Hai

HAI : Hospital Acquired
Infections
Surgical Site Infections, etc.CAUTI,
VAP, NSI
Standard 4
The organization takes actions to
prevent and control Healthcare
Associated Infections(HAI) in
patients
Prevention of Hospital acquired Infections, 2nd edition, G, Ducel et al, World health organization ,2002, WHO/CDS/CSR/2002.12,
Standard 4a
The organization takes actions to
prevent Urinary Tract Infections
Catheter Associated Urinary Tract Infections
• It has been estimated that about 10% of hospitalized patients require urinary
catheterization
• UTIs following catheterization are the most common infections, accounting for up to
40% of all healthcare associated infections
• After catheterization, the risk of acquiring bacteriuria increases with time with an
average daily risk of 3-10% per day
• The overall incidence of bacteriuria in patients with an indwelling urinary catheter in
place for 2-10 days is 26% and nearly 100% in 4 weeks
• It is an estimate that up to 4% of bacteriuric patient will ultimately develop clinically
significant bacteraemia with a case fatality of 13-30%
• Risk factors for CA-UTI are:
* Increased duration of catheterization(i.e.>6 days)
* Female
* Older age
* Diabetes mellitus
* Malnutrition
* Azotaemia (creatinine > 2.0 mg/dL)
4
CDC - Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008
UTI Prevention Strategy-current strategies to prevent CA-UTIs are based on the
implementation of a ‘care bundle'. The catheter care bundle for the prevention of
CA-UTIs was developed by USA institute of health Improvement
Insertion care bundle Maintenance bundle
Avoid unnecessary catheterization Use aseptic technique for daily catheter care (e.g. hand
hygiene, sterile items/equipment)
Use sterile items/equipment Don’t break the closed drainage system. If urine specimen
required ,take specimen aseptically via the sampling port
Insert catheter using strict aseptic non Keep the drainage bag above the floor but below bladder
touch technique level to prevent reflux/contamination
Use closed drainage system Review the need for the catheter on a daily basis.
Chose catheter of appropriate size Remove catheter promptly when no longer necessary
Consider use of antimicrobial

impregnated catheters in high risk
patients requiring short term
catheterization (2-10 days)
5
Summary of strategies to prevent catheter associated UTI
Entry points for bacteria Preventive measures
1.External urethral meatus and urethra Pass catheter when bladder is full for wash out effect
Before catheterization prepare urinary meatus with an antiseptic

Bacteria carried into bladder during (e.g. 0.2% chlorhexidine aqueous solution or povidone iodine)
insertion of catheter
Inject single use sterile lubricant gel or use 2% lignocaine
anaesthetic gel into urethra and hold there for 3 min before
inserting catheter
Use sterile catheter

Use non touch technique for insertion
Ascending colonization/ infection up Keep periurethral area clean and dry; bladder wash and ointments
urethra around outside of catheter are of no value
Secure catheter to prevent movement in urethra
After faecal incontinence, clean area and change catheter
6
2. Junction between catheter and Do not disconnect catheter unless absolutely necessary
drainage tube
Always use aseptic technique for irrigation
For urine specimen collection, disinfect, sampling port by applying

alcoholic impregnated wipe and allow it to dry completely, then
aspire urine with sterile needle and syringe
3. Junction between drainage tube and

collection bag
Disconnection Drainage tube should be welded to inlet of bag during manufacture
Reflux from bag into catheter Drip chamber or non return valve at inlet to bag
Keep bag below level of bladder. If it is necessary to raise collection
bag above bladder level for a short period, drainage tube must be
clamped temporarily
Empty bag every 8h or earlier if full
Do not hold bag upside down when emptying
7

4.Tap at bottom of collection bag
Emptying of bag Collection bag must never touch floor
Always wash or disinfect hands with an alcoholic hand rub before

and after opening tap
Use a separate disinfected jug to collect urine from each bag
Don’t instill disinfectant/antiseptic into urinary bag after emptying
8
Maintenance of urinary catheter
• The date and time of catheter insertion/change should be documented in nursing or
medical note. Regular inspection of catheter and drainage system should be done
• Meatal cleansing should be performed at interval appropriate for keeping the meatus
free from encrustations and contamination. Meatal cleaning with antiseptic solution is
not necessary. Daily routine bathing or showering is all that is needed to maintain
meatal hygiene
• The bag and tubing must all the time be below the level of bladder so that flow can
be continuously maintained by gravity. Where dependent drainage cannot be attained
e.g. during moving and handling, clamp the urinary drainage tube and remove it as
soon as dependent drainage can be resumed
• The drainage bag should be emptied regularly via drainage tap at the bottom of the
bag to maintain urine flow and to prevent reflux. Hands must be disinfected and non
sterile single use gloves should be worn before emptying each bag.
• Alcohol impregnated swabs may be used to decontaminate the outlet (inside and
outside) before and after emptying the bag. When the bag is empty, the tap should be
closed securely and wiped with a tissue
• When emptying the bag use a separate container for each patient and avoid contact
between the drainage bah and container
9
Maintenance of urinary catheter
• The urine receptacle should be heat disinfected and stored dry after each use. Single
use disposable receptacle may be used.
• Routine bladder irrigation or washout with antiseptics or antimicrobial agents is not
recommended. If the catheter becomes obstructed and can be kept open only by
frequent irrigation, the catheter should be changed. However continuous or
intermittent irrigation may be indicated during urological surgery and should be
undertaken on the advice of urologist
• Condom use for 24 hours period should also be avoided and other methods such as
napkins or absorbent pads, used at night
• Sample of urine for bacteriological examination should be obtained from a sampling
port using aseptic technique. The sampling port must first be disinfected by wiping
with a 70% isopropyl alcohol impregnated swab. The sample than be aspirated using
a sterile small bore needle and syringe and transferred into a sterile container
• Urinary catheter should not be changed as long as they are functioning well. Culture
of urine sample after catheter removal is indicated only for patients where there is a
high degree of suspicion or symptoms suggestive of infection
10
Standard 4b
The organization takes actions to prevent
Ventilator Associated Pneumonia
• Healthcare associated pneumonia is hospitalized patients has a mortality
rate of up 40%
• The risk of developing VAP is estimated at 3% per day for the first 5
days of mechanical ventilation, 2% per day for days 6 to 10, and 1% per
day for every day beyond 10 day of mechanical ventilation
• In addition to high morbidity and mortality,VAP is associated with
greater time spent of the ventilator, and longer ICU and hospital stay
• Severely ill patients in ICU are at increased risk of colonization with
microorganism specially with gram negative bacilli
• The presence of invasive medical devices is an important contributor
because it causes mechanical and chemical injury to the ciliated
epithelium of the respiratory tract leading to loss of the first line defense
mechanism
12
• Healthcare associated pneumonia in hospitalized patients has a mortality
rate of up 40%
• The risk of developing VAP is estimated at 3% per day for the first 5
days of mechanical ventilation, 2% per day for days 6 to 10, and 1% per
day for every day beyond 10 day of mechanical ventilation
• In addition to high morbidity and mortality,VAP is associated with
greater time spent of the ventilator, and longer ICU and hospital stay
• Severely ill patients in ICU are at increased risk of colonization with
microorganism specially with gram negative bacilli
• The presence of invasive medical devices is an important contributor
because it causes mechanical and chemical injury to the ciliated
epithelium of the respiratory tract leading to loss of the first line defense
mechanism
13
Risk factors for hospital acquired and ventilator associated pneumonia
Patient related factors Medical interventions
Chronic lung /cardiopulmonary diseases Prolonged hospitalization
Extreme age (elderly or preterm neonate) Mechanical ventilation
Obesity or malnutrition Presence of foreign bodies, e.g. endotracheal and
nasogastric tubes
Chronic disease or impaired immunity Aspiration of gastric content due to depressed
consciousness (coma,CVA ,use of sedative or hypnotic
drugs)
Heavy smoker Achlorhydria,H2 antagonist, antacid therapy, proton
pump inhibitor
Difficulty breathing due to major trauma,
abdominal/thoracic surgery, neuromuscular disease
General anesthesia
Immunosuppressive or cytotoxic drugs
Severe illness,e.g. septic shock
14
Current strategies to prevent VAP are based on the implementation of a
“Care Bundle”
Regular observation Ongoing care
Elevation of the head of the bed to 30-450C Adherence to hand hygiene and
aseptic technique
Daily assessment of sedation with readiness Oral hygiene
to extubate
Gastric ulcer prophylaxis Subglottic suctioning of respiratory
secretion
Management of ventilator tubing
Appropriate humidification of inspired gas
Deep vein thrombosis prophylaxis
15
Major interventions used in prevention of VAP
Procedure/device Intervention to decrease risk
• Use single use disposable gloves and wash hands before and
Suctioning after the procedure
• Use sterile suction catheter and sterile fluid to flush catheter
• Change suction tubing between patients
• Use closed suction system, if possible
• Use single use disposable, if possible

