Protecting the Healthcare Worker From Blood Borne Infections

8/7/2019 Protecting the Healthcare Worker From Blood Borne Infections

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PROTECTING THEHEALTHCARE WORKERFROM BLOODBORNE

INFECTIONS

Prof. Khalifa Sifaw Ghenghesh

Dept. of Medical Microbiology

Faculty of Medicine

Al-Fateh University


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General Information

Infection Control Techniques:Cleanliness, Disinfection and

Sterilization.Not Costly and are of great

value. Due to amount of protection

providedStrongly supported by

organizations such as WHO, CDC and other health

agencies and professionalassociations.


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Bloodborne DiseaseTransmission

Important Bloodborne Diseases:

HBV, HCV and HIVAll have been transmitted in

occupational settings

Blood is the single mostimportant source

Protective measures:

Preventing exposure to blood

Receiving HBV vaccination


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Risk of HBV infection following aparenteral (i.e. needlestick or

cut) exposure:HBV transmission is greater

than for HCV or HIV

Directly proportional toprobability of:

blood containing HBsAg

Immunity status of recipient

Efficiency of transmission


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Probability of the Source of

Blood Being Positive for HBV

In General population in Libya:2.5-8%

In High Risk Groups: 5-15% Individuals from high endemicity

areas:

China, Southeast Asia, sub-Sahara Africa.

Clients in institutions for mentallyretarded.

IV drug users and homosexualactive males.

Household contacts of HBV carriers.


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Risk of Infection Following OneNeedlestick Exposure to Blood

From HBV infected patient:

6-30% (in individuals with noprior HB vaccination orpostexposure prophylaxis).

From HCV infected patient:

~ 3-10%From HIV infected patient:

< 0.3%


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Barrier Precautions

Healthcare workers must: Wear gloves when touching

mucous membranes, wounds,

blood and other body fluids orobjects contaminated with themor when carrying any invasiveprocedure.

Wash their hands and reglovethem before performingprocedures on another patient.

Never reuse a single pair of glovesor wash them between patients.


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Wear surgical masks and protectiveeyewear when splashing or spattering

of blood, saliva or other body fluids islikely.

Wear reusable or disposable gowns,laboratory coats, or uniforms whenclothing is likely to be soiled with

blood, or other body fluids. Gowns should by changed at least

daily or when visibly soiled withblood.

Reusable gowns should be washedusin normal laundr c cle.


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Types of Gloves

Disposable examination gloves: Made of vinyl or latex. For procedures involving contact with

mucous membranes. Sterile disposable gloves:

Used when sterility is necessary >during surgical procedures.

General purpose utility gloves: Used when cleaning instruments,

equipment, and contaminatedsurfaces.

Rubber household gloves are suitable,and can be decontaminated


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IMPORTANT

NEVER reuse surgical orexamination gloves.

Utility gloves may be reused if theyare not punctured or torn. Theyshould be properly decontaminatedbefore reuse.

If your gloves are torn, cut orpunctured, remove them immediat-ely and dispose of them properly.Then wash hands thoroughly withsoap and water and put a new pair

of gloves.


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IMPORTANT

Regardless of gloves type, makesure your gloves are intact before

using them. It is not necessary to double-

glove, as long as the glove isintact.


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EYEWEAR

You should wear mask or protectiveglasses or goggles, or chin-length faceshield to protect your self from spatter.

Wear facial protection whenever bloodor other body fluids may be spattered >during patient treatment, while cleaninginstruments or disposing ofcontaminated fluids.

Use new surgical mask for everypatient. If mask becomes wet duringtreatment, the mask should be replaced.

Wash reusable facial protectiveequipment with detergent and waterbetween patients and disinfect with

proper disinfectant.


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NEEDLESTICK PRECAUTIONS

Healthcare workers should takeprecautions to prevent injuries

caused by needles and other sharpinstruments.

1. A disposable syringe with adisposable needle:

Single use only Should not separate the disposableneedle from its disposable syringe.

Once used, SOULD be disposed ofimmediately and properly.

NEVER recap.


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2. A non-disposable aspiratingsyringe with a disposable needle:

One exception to the rule againstrecapping

Recap them using a one-handedtechnique > the cap stabilized by

forceps or appropriate device. OR by the scoop technique.


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Disposal of Sharp Instrumentsand Infectious Waste

Syringes and Needles:

- Disposable syringes and needles andother disposable sharp items shouldbe placed in puncture-resistantcontainers for disposal.

- The puncture-resistant container

should be located as close aspractical to the use area.


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Solid or Liquid Waste:

- Solid waste such as blood contaminated

gauze, cotton rolls, disposable gownsand masks should placed and secured inleakproof plastic bag.

- Do not contaminate the outside of thebag.

- Soiled linen should be washed with hotor cold water with detergent and, ifpossible, chlorine bleach. Normalwashing and drying cycles are used.


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- Handle soiled linen as little as possible.

- Wash your hands after handling soiled

linen.


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Management of Exposure

Occupational exposure is defined as: Contact with blood, tissues or other body

fluids to which universal precautions apply,

including laboratory specimens that containHIV, HBV or HCV with:

1. An injury to the skin *e.g. needlestick orcut with sharp object).

2. Mucous membranes, or

3. Skin (especially when exposed skin is

chapped, abraded, or afflicted withdermatitis, or the contact is prolonged orinvolves an extensive area).

The source patient should be informed andtested for serological evidence for HIVinfectios, HBsAg and HCV antibodies afterconsent is obtained.


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Postexposure Management:Wound Care

Clean wounds with soap and water

Flush mucous membranes withwater

No evidence of benefit for: application of antiseptics or

disinfectants

squeezing (milking) puncture sites

Avoid use of bleach and otheragents caustic to skin


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Postexposure Management:

The Exposure Report

Date and time of exposure

Procedure detailswhat, where,how, with what device

Exposure details...route, bodysubstance involved,

volume/duration of contact Information about source

person and exposed person

Exposure management details


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Recommended Postexposure Management:PEP for Exposure to HBV

Treatment when source is nottested or status unknown

HBIG x 1 and initiatehepatitis B vaccine series

No treatment If known high-risk source

treat as if source were

HBsAg positive Test exposed person for

anti-HBs1. If adequate, no treatment2. If inadequate, vaccinebooster and recheck titer in1-2 mos

Vaccination and antibodystatus of exposed person

Unvaccinated

Previously vaccinated

Known responder

Known nonresponder

Antibody responseunknown


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Postexposure Managementfor HCV

IG, antivirals not recommended forprophylaxis

Follow-up after needlesticks, sharps, ormucosal exposures to HCV-positiveblood Test source for anti-HCV

Test worker if source anti-HCV positive anti-HCV and ALT at baseline and 4-6 months

later

For earlier diagnosis, HCV RNA at 4-6 weeks

Confirm all anti-HCV results with RIBA

Refer infected worker to specialist formedical evaluation and management


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Protecting the Healthcare Worker From Blood Borne Infections

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