Injection Injuries

Introduction
A type of injury that can occur during inoculation is a needle stick injury. If the pig suddenly jumps or moves, a worker could accidentally be stuck by the needle. Needle stick injuries have also occurred when workers have carried syringes loaded with medication in their pockets.

OSHA Standard(s)
The Occupational Safety and Health Act (OSH Act) requires employers to comply with hazard-specific safety and health standards. In addition, pursuant to Section 5(a)(1) of the OSH Act, often referred to as the General Duty Clause, employers must provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm.

OSHA has previously used the General Duty Clause to cite employers where employees were exposed to cuts, punctures and injections causing increased risk of infection and/or immune reaction through poor handling practices of needles and scalpels when processing piglets, sows and hogs or administering medical treatment to hogs.

Other violations using the General Duty Clause related to needlesticks have included employees observed repeatedly straightening the 1.5" x 16 gauge needles in a pump syringe gun with their thumb; employees carrying multiple needles, new and recapped, in overall pockets of their uniforms; and employees not instructed on safe sharps handling practices such as avoiding the recapping of sharps and proper disposal of sharps.

Hazard
Needle stick injuries can be very serious. Certain antibiotics and other medications designed for animals can result in severe medical reactions, or even death, if they are injected into a person. Some products can cause tissue irritation or inflammation.

Vaccines in a mineral oil carrier can result in an inflammatory reaction when injected. The reaction is related to the volume injected (i.e. a small amount injected may result in little inflammation). A large volume of oil, such as in pig vaccine, requires treatment similar to those for conventional high pressure injection injuries (Couzens & Burke, 1995). The mineral oil used in veterinary vaccines can also cause a long-term chronic granulomatous reaction leading to abscess formation or tissue death if accidentally injected. Surgical procedures may be required to remove the oil to prevent chronic conditions or tissue death.

Because a potential risk exists for the transmission of diseases from animals to humans and because the OSHA standard does not cover all exposures to animal blood, it may be important to employers and employees working in facilities with animals to practice the principles of general industrial hygiene, including the institution of a hierarchy of controls. Standard precautions, good work practices, the implementation of engineering controls (e.g., sharps disposal containers, self-sheathing needles) and the use of personal protective equipment are means to prevent occupational exposures to animal blood and other potentially infectious materials. The American Veterinary Medical Association (AVMA) recommends voluntary compliance with OSHA’s bloodborne pathogens standard in order to best protect employees working in veterinary or other animal settings. See February 1994 journal article (JAVMA, Vol. 204, No. 3).

There are specific dangers faced by women who come into contact with reproductive hormones by needle stick or absorption. These drugs can disrupt the menstrual cycle and cause future reproductive issues and can also disrupt the normal cycle of pregnancy (cause miscarriage or prolong pregnancy).

Lutalyse, Prostamate, or Estrumate are administered by injection and are used to induce farrowing. If absorbed by a pregnant employee it can cause her pregnancy to be aborted.

Although PG600 and Oxytocin do not have any specific warning for female workers on their MSDS label (occupational exposures have not been fully investigated for oxytocin) they are still reproductive hormones and may be a risk to female workers. Oxytocin and and prostaglandins, when injected into women, have resulted in miscarriages.

[Do producers already know this? Could this paragraph be eliminated?-ms] PG600 is also administered by injection. PG600 is used to induce heat in non-cycling gilts or in healthy sows that are having trouble returning to heat after weaning. Oxytocin is injected into a sow while she is farrowing to strengthen the uterine contractions and aid in delivery.

Finally, Matrix comes in liquid form and is poured over sow’s feed. It is an oil-based product and is readily absorbed through the skin. Absorbing Matrix can prolong pregnancy. Women who may be pregnant, with known or suspected breast cancer, or undiagnosed vaginal bleeding should not handle Matrix.

If a female worker does not feel comfortable handling the reproductive hormone due to its effects, she may be exempt from this task. [what does “may be exempt” mean? Does it mean women of child-bearing years only? When wouldn’t she be exempt? If there were no men around to do the task? Who decides? I couldn’t find any kind of guideline or standard. – ms]

Prevention & Control
Employers are responsible for the safety of their employees and should have guidelines and training for sharps safety and to prevent needlestick injuries.

Develop a sharps handling plan. See Model Infection Control Plan for Veterinary Practices, 2006.

Needlestick Injury Prevention from the National and State Public Health Veterinarians (Jeff Bender gave verbal permission, to John Shutske, to use the material as long as it was properly cited.):

• Never remove needle caps by using your mouth.
• Do not recap needles except in rare instances when required as part of a medical procedure or protocol. Recapping causes more injuries than it prevents (67). When it is absolutely necessary to recap needles as part of a medical procedure or protocol, or if a puncture-proof, leak-resistant sharps container is not available, a mechanical device such as forceps can be used to replace the cap on the needle or the one-handed "scoop" technique may be employed (68). This technique involves holding the syringe with the attached needle or the needle hub alone (when unattached) and scooping or sliding the cap, which is lying on a horizontal surface, onto the needle’s sharp end. Once the point of the needle is covered, the cap is tightened by pushing it against an object, or by pulling the base of the needle cap onto the hub of the needle with the same hand holding the syringe.
• Dispose of all sharps in designated puncture-proof sharps containers.
• Dispose of the used syringe with attached needle in the sharps container when injecting live vaccines or aspirating body fluids. For most other veterinary procedures, use the needle removal device on the sharps container and dispose of the syringe in the regular trash.
• Sharps containers should be located in every area of the workplace where sharps are used.
• Do not transfer sharps from one container to another.
• Devices that cut needles prior to disposal should not be used because they increase the potential for aerosolization of the contents.
• Never dispose of sharps in the regular trash.
• Document the periodic evaluation of safe needle devices that may prevent recapping action.
• Develop, communicate and enforce standard operating procedures for safe sharps handling. Implement satellite locations of sharps containers to make immediate disposal of used sharps more convenient for employee practice.

Prevent accidental injection of medications or vaccines.

• Always read the package insert, the label, and the material safety data sheet (MSDS) for the medication being administered. This will give you important safety information.
• Assess your workers to make sure their employee can read and comprehend the information on MSDS as well.
• Develop a training plan that includes information delivery in written and verbal formats relevant to the MSDS, demonstration of the safety information and assessment for understanding (e.g. asking for a repeat demonstration or asking some questions), develop a policy for reporting and documentation of each needlestick injury.
• Develop and implement a protocol to ensure medical evaluation of all needlestick injuries [these 4 points not from above cited souce, added and based on OSHA citation and abatement measures -- ms].

Reinforce to your workers:
• Only use the product as directed.
• Never carry an uncapped needle in your pocket.
• Don’t use bent or damaged needles.
• Change needles often. [what does often mean for pig needles? what is "often"? This should be stated clearly such as "every x injections." -- ms]

Note: Workers whose duties involve giving shots to the animals – or administering medication at any time – should be instructed to immediately report any accidental injections of antibiotics or medications to their supervisor. In case of accidental injection, the employee should immediately wash the area with soap and water and report the incident to their supervisor. If the medication can cause serious reactions to humans, it will also be important to see a doctor. Deaths and severe medical reactions have been reported after accidental injections by humans of certain medications meant for animals. If an employee is accidentally injected with a medication and has a seizure, stops breathing, or has another severe reaction, immediately call 911 for professional emergency medical help.

Finally, when practical, consider using another less-hazardous antibiotics/vaccines.

Make copies of the MSDSs and have them available in various locations throughout the facility (e.g. near the phone, in areas where they are used, and at supervisor stations). In case of emergency, you will want to be able to provide the MSDS to emergency providers.