Suction Bottle • Non disposable bottle should be washed with detergent and
allowed to dry or heat disinfect in washing machine or send to
sterile supply unit
16
Ventilator breathing • Replace mechanical ventilators, if soiled or malfunctioning
circuits • Periodically drain breathing tube condensation traps, taking
care not to spill it down the patients trachea; wash hands after
procedure
• Use HME (heat and moisture exchangers) ventilator circuits. if
possible
• Fill with sterile water only
Nebulizers • Change nebulizers between patients by using sterilization or a
high level disinfection or single use nebulizers if possible
17
Humidifiers • Fill with sterile water which must be changed every 24 hour or
sooner if necessary
• Clean and sterile humidifiers between patinets.Single use
disposable humidifiers are available but they are expensive
• After every patient, clean and disinfect ventilators

Ventilators • Sterilize/disinfect (high level) reusable components as per
manufacturer’s instructions
18
Standard 4c
intra vascular device infections
Catheter Related Bloodstream Infection
• Catheter related bloodstream infection (CR-BSI) is one of the most
important complications of venous access
• The risk of infection associated with these IV catheters can be
minimized by adherence to aseptic technique during and after catheter
insertion
• Risk of infection increases with duration of catheterization,IV catheters
should be used only when absolutely necessary and must be removed
when no longer needed
• Current strategies to prevent CR-BSI are based on the implementation of
a “care bundle”
• For detailed information refer to section of “Best Infusion Practices”
20
Care bundle to prevent catheter associated infection with peripheral IV
cannula
Insertion care bundle Maintenance care bundle
Avoid unnecessary cannulation Review need for catheter on a daily basis
Insert IV catheter using strict aseptic Inspect cannula on a daily basis for sign of
technique and use sterile items infection
Disinfect skin with 2% chlorhexidine gluconate Use aseptic technique for daily care (hand hygiene
in 70% isopropyl alcohol and allow it to dry before accessing the device and disinfect catheter
hubs)
Use a sterile,semipermeable transparent Replace cannula in a new site after 72-96 hour or
dressing to allow observation of insertion site earlier if clinically indicated
Record date of insertion in medical records Replace cannula immediately after administration
and cannulation site of blood/blood product and 72 hours after other
fluids
21
Care bundle to prevent central venous catheter infections
Insertion care bundle Maintenance care bundle
Use single lumen unless indicated otherwise Review need for CVC on a daily basis and remove
promptly if not required
Use maximal sterile barrier precautions during Inspect CVC site on a daily basis for sign of
insertion infection
Avoid femoral site; subclavian vein is the Use aseptic technique for daily care (hand hygiene
preferred site before accessing the device and use of sterile
single use of antiseptic solution to disinfect hubs)
Disinfect skin with single use sterile solution of

