Commentary

When working in medical and dental spaces, there are sometimes risk of accidental skin puncture, when needles, dental burrs (the drill bits), scalpels, and other items – referred to as sharps are involved.  Which means there is also the risk of infection.   
I got stuck by a used needle once while working as an orderly, prior to medical school. I was cleaning up a deep sink and trash-area, removing a sharps disposal container.  The containers were then made of cardboard and one of the needles protruded enough to puncture my finger.  While I was a little worried, I did not develop any illness. 

Thanks to better disposal containers, this type of injury was engineered out.  Over recent years I recall observing a handful of sharps injuries centered around working with a needle or dental burr, even a surgical case involving a skin retractor. 
Fortunately, in the vast majority of exposures and subsequent blood-born infection, (e.g., HIV, Hepatitis B, Hepatitis C) is very small. It can take a considerable amount of infectious blood “injected” deeply, or exposed through a skin scrape, cut, or through mucous membranes or the eyes, to cause infection.  Those exposures didn’t involve much blood, and proper follow-up didn’t lead to any healthcare providers developing any blood-borne disease. 

A major factor decreasing the risk in the Winn Army Community Hospital beneficiary population is uniformed personnel and nearly everyone military age and younger, are tested periodically for HIV and all healthcare workers are vaccinated against Hepatitis B. Regrettably, there is no vaccine against Hep C, yet.

For medical procedures there is never a need to recap a needle. For dental procedures, I am only aware of one situation where recapping is still done, for now. Recapping is done before removing an anesthetic injection cartridge from the cartridge-holding device.  This should be a one-handed process to avoid any chance of sticking the other hand. You accomplish this by placing the cap, so it lies flat or inclined on a surface, then replacing the cap on the needle without using your other hand.  You can also place the cap it in a cap holder to keep the cap secure and upright.  You then place the needle into the cap using one hand.   Some of the holders are cardboard, while others are metal.

Hospital policy builds in training to lessen the threat of sharps injury infections.  Anyone who experiences a sharp injury should first attempt to squeeze the area to expel any blood, then thoroughly wash the area with soap and water.  Thoroughly rinse your eyes in case of blood or fluids exposure around the eye(s). Notify a supervisor and Occupational Medicine next.  The injured worker and supervisor should complete a Mishap Report and submit the report to the Supervisor Safety Office. The exposed person should, as soon as possible, report to Occupational Medicine during duty hours (7:30 a.m. To 4:30 p.m., Monday through Friday; or to the Emergency Department is the exposure is after hours, the weekend or holidays.
 
When possible, include the name and DoD ID Number of the “source” patient to include the date, and results, of their most current HIV test, hepatitis B vaccination date, and any other pertinent medical history that could indicate potential concern.  
Occupational Medicine will order blood samples to verify the patient is free of disease (Hep B, Hep C, and HIV).  We’ll advise the patient on their level of risk from the exposure; based on the current medical literature and guidance from the Defense Health Agency, and the Centers for Disease Control (CDC) and Prevention. 

We will also offer access to medication if there is a high risk of HIV infection. These must be started within 72 hours of exposure and taken daily for 28 days to reduce the risk of HIV transmittal. They can cause side effects, such as nausea. If not previously vaccinated a Hepatitis B immunoglobulin (HBIG) can be given, as well as Hepatitis B vaccination to mitigate the risk if exposed to it. This should be done within 24 hours, and before 7 days post-exposure. Risk of developing Hepatitis B is about 6-30% after a known infected source patient stick, if the “stuckee” was not vaccinated.  For HIV the risk is less than 1%
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No one “should” get sharps sticks, but until a combination of AI, and very agile robots, take over a lot of medical and dental functions, we need to be careful not to become “stuckees”.  
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