for Post exposure prophylaxis as recommended by the Hospital
Infection Control Committee. This may include, but not limited to,
Immunoglobulin shots, medications for Antiretroviral Therapy and further need for
testing like ELISA.

DEFINITIONS
Needle prick injury exposure occurrences due to needle stick injuries include:
Percutaneous, needle sticks, puncture wounds or lacerations from a contaminated
needle or other sharp instrument.

Recapping
Recapping needles using two-handed methods increases the risk of needle-stick
injuries and is not recommended. However, where such action is unavoidable,
the one-hand scoop technique reduces the risk of needle-sticks.

Sharp
Any object that can penetrate the skin; sharps include needles, scalpels, broken
glass, broken capillary tubes and exposed ends of dental wires.

Sharps container:
A puncture-resistant, rigid, leak-resistant container designed to hold used sharps
safely during collection, disposal and destruction

POLICY
 All sharps are considered medical waste;

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

 Disposable syringes with needles, scalpel blades and other sharps items shall
be placed into puncture-resistant containers located in the area of use;
 Needles must not be recapped, purposely broken, bent or otherwise
manipulated by hand;
 If recapping is absolutely necessary, use "SCOOP/ FISH HOOK" method;
 Disposable needles and syringes are considered as one unit and not separated
and shall be disposed as one unit;
 Sharps containers shall not be reopened once they are closed. They also shall
not be cleaned in any other manner that would expose the employees to the
risk of percutaneous injury;
 Do not keep syringes, needles or any other item in your pocket;
 Never leave sharps lying around, dispose immediately;
 Replace sharps container when the container is three quarters full and manage
in a secure manner;
 Sharps containers while being in use shall be kept away from pathways above
the level of the floor.

INJURY FROM AN HIV POSITIVE SOURCE

1. The HCW blood is tested for baseline antiHIV antibody.

2. PEP Guidelines by the Centers for Disease Control are instituted immediately
(basic or expanded ART regime according to the exposure code)
3. HIV Status of the exposed HCW is then tested again at 6 weeks, 3 months and
six months.

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

4. The HCW is also followed up for any side effects while taking the antiretroviral
therapy.

INJURY FROM AN HBsAg POSITIVE SOURCE

1. Maximum number or HCW are immunized against HBV due to the hospital
policy.
2. Investigations for baseline HBsAg and the antiHBs titre are done for the HCW. If
the AntiHBs titre is positive, no PEP is required.
3. If the vaccination doses are incomplete and the antiHBs titre is positive,
vaccination is continued as per schedule with no other interventions.
4. If HCW is a non responder or has not completed the vaccination series and the
antiHBs titre is negative, both the Hepatitis B immunoglobulin and vaccination
against HBV are given.

INJURY FROM AN HCV POSITIVE SOURCE

1. The HCW’s blood is first tested for baseline antiHCV antibody.

2. All HCW who sustain NSI from HCV positive sources are referred to the
gastroenterology team for liver function monitoring.
3. The HCW is followed up by the GI doctor for 6 months.

4. If the antiHCV antibody ELISA test is positive, the test is reconfirmed using a

recombinant immunoblot assay.

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

POLICY FOR POST NEEDLE STICK INJURY

In the event of a needle stick or sharps injury, immediately:
1. Wash area with soap and water
2. Allow to bleed freely
3. Wrap the wound with sterile gauze;
4. Proceed to the Emergency Room for immediate treatment, appropriate to the
injury. Treatment must include:
 Examination
 Screening
 Infection prophylaxis
 Wound care
5. Treatment must be documented in the employee's MR file.
6. The Emergency room must inform the following:
 Unit Manager/Supervisor
 Infection Control Physician
7. The ER must complete a report including:
 Precise description of how, where, and when the injury
occurred
 Follow-up treatment
 Description of the involved sharp
8. The ER must forward the report to the IC Physician for completion.
9. Any contamination following needle stick or sharp injury requiring long
treatment must be indicated for recommended Post Exposure Prophylaxis.

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

DISPOSAL OF SHARPS
When sharps containers are 3/4 full they should be securely sealed by healthcare
worker:
1. Plaster the lid with tape.
2. Put the sharps containers in yellow infectious plastic bag, sealed with plastic cable.
3. Label with date, unit/clinic and initials and ID number of healthcare worker.
4. The containers shall be picked up by housekeeping staff with other bio-hazardous
waste to the waste storage room.

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

Figure 1. Flowchart of the Hospital Protocol for Needle Stick Injuries

The diseases transmitted by needle stick injuries are major health hazards and at times
may be life-threatening. They are also difficult to treat and may require lifelong
treatment. Hence, it is important to include the knowledge of health hazards of NSI,
PEP, and a specific protocol in case of an NSI in the teaching curriculum of HCWs.

Hospitals should therefore focus on policies for reducing transmission and should
create awareness among both staff and students about the safety precautions by
conducting seminars, sessions, and training programs from time to time.

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

References
1. Centers for Disease Control and Prevention (CDC Manual for Needle Stick Injuries).

2. Ghanei Gheshlagh R, Aslani M, Shabani F, Dalvand S, Parizad N. Prevalence of

needlestick and sharps injuries in the healthcare workers of Iranian hospitals: an
updated meta-analysis. Environ Health Prev Med. 2018 Sep 07;23(1):44.

2. Vilar-Compte D, de-la-Rosa-Martinez D, Ponce de León S. Vaccination Status

and Other Preventive Measures in Medical Schools. Big Needs and Opportunities. 
Arch Med Res. 2018 May;49(4):255-260.

3. Joukar F, Mansour-Ghanaei F, Naghipour M, Asgharnezhad M. Needlestick

Injuries among Healthcare Workers: Why They Do Not Report their Incidence? 
Iran J Nurs Midwifery Res. 2018 Sep-Oct;23(5):382-387.

4. Triassi M, Pennino F. Infectious risk for healthcare workers: evaluation and

prevention. Ann Ig. 2018 Jul-Aug;30(4 Supple 1):48-51.

5. Oche OM, Umar AS, Gana GJ, Okafoagu NC, Oladigbolu RA. Determinants of
appropriate knowledge on human immunodeficiency virus postexposure prophylaxis
among professional health-care workers in Sokoto, Nigeria. J Family Med Prim
Care. 2018 Mar-Apr;7(2):340-345.

6. Dulon M, Wendeler D, Nienhaus A. Seroconversion after needlestick injuries -

analyses of statutory accident insurance claims in Germany. GMS Hyg Infect
Control. 2018;13:Doc05.

7. Pereira MC, Mello FW, Ribeiro DM, Porporatti AL, da Costa S, Flores-Mir C,
Gianoni Capenakas S, Dutra KL. Prevalence of reported percutaneous injuries on
dentists: A meta-analysis. J Dent. 2018 Sep;76:9-18. 

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I
 Republic of the Philippines Doc. No.
PROVINCE OF DAVAO OCCIDENTAL Rev. No.
DAVAO OCCIDENTAL GENERAL HOSPITAL Effective date:
Lacaron, Malita, Davao Occidental

“QUALITY HEALTH CARE FOR ALL”

POLICY ON THE PREVENTION AND

TREATMENT OF
NEEDLESTICK INJURIES AND SAFE Page
DISPOSAL OF NEEDLES

Prepared by: Reviewed by: Approved by:

Bonnie Jane S. Ranches,RN Julius D. Lucenara, RN Glinard L. Quezada, M.D.

Health Officer I Nurse III Medical Center Chief I