2% chlorhexidine gluconate in 70% isopropyl
alcohol and allow it to dry
Use a sterile,semipermeable dressing
22
Standard 4d
Surgical site infection
Surgical Site Infections
General measures to prevent surgical site infections
• Personnel working in the OT must ensure that standard infection control
precautions are implemented for every patients
• If the patient has already an infection then additional precautions may include
the use of experienced surgeons and operating teams to minimize the likelihood
of accidents and complications and the additional use of PPE.
• Surgical lists should be schedules on the basis of clinical urgency and
scheduling infected dirty) cases at the end of the day is recommended if possible
• Adequate time must be allowed to ensure that there is sufficient time for
cleaning and safe disposal of clinical /pathological waste between cases.
• Once the OR is clean and all the surfaces are dry,the OR should be used for the
next patient without delay
• Staff with bacterial skin infections or eczema should not be allowed in the
theatre until the lesion is treated and healed
24
General measures to prevent surgical site infections
• The number of staff in the OR must be kept to the essential minimum
• Door to OR should be closed at all times to maintain positive pressure and to
avoid mixing of the corridor dirty air with the OR clean air
• Outside clothing must be changed for clean, laundered OR attire/scrub suite
which is worn in the operating suite
• OR clothing should not be worn outside OT.OR gowns should be made of
waterproof fabric with an ability to breathe and should be comfortable to wear
• Current strategies to prevent SSI are based on the implementation of a “Care
Bundle”
Surgical site infections care bundle
1.Appropriate use of antibiotic
2.Appropriate hair removal
3.Postoperative glucose control (major cardiac surgery patients)
4.Posoperative normothermia (colorectal surgery patients)
25
Preoperative patient care
• Patients with preexisting skin lesions or infections in another site and treatment
with steroid and immunosuppressive drugs ,are more prone to get SSI due to
impaired host defense mechanisms. These should be treated/corrected before an
elective operation is planned
• Hair should not be removed at the operative site unless the presence of hair will
interfere with the operation. If hair to be removed then only the area needing to
be incised should be shaved
• For hair removal depilatory cream should be used day before the operation with
caution as it can cause serious skin irritation and rashes which may lead to
wound infection
• Alternatively hair can be removed with clippers in the anesthetic room
immediately before the operative procedure. If clippers are used then the clipper
head must be sterile
• Razors and shaving brushes must not be used for this purpose
26
Preoperative patient care
• Antibiotic prophylaxis is generally recommended in most of the cases.
• All antibiotic should be administered IV between 30-60 min before incision
(usually give at the time of induction of anesthesia ),2 hr are allowed for the
administration of IV vancomycin and fluoroquinolones.
• Vancomycin should not be used routinely for prophylaxis and should be
reserved on patients with MRSA
• Repeat dose of antibiotic should be given for the operation when the duration of
operation exceeds 3hr or in case of massive hemorrhage (>2L of blood is lost in
an adult). Do not give prophylactic antibiotic for more than 24hr; discontinue
within 48hr for cardiac procedures
• Prophylactic antibiotic dosage for adults: cefuroxime 1.5g IV (750mg if body
weight,50 kg),clindamycin 900mg IV;metronidazole 500mg IV and co-
amoxiclav 1.2 g IV
27
Postoperative patient care
• Postoperative stay should be minimized and patient discharge is advised as soon
as possible
• It is important that blood glucose level is controlled during immediate
postoperative period and it is maintained at less than 200mg/dL for the patient
undergoing cardiac surgery
• Staff should be trained in the appropriate method of dressing the wound.
Frequency of dressing should be kept to minimum and dressing should be
opened for 48hr after the operation unless infection is suspected
• The longer a wound is open and the longer it is drained the greater risk of
contamination.
• Postoperative infections acquired in theatre are usually deep seated and often
occur within 3 days of the operation or before 1st dressing
28
The organization provides adequate and
appropriate resources for prevention and
control of healthcare associated infections
Standard 5
• Adequate and appropriate personnel protective equipment
,soaps and disinfectants are available and used correctly
• Adequate and appropriate facilities for hand hygiene in all
patient care areas are accessible to health care providers
• Isolation /barrier nursing facilities are available
• Appropriate pre and post exposure prophylaxis is provided
to all concerned staff members
30
Occupational exposure to blood borne pathogens
• Occupational exposure (OE) to blood borne pathogens from needle

stick and other sharp object injuries (NSIs) is a serious problem
for all healthcare workers (HCWs) and yet many of these injuries
are preventable.
• There are at least 33 blood borne pathogens that can be transmitted

from a patient to a HCW as a result of an OE.
• The prevention of sharps injuries is an important step in preventing

the transmission of blood borne viruses to healthcare workers.
* Policy and Guidelines for the prevention of sharps injuries in the NSW public health system. PD2007_052, June 2007
Definition
• An occupational exposure that might place
a healthcare worker at risk for HBV, HCV,
or HIV infection is defined as:
– A percutaneous injury (e.g. a needle
stick or cut with a sharp object) or
– Contact of mucous membrane or non-
intact skin (e.g. exposed skin that is
chapped, abraded, or afflicted with
dermatitis) with blood, tissue, or other
body fluids that are potentially
infectious
Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV,
and HIV and Recommendations for Postexposure Prophylaxis. MMWR 2001;50(No. RR-11)
Seroconversion rates
Estimates of seroconversion rates following NSI (source +ve patient)
• 30% for HBV (HBsAg, HBeAg positive)
– Rate decreases significantly if immunized
• 1.8% - 3% for HCV, (depending on PCR status)
– No vaccine available, population prevalence increasing
• 0.3% for HIV
– PEP medication for life, serious side effects
• WHO has reported that the number of HCW infected after NSI / BBF
worldwide annually are:
– 21 mm HCW infected with HBV
– 2~4.5mm HCW infected with HCV
– 70,000~150,000 HCW infected with HIV
– 1.3 mm early deaths
Centers for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and
HIV and Recommendations for Postexposure Prophylaxis. MMWR 2001;50(No. RR-11)
NSI & BBF usually occurs in the following situations
• During and after an IV line insertion

• Recapping needles
• Sudden patient movement (children)
• Inappropriate disposal of Biomedical waste
• Transferring of body fluid from syringe to containers
• Failure to clean blood splashes off the lids of sharps container
Effective NSI Surveillance is critical
 Who? Job category of injured employee

 What? Device associated with the injury
 Where? Location where the injury occurred
 When? Before, during or after use of device
 How? Procedure associated with injury
Data drives targeted prevention strategies

Who is most at risk?
• Data from the CDCs National
Surveillance System for Healthcare
Workers (NaSH) show that Nurses,
Physicians and Laboratory
Technicians sustain the highest
number of per cutaneous injuries
• EPINet data (NSW Health): Nurses

= 40% sharps injuries
• 82% of all Blood/Body fluid

exposures reported to NaSH (1995-
2000) due to per cutaneous injuries
sourced from the Sharps Injury Prevention Programme Workbook, CDC 2004
Distribution of NSI / BBF amongst HCW’s
EPINet USA - 87 institutions - 1993-2001 - incidents:25,577

House keeping and laundry (4%)
Technicians (5%) Students (2%)
Laboratory (4%)
Others (8%)
Phlebotomists (5%) Staff physicians (6%)
Other assistants (4%)
OR Nurses (5%) Residents (9%)
Respiratory
therapists (2%)
Nurses ( 55%)
International Health Care Worker Safety Center, Univ. of Virginia

Where did the injury occur?
EPINet US - 87 institutions, 1993-2001, incidents: 25,577

Patient’s room (34%)
Other (9%)
Clinic (1%) Right outside

Disposal area (2%) patient’s room
(2%)
Laboratory (3%) Emergency
Procedure rooms (5%) Room (8%)
Outpatient clinics (6%)

ICU (7%)
OR (23%)
International Health Care Worker Safety Center, Univ. of Virginia

WHO Policy Principles
The most important response to the risk of occupational
exposure is to prevent it from occurring”
• Educating & informing of safe practices
• Identifying unsafe practice
• Ensuring usage and adequate supply of safety engineered devices
• Improving the safety of equipment
• Implementing quality control and monitoring systems
“Post-exposure prophylaxis to prevent HIV infection” Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection. WHO
2007 ISBN 978 92 4 159637 4
What needs to be done…
• Surveillance and pooled data
• Universal precautions awareness and regular education
• Provision to provide Post exposure management in all facilities and

ensuring implementation
• Effected healthcare worker needs to taken care of - counseling, treatment
• Use of safer devices and technology
• Policy to implement safety guidelines

Worldwide Needle stick and Sharp Object Injury estimates
• USA - CDC estimates 385,000 needlesticks

and other sharps related injuries each year
(hospital based HCWs only)1
• Canada – More than 69,000 sharps injuries

to HCWs every year
• UK - An estimated 100,000 HCWs suffer

needlestick injuries each year
• Australia – An estimated 13,000 sharps

injuries to HCWs every year2
What is the true magnitude

HCW surveys indicate 40% or more
underreporting rates of needlestick and
of the NSI problem??
other sharp object injuries
1. Estimates derived by combining data from the EPINet and NaSH networks
2. Report on the Inquiry into Nursing - The patient profession: Time for action. June 2002
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2002-04/nursing/report/ (Accessed 25 February 2008)
Immediate Management of NSI
• Bleeding should be encouraged. It should not be squeezed

This is the most important part of PEP
• Skin wounds should be washed with soap and running water
• No evidence that antiseptics are useful and caustic agents
(bleach) may do more harm than good
• Mucous membranes flushed thoroughly with water (no soap)
• Eyes should be irrigated with a liter of saline
Necessary documentation post exposure
• Name and data of source
• Time and date of exposure
• Nature of exposure (per cutaneous , non intact skin or mucous membrane)
• Body site exposed and contact time
• Infective state of the source, if documented
• For per cutaneous injuries, a description of the injury (depth of
wound, solid vs hollow needle, sharps etc.)
• Circumstances under which the exposure incident occurred
• Previous testing and immune status of the exposed HCW
Exposure To Hep B – HCW Management
HCW Vaccinated HCW Not Vaccinated
Antibody >10 iu/ml Antibody <10 iu/ml Immediate Vaccine –

(within 7 days) Along
with HBIg (0.06 ml/Kg)
No Addl
Treatment
Pt HBs Ag -ve Unknown Source Pt HBsAg +ve
HCP:Booster dose or HCP:Booster dose or

Complete series Complete series + HBIg
CDC-MMWR June 29, 2001 / Vol. 50 / No. RR-11

– Updated US PHS Guidelines for Management of Occup Exposure to HBV,HCV and HIV and
Recommendations for PEP
HEPATITIS C – POST EXPOSURE MANAGEMENT
• Determine status of Source (Anti-HCV)
• No Active Prophylaxis-Immunoglobulin's not effective
• Interferon not recommended for prophylaxis
• Blood Test immediately and at 6 mths
• LFT and Anti HCV at 4 – 6 mths
CDC-MMWR June 29, 2001 / Vol. 50 / No. RR-11

– Updated US PHS Guidelines for Management of Occup Exposure to HBV,HCV and HIV and
Recommendations for PEP
Post Exposure Prophylaxis- NACO guideline
Assessing Nature of Exposure
Three categories are described, based on the amount of blood/body fluid and the entry port .These
categories are intended to help in assessing the severity of the exposure, but may not cover all the
possibilities
Category Definition and example

Mild Mucus membrane/non-intact skin with small volume, e.g., a superficial wound
(erosion of the epidermis) with a plain or low calibre needle; contact with the eyes
or mucous membranes; subcutaneous injections following small bore needles.
Moderate Mucus membrane/non-intact skin with large volumes or percutaneous superficial

exposure with solid needle (e.g., a cut or needle stick injury penetrating gloves).
Severe Percutaneous with large volume, e.g., an accident with wide bore needle (>18G)
visibly contaminated with blood; a deep wound (haemorrhagic wound and/or very
painful); transmission of a significant volume of blood; an accidental injury with
material, which has previously been used intravenously or intra-arterially.
NACO Guidelines: Post Exposure Prophylaxis Guidelines for Occupational

Exposure
Assessing the HIV status of the source of exposure
HIV status of the source Definition of risk in source

HIV negative Source is not HIV infected (but consider HBV and HCV)
Low risk HIV positive and clinically asymptomatic

High risk HIV positive and clinically symptomatic
Unknown Status of the patient is unknown and neither the patient
nor his/her blood is available for testing

Exposure
PEP Medications/Regimen:
• PEP has its greatest effect if started within 2 hours of exposure. Ideally, therapy should be started
within 2 hours and definitely within 72 hours of exposure.
• Never delay starting therapy due to uncertainty. Re-evaluation of the expose person should be
considered within 72 hours post exposure, especially if additional information about the exposure or
source person becomes available.
• If the risk is insignificant, PEP could be discontinued, if already started. Exposed individuals who
are known or discovered to be HIV positive should not receive PEP.
Dosages of the Drugs for PEP for adults and adolescents- FDC of Tenofovir ( TDF) 300
mg plus Lamivudine (3TC) 300 mg plus Efavirenz (EFV) 600 mg once daily for 4
weeks. If the source is already on ART, start the exposed person the above mentioned
regimen at the earliest with proper counseling and then refer for an expert opinion

