Needlestick injuries are an occupational hazard for millions of healthcare workers. Even though universal guidelines have decreased the risks of needlestick injuries over the past 30 years, these injuries continue to occur, including in dermatologic, plastic surgery, and aesthetic practice, as these directly handle sharps on a daily basis, multiple times a day

The main risks from needlestick injury are the potential exposure to infections, such as hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV), and other types of infections. This can occur when a sharp that is contaminated with blood or another bodily fluid from a patient pierces the skin of another person.

It is crucial that all members of the team that handles any type of treatment with needles and syringes are fully aware of and trained on this subject, and that this training is regularly updated and reinforced.

Prevention

General precautions

1. Avoid hand to hand passage of sharps
2. Maintain a consistently organized treatment tray
3. Position treatment table and instruments at an appropriate height and in a convenient and accessible location
4. Avoid oversized surgical gloves
5. Ensure universal access to safe injection and safety boxes
6. Make all injectable syringes and needles available with matching quantities of injection equipment and safety boxes
7. Plan on making a safety protocol and guidelines to raise awareness, lay good practice on needlestick injury and infection control, record incidents and accidents, and staff training on the correct use of safer needles and disposal procedures.
8. Consider using personal protection equipment (PPE) such as gloves, facemasks, and goggles to avoid any inadvertent transmission of blood or other bodily fluids.
9. Get vaccinated against HBV (unfortunately, there are not yet any preventive vaccines available for HCV or HIV).

Syringes and Needles

Parenteral treatment and procedures should be accessed in an aseptic manner.

1. Medications should be drawn up in a designed clean medication area that is not adjacent to areas where potentially contaminated items are placed.
2. Always enter a medication vial with a sterile needle and sterile syringe, even when obtaining additional doses of medication for the same patient.
3. Use a new syringe and needle for each patient. It is not right to use the same syringe to give an injection to more than one patient. Even if you don't draw back before injecting, there is still a possibility that small blood can flow into the needle and syringe even when only positive pressure is applied outward.
4. A needle should not be left inserted into a medication vial septum for multiple uses. This provides a direct route for microorganisms to enter the vial and contaminate the fluid.
5. Avoid placing your hand in direction of applied force.

Single-dose/single-use vials of medications

Single-dose vials are vials of liquid medication or diluent for parenteral or skin injections that are meant for use in a single patient for a single procedure or treatment. Single-dose vials are labeled as such by the manufacturer and typically lack an antimicrobial preservative.

1. Choose the smallest vial necessary for your patient's needs when making purchasing decisions to prevent unnecessary waste or temptation to use contents from a single dose for more than one patient.
2. Draw on a single-dose vial only once so as to prevent inadvertent contamination of the vial.
3. If the single-dose vial will be punctured more than once for a single patient for a part of a single procedure, it should be with a new needle and new syringe.
4. The vial must be discarded at the end of the procedure and not stored for future use.
5. Medication vials should always be discarded whenever sterility is compromised or dubious such as expired or has been opened.

Multi-dose vial of medication

Multi-dose is a vial of liquid medication or diluent intended for parenteral or skin injections and infusion that contains more than one dose of medications. Multi-dose vials are labeled as such by the manufacturer and typically contain an antimicrobial preservative to help prevent the growth of bacteria. The preservative has no effect on viruses and does not protect against contamination when aesthetic providers fail to follow safe injection practices.

1. Limit the use of multi-dose vials and dedicate them to a single patient whenever possible.
2. If multi-dose vials must be used for more than one patient, they should be kept or accessed in the immediate treatment area. this is to prevent inadvertent contamination of the vial through direct or indirect contact with potentially contaminated surfaces or equipment that could then lead to infections in subsequent patients. If the vial enters the immediate treatment area (patient rooms or bays, or opening rooms), it should be dedicated to that patient only and discarded after its use.
3. If the multi-dose vial has been opened or accessed (e.g. needle punctured) the vial should be dated and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial.
4. Vials should always be discarded whenever sterility is compromised or questionable

Disposal and segregation

1. Avoid recapping needles. do not return the cap of the syringes and needles but instead, throw it directly at the disposal box.
2. Immediately dispose of used syringes.
3. Provide rigid, puncture-proof sharps disposal boxes as near as possible to the treatment area where needles are being used or got from

Treatment

Measures after needlestick injury and infection should be quick and follow the below instructions:

1. If the skin is punctured, bleeding under running water should be gently encouraged, to prevent infection of other areas of the hand/skin
2. Washed the injured part with soap and water, but not rubbed or sucked
3. If there is any possibility of HCV, HBV or HIV exposure, urgent medical advice should be sought for the relative indications for appropriate treatment.
4. Report and record any incident to investigate the issue and immediately address it.

Conclusion

Though there a lot of needle usage in our aesthetic practice, we can still minimize needlestick injury and infection by laying and adopting safety plans to prevent injuries and treat such when that time comes. these measures can keep your employees, patients, and your community safe.