Biological Risk in Medicine, Their Health Risk

8/8/2019 Biological Risk in Medicine, Their Health Risk

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Biological risks in medicine, their

health risks and how to avoid them

Robert Teir


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Table of contents

What are biological hazards?

How do health care workers (HCW) get

contaminated by biological hazards? Biological pathogens

Infection contol guidlines

Infections due to blood exposure to HCWaccidents

Postexposure statistics


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What are biological hazards?

Biological hazards, also known as biohazards,refer to biological substances that pose a threatto the health of living organisms. This can include

medical waste or samples of a microorganism,virus or toxin (from a biological source) that canimpact human health.

The term and its associated symbol is generally

used as a warning, so that those potentiallyexposed to the substances will know to takeprecautions.


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How do HCW get contaminated from

biological hazards?

Through breaks in the skin, cuts, scratches,

scrapes and open sores will all allow

microorganisms easy access to the body. Injection through contaminated sharps.

Animal bites will actively transfer any

microorganisms in the animals mouth into theperson bitten.


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Biological pathogens can be classified

into found different categories.

Hazard Category 1 - Unlikely to cause humandisease

Hazard Category 2-

Can cause human diseaseand may be a hazard to employees

Hazard Category 3 - Can cause severe humandisease and may be a serious hazard to

employees Hazard Category 4 - Causes severe human

disease and is a serious hazard to employees;


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Biological pathogens:

Bacillus subtilis, canine hepatitis, Escherichia coli, varicella,epatitis A, B, and C, influenzaA,Lymedisease, salmonella,mumps, measles, scrapie, dengue fever, and HIV anthrax, West Nile virus, Venezuelan

equine encephalitis, SARS virus, variolavirus (smallpox), tuberculosis, typhus, Rift Valleyfever, Rocky Mountain spotted fever, yellow fever,and malaria. Bolivian and Argentine hemorrhagicfevers, H5N1(bird flu), Dengue hemorrhagic fever, Marburgvirus, Ebola virus, hantaviruses, Lassa fever, Crimean-Congo

hemorrhagic fever, Among parasites Plasmodium falciparum, which

causes Malaria, and Trypanosoma cruzi, whichcauses trypanosomiasis, also come under this level.


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Infection control guidelines:

Staff education:

1. Instructions of dressing and undressing

2. Importance in following the rules andconsequences

3. Training on performing high risk procedures

4. On importance of monitoring and reportingof own health


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Dress and behavioral precautions

1. Airborne precautions using N95

masks/respirators2. Contact precautions

3. Eye protection

4. Hand cleaning5. Hand usage (do not touch ears or nose at work)

6. Care of disposal and excretions

7. No eating or drinking in wards

8. Staff coming into contact with patiends bodyfluids should immediatly take a showe


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A recall phone call has been shown an effectiveand straightforward method to improveimmunization rates


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Testing HCW.


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Some statistics

Around 3 million HCW are exposed to bloodevery year by accident

Gloves get tourn in 1:3 of the procedures

In every 15th surgical operation the skin getspunctured

The average transmission rates are highest forpercutaneous injuries from hepatitis B (22-31%)

Surgeons' shoes had evidence of blood andcontamination, with 63% of all surgeons havingblood-contaminated shoes.


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Collecting data from 60 U.S. hospitals, the center concludedworkers suffer approximately 384,325 sharps and

percutaneous injuries annually. The institute's tally on needlestick injuries per year among

healthcare workers is 800,000, the majority being nursesand physicians. Treating injuries costs between $500 and$3,000 per stick, according to the Occupational Safety and

Health Administration. The use of safety equipment was associated with a 20% to

30% reduction in the risk of injuries or near-miss incidents,respectively. Furthermore, nurses in hospitals with poorstaffing levels and work climate noted a 50% or greaterincreased risk of injuries.


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During 2002-2007, a total of 401 acute

illnesses associated with work-relatedantimicrobial pesticide exposures in health-

care facilities were reported

Occupations with the most cases werejanitors/housekeepers (24%), followed by

nursing/medical assistants (16%) and

technicians (15%).


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Table 3. Occupational death rate for various jobs, United States (in descending order)*

Occupation No. employed ( 103) Total deaths Death rate

Fisherman 39 46 1,179

Construction worker 8251,108 1,198 1,0811,452

Pilot 107129 102 791953

Military (active and reserve) 2,600 94 361

Truck driver 2,5443,365 530 157208Protective service 2,000 219 108

Firefighter 1,100 102 93

US workforce 136,000 5,780 42.5

Healthcare worker 6,2009,100 157353 1757

Sheetmetal worker 172207 8 3946

Bartender 339427 10 2329Lawyer 490920 6 714

Waiter 1,8931,981 9 5

*Numbers represent average of annual deaths during 3-year period, 20002002. Range of number employed reflects 2 different

federal databases (see text). Rates expressed per 1 million workers . [Kent A. Sepkowitz ]


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Postexposure prophylaxis (PEP)

Recommendations for HBV PEP managementinclude initiation of the HB vaccine series toany susceptible, unvaccinated person who

sustains an occupational blood or body fluidexposure. PEP with hepatitis B immuneglobulin (HBIG) and/or HBV series should beconsidered for occupational exposures after

evaluation of the HBsAg status of the sourceand the vaccination and vaccine-responsestatus of the exposed person.


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Postexposure prophylaxis (PEP)

Recommendations for HIV PEP include a basic 4-week regimen of two drugs (zidovudine andlamivudine) for most HIV exposures and anexpanded regimen that includes the addition of athird drug for HIV exposures that pose anincreased risk for transmission. When the sourceperson's virus is known or suspected to beresistant to one or more of the drugs considered

for the PEP regimen, the selection of drugs towhich the source person's virus is unlikely to beresistant is recommended.


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References

(1) http://en.wikipedia.org/wiki/Biological_hazard

(2)Gailiene G, Cenenkiene R.

Department of Infection Control, Hospital of Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, [email protected]

(3)

Updated U.S. Public Health Service Guidelines for the Manage-ment of Occupational Exposures to HBV, HCV,and HIV and Recommendations for Postexposure Prophylaxis, MMWR, June 29, 2001, Vol. 50, RR-11.

(4,5)[29] Quinley JC, Shih A. Improving physician coverage of pneumococcal

vaccine: a randomized trial of a telephone intervention. J Community

Health 2004;29:10315.

[30] Vilella A, Bayas JM, DiazMT, Guinovart C, Diez C, Simo D, et al. The

role of mobile phones in improving vaccination rates in travelers. Prev

Med 2004;38:5039.

(6)Seef LB, Wright EC, Zimmerman HJ, Alter HJ, Dietz AA, Felsher BF,

et al. Type B hepatitis after needle-stick exposures: prevention with

hepatitis B immune globulin: final report of the Veterans Administration

Cooperative Study. Ann Intern Med 1978;88:285-93. (7) c Rotter M. (1999). "Hand washing and hand disinfection". Hospital epidemiology and infection control 87.

(8) BAS H&S Procedure 10 - Biological Risk Assessment v1. Reviewed - 26 Jan 2005

(9,10)9. Ojajarvi J. Effectiveness of handwashing and disinfection methods in re-

moving transient bacteria after patient nursing. J Hyg 1980;85:193-203.

10. Parry MF, Hutchinson JH, Brown NA, Wu CH, Estreller L. Gram-

negative sepsis in neonates: a nursery outbreak due to hand carriage

of Citrobacter diversus. Pediatrics 1980;65:1105-9.

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Biological Risk in Medicine, Their Health Risk