LOADING

Type to search

Infection Control

What should I do if a puncture injury occurs, resulting in bleeding?

Share

This question was submitted by a general dentist: What should I do if a puncture injury occurs, resulting in bleeding?

Dr. Nita Mazurat, representing the Organization for Safety, Asepsis, and Prevention (OSAP) has provided this quick initial response

bigstock-Needle-Stick-Injury-6020086All offices should have an Office Infection Control Manual with post-exposure protocol developed utilizing information from their Provincial Dental Association. Additionally, one person in the office should be designated to assist when occupational injuries occur. 

When an injury involves exposure to a healthcare worker from a patient’s blood, or other high risk body fluids with visible blood, the dental worker must report the injury to the designated person in the practice as soon as possible. Steps to follow include administering basic first aid, ensuring the device involved in the injury is not reused on the patient, and determination if the event is a significant exposure which will require referral of the patient (in this case, the source person) and the healthcare worker (in this case, the exposed person) to an appropriate healthcare provider as soon as possible for evaluation and follow-up.  This is generally performed in a hospital setting since  most hospitals have protocols in place to manage risks and healthcare workers who have experienced blood transmission injuries.  When the injury is not deemed to have resulted in transmission of blood, there is no requirement for blood testing of the source. 

 

Do you need further information on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

Your are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on “Leave a reply“ below. You are welcome to remain anonymous and your email address will not be posted.

 

6 Comments

  1. Unfortunately I find this response very quick and administrative, leaving the question unanswered.
    I would suggest immediate removal from the situation, explaining to the patient what has just happened. Immediately remove the gloves, wash the area thoroughly with water and an antibacterial soap, promoting bleeding to flush the area as well. Once cleaned, pressure to stop the bleeding and assessment of the wound for further treatment…including the patient’s medical history and blood evaluation. Be honest with the patient usually ensures they will be honest back to you. However, if there is any doubt whatsoever then seek further medical evaluation and treatment.
    Further to this, one should fully evaluate how this incident happened..whose fault was it, what were the circumstances, etc. Then one must make changes to their protocols to insure this will not happen again. For instance, my DA never uncaps the syringe or passes “sharps” to me. These are already on my tray and are never passed back or forth. Hence I haven’t had a “needlestick: in over a decade…and neither have my staff.
    Hope this helps.

    Reply
  2. JCDA Oasis July 5, 2013

    On behalf of Dr. Karen Black, DMD; FAGD:

    My understanding is that encouraging bleeding from the wound for a brief time, followed by cleansing with hydrogen peroxide, is the standard of care for a puncture wound. Is this appropriate care? – and if so it should have been included in the response.

    Reply
  3. Point well taken! It is hard to determine the amount of prescriptive information clinicians prefer to receive.
    Thank you for your comments. You have provided an excellent start on the step-by-step procedures following a percutaneous injury. The steps that follow are provided with the assumption that the ‘source’ is the patient and the ‘exposed’ is an operator which includes any member of the dental team.
    Following a sharps or percutaneous injury the following steps should be taken:
    1. Stop treatment.

    2. Inform the patient so they know an injury has occurred and they are safe.

    3. Remove gloves, wash hands.

    4. Flush the area with copious amounts of water.
    There is no documented evidence to support that squeezing the wound will further reduce the risk of transmission of bloodborne infection. Antiseptics, bleach, and skin washes should not be used as there is no evidence of their efficacy and their effect on local defense mechanisms is unknown. (MMWR 2001;50(RR-11) and UK Chief Medical Officers’ Expert Advisory Group on AIDS, Department of Health. HIV Post-Exposure Prophylaxis February 2004)

    5. Determine the need for first aid. If there is no requirement for sutures, the area should be covered.

    6. Determine the nature of the incident. If it is a significant exposure (transfer of a high risk body fluid), the source person (here considered to be the patient) will be asked for consent for blood testing. Although the chart will reveal the medical history and it is updated with each dental visit, not all patients reveal their medical conditions and not all patients are aware of their medical conditions. If it is determined that this has been a significant exposure, and the patient has agreed to blood testing, they should be transported to a facility for blood testing. The patient should be asked if they wish to notify family and/or workplace due to the unexpected time required to perform testing at a healthcare facility such as a hospital.

    7. Determine how to proceed with the patient’s immediate needs since dental treatment has been initiated and if the area has been contaminated with operator blood, instruments and surfaces will require replacement with fresh sterile instruments and surfaces will require decontamination.

    8. The incident is reported in the chart including the patient’s and operator’s perceptions of the incident. The incident will also be recorded in the office’s Infection Control Manual with further reflections of root cause possibly with corrections to process.

    9. Follow up will be determined by the extent of the injury and the results of the blood
    testing.

    Dr Ford has made a further excellent comment. The incident needs to be reviewed by the members of the dental team to determine the cause of the failure. The culture of safety in a dental office examines process without assessing blame to individuals. There is a validated instrument that can be used by offices to access their culture of safety at https://oralhealthquality.wordpress.com/

    Reply
    1. Awesome reply…thank you very much for the recognition…

      1. Thank you for the post and the lovely reply Dr Ford!

    2. This I can cut and paste into my office manual, without editing….useful day to day type of stuff….well done

Leave a Comment

Your email address will not be published. Required fields are marked *

%d bloggers like this: