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In 2010, a new European directive was published on needle stick injuries with the aim to create the safer working environments by preventing injuries caused by medical sharps.
In the UK, The Health & Safety (Sharps Instruments in Healthcare) Regulations 2013 were introduced to meet the requirements on the EU Directive 2010/32 and aspects existing UK legislation does not specifically address.
The risk of needle stick injuries is highest amongst workers in health and social care environments who directly handle sharps but also includes workers who may inadvertently be put at risk when sharps are not stored or disposed of correctly.
The main risk from a sharps injury is the potential exposure of infections such as blood borne viruses (BBV). This can occur where the injury involves a sharp that is contaminated with blood or a bodily fluid from a patient. The BBV of most concern are:
Hepatitis B is an infectious illness caused by Hepatitis B virus (HBV) which infects the liver of humans, and causes an inflammation called hepatitis. Hepatitis B is one of the most common infectious diseases in the world and is passed from one person to the other through body fluids. Hepatitis B infections are either acute or chronic.
Acute infections can last between a few weeks and a few months. It is possible to recover from acute hepatitis B on your own. The infected person can remain healthy without any symptoms while the virus clears from the body. Some will not even know they have been infected. However, until the virus completely gone from the body, it is able to be passed on to others. Chronic hepatitis B is much more serious; if you contract this strain of the disease it will be with you throughout your life and there is a chance you will go on to develop permanent scarring of the liver, called cirrhosis, and you may eventually develop liver cancer.
Symptoms are similar to those of hepatitis A, which include:
For chronic hepatitis B infection there are 2 different types of treatment interferon and anti-viral drugs. Interferon is a protein that is naturally produced by your body in response to a viral infection. It works by preventing the virus multiplying inside your cells. Injections of Interferon will prevent further damage to your liver.
There can be side effects to taking this treatment, including flu like symptoms, especially in the early stages. These side effects can be severe, so they are not suitable for long-term treatment. Antiviral drugs can also help to stop the virus from multiplying in your body. They include:
Hepatitis C is an infection of the liver caused by the hepatitis C virus. It can cause inflammation and fibrosis of the liver tissue and occasionally significant liver damage. In some cases, those with cirrhosis will go on to develop liver failure or worse complications, including liver cancer or life-threatening esophageal varices and gastric varices.
Many people do not realise they have been infected with the virus as there are no symptoms.Flu-like symptoms can occur but can easily be mistaken for another illness. An estimated 180 million people worldwide are infected with hepatitis C with and estimated 200,000 to 500,000 people infected in England and Wales.
You can become infected with hepatitis C if you come into contact with the blood or, less commonly, body fluids of an infected person. The hepatitis C virus mutates very easily, which makes it hard to create a vaccine, and the virus has different genetic variants.
In most cases, the initial infection doesn't cause any symptoms. When it does, they tend to be vague and non-specific. Possible symptoms of Hepatitis C infection include:
The most common symptom experienced is fatigue, which may be mild but is sometimes extreme. Unlike Hepatitis A and B, Hepatitis C doesn't usually cause people to develop jaundice.
About 20-30% of people clear the virus from their bodies but for about 75% of infected people, it lasts for more than 6 months, known as chronic hepatitis C. In these cases, the immune system has been unable to clear the virus and will remain in the body long term unless medical treatment is given. Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all.
Around 1 in 5 people with chronic Hepatitis C develops cirrhosis of the liver within 20 years.
People with chronic Hepatitis C infection should be seen by a hospital liver specialist who may recommend antiviral drug treatments either as single drug therapy or as combination therapy.
Blood tests are required to identify which strain of Hepatitis C infection is present and how well the liver is functioning, and a liver biopsy to establish whether cirrhosis is occurring.
Treatment is usually a combination of two drugs: Interferon (which is given as an injection) and Ribavirin (given as a capsule or tablet):
Interferon is a protein that is naturally produced by your body in response to a viral infection. It prevents the virus multiplying inside your cells.
Ribavirin is a type of antiviral drug that stops the Hepatitis C virus from spreading inside the body.
Treatment usually lasts for 6 or 12 months. A blood test is done after 4 weeks, and again after 12 weeks, to see how well you are responding. Treatment is usually stopped if you do not show a good response after 12 weeks.
These drugs offer the best chance to clear the virus from the body, and are often used together as dual or combination therapy which has been shown to be effective in 55% of cases. Some genetic variants of the Hepatitis C virus are more likely to respond than others and even if the virus isn’t completely cleared, the treatments can reduce inflammation and scarring of the liver.
However, there are side effects to these drugs that some people find difficult to tolerate.
Human Immunodeficiency Virus is a lentivirus that causes AIDS, a condition in humans where a weakened immune system allows life-threatening infections and cancers to swarm the body. Through the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk, HIV is able to be passed along to another person. Within these bodily fluids, HIV will be present as both free virus particles and a virus within infected immune cells. The 1st stage of HIV is known as primary HIV infection. Many people develop symptoms, but might not recognise them. The symptoms of HIV usually occur 2 to 6 weeks after infected with HIV.
These symptoms are often very mild, so it is easily mistaken for a cold or glandular fever. However, it is unusual to get these symptoms in conjunction with a rash, so if you are concerned about the risk of HIV infection you should request a test from your GP.
After the primary symptoms have dissipated, HIV will often not cause any further symptoms for many years. This is known as asymptomatic HIV infection. However during this time, the virus will still be reproducing and is continuing to damage your immune system.
If you are diagnosed with HIV, you will be referred to an HIV clinic and be offered counselling. You will need to undergo regular blood tests as part of your treatment.
The tests are used to measure your CD4 count (this is the number of CD4 cells in your blood) and your viral load (this is the amount of HIV in your blood).
This allows the HIV clinic to see the progression of the disease and judge the likelihood that you will develop a HIV-related infection.
As a general rule:
A CD4 count of 500 or above - no risk of HIV-related infection
A CD4 count of less than 200 - high risk of serious HIV-related infection
There is no cure or vaccine for HIV. However, combination therapy slows the progression of the virus and can prolong life. A combination of medicines is needed because of the adaptive nature of the virus, as it can become resistant to the medication.
The regulations outline requirements that must be met in to order comply with legislation these include: