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- A blood or body fluid exposure that occurs as a consequence of a work-related activity - There are two types of blood and body fluid exposure:
Percutaneous exposure (penetrates the skin) e.g. needlestick injury (NSI) or cut with a sharp object such as a scalpel blade Non-percutaneous or mucocutaneous exposure (contact of mucous membrane or intact skin with blood or body fluids) e.g. blood splash to the eye
India it is largely underestimated The WHO estimates about 3 million of the 35 million health care workers worldwide are exposed to blood-borne pathogens each year
(including
- Contaminated sharps pose the greatest risk to healthcare workers of occupational exposure to blood borne viruses
How does transmission of a blood borne virus occur from a contaminated sharp?
- Transmission requires transfer of bloodcontaining material by injection or via sharp instruments through the skin - The risk of transmission is influenced by: Organism Volume of blood Status of source Status of staff member
Sharps Management
Institutions should follow Universal Precautions strictly to reduce incidence of NSI Universal precautions are intended to prevent the exposure of health-care workers and patients to bloodborne pathogens.
These must be practised in regard to the blood and body fluids of all patients, regardless of their infection status
Hand-washing before and after all medical procedures 2.Safe handling and immediate safe disposal of sharps: Not recapping needles; Using special containers for sharp disposals; Using needle cutter/destroyers; Using forceps instead of fingers for guiding sutures; Using vacutainers where possible 3. Use of protective barriers whenever indicated to prevent direct contact with blood and body fluid such as gloves, masks, goggles, aprons, and boots. 4.A HCP who has a cut or abrasion should cover the wound before providing care
The person who has used the sharp is responsible for its immediate safe disposal following use, preferably at the point of use.
Before use
After use
NEEDLE-PRICK INJURY ACCIDENTS MANAGEMENT 1. First Aid Measures 2. Immediate Follow-Up Actions 3. Filling in incident /accident report
the supervisor should complete Accident Report Form &sent it to Health and Safety Office through the Department within 72 hours Report of an accident arising out of and in the course of employment to an employee obtained from the HRD
By definition,
Post exposure prophylaxis (PEP) refers to the comprehensive management given to minimize the risk of infection following potential exposure to blood-borne pathogens (HIV, HBV, HCV).
HIV INFECTION
Percutaneous needle stick injury has an infectivity rate of 0.3 % The risk may appear trivial, however, it is a major concern for health care workers The chances of transmission of HIV were found to be higher
If blood is visible in device If needle is used in piercing artery or vein A deeper injury
EC3
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Drugs Used
Basic regimen: Zidovudine (AZT) 600 mg in divided doses (300mg/twice a day or 200 mg/thrice a day for 4 weeks
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Lamivudine (3TC) 150 mg twice a day for 4 weeks Expanded regimen:4 weeks therapy Basic regimen
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Indinavir 800 mg/thrice a day, or any other protease Inhibitor.
Remember.
Provide a pre-test and post-test counselling. HIV testing should be carried out on three ERS (ELISA/ Rapid/ Simple) test Refrain from donating blood, semen or organs/tissues and abstain from sexual intercourse. Women should not breast -feed their infants
Steps to be undertaken by the Infection control officer on receiving information about exposure:
1. All NSI should be reported to the State AIDS Control societies giving the Exposure Code and the HIV Status code. 2. The State AIDS Societies should in-turn inform NACO about the cases periodically.
3.
A register should be maintained in all hospitals and at the level of the State AIDS Control societies
4. NACO has decided to supply PEP drugs to all cases in government hospitals through the State AIDS Control societies 5. Infection control officers in all hospitals have been directed to ensure that PEP drugs are available at all times.
Hepatitis B Virus
HBV vaccination status of exposed person
Never vaccinated
Give complete hepatitis B vaccine series Hep B IV Ig , 0, 1 and 6 months of Hep B recombinant sub unit vaccine Give Hep B Vaccine Booster
Quick FACT:
HBV vaccination is recommended for all healthcare workers (unless they are immune because of previous exposure).
HCV infection
The incidence in health care workers is equal to general population However, it is a major occupational hazard No prophylaxis available against hepatitis C.
Post-exposure management for HCV is based on early identification of chronic HCV disease.
References
1. Queensland Health. Infection Control Guidelines. Appendix P3: Management of Blood and Body Fluid Exposure (updated 2006). Brisbane: Queensland Government. Centers for Disease Control and Prevention. Workbook for Designing, Implementing and Evaluating a Sharp Injury Prevention Program. 2004. Atlanta: US Department of Health and Human Services. Whitby R, McLaws M. Hollow bore needlestick injuries in a tertiary teaching hospital: epidemiology, education and engineering. Med J Aust 2002; 177(8): 418-422.
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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): 1-7.
Sources:
1. http://www.cdc.gov/niosh/2000-135.html
2. http://www.osha.gov/SLTC/etools/hospital/hazards/sharp s/sharps.html#NeedlestickInjuries