Exposure
Universal Precaution for Preventing Needle Stick Injury
• Proper hand hygiene

• Use personal protective equipment
• Avoid the use of needles where safe and effective alternatives
are available
• Avoid recapping needles
• Plan for safe handling and disposal before beginning any
procedure using needles
• Dispose of used needles promptly in appropriate puncture
proof sharps disposal containers
• Use devices with safety features.
Universal Precaution for Preventing Needle Stick Injury Cont’d…
• Report all NSI /sharps-related injuries and blood exposure

promptly to ensure that you receive appropriate follow up
care
• Tell the hospital about hazards from needles that you
observe in your work environment
• Participate in blood-borne pathogen training
• Follow recommended infection prevention practices,
including hepatitis B vaccination
• Regard all waste soiled with blood/body substances as
contaminated and dispose of according to relevant
standards
Usage of Safety Products
• Safety Device should offer

Robust safety from NSI
• A Plastic shield with no sharp edges
• Shield completely encapsulates the
needle tip
No unanticipated blood exposure
• Reduced risk of blood splash
• No Pooling in the clip
* Data on file, From a recent clinical study in Europe

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HAI : Hospital Acquired

Consider use of antimicrobial

Before catheterization prepare urinary meatus with an antiseptic

Use sterile catheter

For urine specimen collection, disinfect, sampling port by applying

3. Junction between drainage tube and

Entry points for bacteria Preventive measures

Emptying of bag Collection bag must never touch floor

Always wash or disinfect hands with an alcoholic hand rub before

Don’t instill disinfectant/antiseptic into urinary bag after emptying

Deep vein thrombosis prophylaxis

• Use single use disposable, if possible

• After every patient, clean and disinfect ventilators

Disinfect skin with single use sterile solution of

Use a sterile,semipermeable dressing

• Occupational exposure (OE) to blood borne pathogens from needle

• There are at least 33 blood borne pathogens that can be transmitted

• The prevention of sharps injuries is an important step in preventing

• During and after an IV line insertion

 Who? Job category of injured employee

Data drives targeted prevention strategies

• EPINet data (NSW Health): Nurses

• 82% of all Blood/Body fluid

EPINet USA - 87 institutions - 1993-2001 - incidents:25,577

International Health Care Worker Safety Center, Univ. of Virginia

EPINet US - 87 institutions, 1993-2001, incidents: 25,577

Clinic (1%) Right outside

Outpatient clinics (6%)

International Health Care Worker Safety Center, Univ. of Virginia

• Universal precautions awareness and regular education

• Provision to provide Post exposure management in all facilities and

• Effected healthcare worker needs to taken care of - counseling, treatment

• Use of safer devices and technology

• Policy to implement safety guidelines

• USA - CDC estimates 385,000 needlesticks

• Canada – More than 69,000 sharps injuries

• UK - An estimated 100,000 HCWs suffer

• Australia – An estimated 13,000 sharps

What is the true magnitude

• Bleeding should be encouraged. It should not be squeezed

HCW Vaccinated HCW Not Vaccinated

Antibody >10 iu/ml Antibody <10 iu/ml Immediate Vaccine –

Pt HBs Ag -ve Unknown Source Pt HBsAg +ve

HCP:Booster dose or HCP:Booster dose or

CDC-MMWR June 29, 2001 / Vol. 50 / No. RR-11

• Determine status of Source (Anti-HCV)

• No Active Prophylaxis-Immunoglobulin's not effective

• Interferon not recommended for prophylaxis

• Blood Test immediately and at 6 mths

• LFT and Anti HCV at 4 – 6 mths

CDC-MMWR June 29, 2001 / Vol. 50 / No. RR-11

Category Definition and example

Moderate Mucus membrane/non-intact skin with large volumes or percutaneous superficial

NACO Guidelines: Post Exposure Prophylaxis Guidelines for Occupational

HIV status of the source Definition of risk in source

Low risk HIV positive and clinically asymptomatic

NACO Guidelines: Post Exposure Prophylaxis Guidelines for Occupational

NACO Guidelines: Post Exposure Prophylaxis Guidelines for Occupational

• Proper hand hygiene

• Report all NSI /sharps-related injuries and blood exposure

• Safety Device should offer

* Data on file, From a recent clinical study in Europe

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