UNIVERSAL HEALTH UNIVERSAL HEALTH PRECAUTIONS andPRECAUTIONS and

Biohazards Biohazards To Health CareTo Health Care

WorkersWorkers

Dr.T.V.Rao MDDr.T.V.Rao MD

What are Universal PrecautionsWhat are Universal Precautions

Universal precaution are control Universal precaution are control guidelines designed to protect workers guidelines designed to protect workers

from exposure to Diseases spread by from exposure to Diseases spread by Blood and other Body fluids. Blood and other Body fluids.

CDC CDC

Why Universal healthWhy Universal healthPrecautions.Precautions.

The concept of Universal Health Precautions The concept of Universal Health Precautions emphasizes that all our patients should be emphasizes that all our patients should be

treated as though they have potential treated as though they have potential blood born infections, and can infect the blood born infections, and can infect the

caring health care workers. ( CDC )caring health care workers. ( CDC )

Human materials/Tissues Human materials/Tissues considered Highly Infectiousconsidered Highly Infectious

1 Blood1 Blood2 Semen2 Semen3 Vaginal secretions3 Vaginal secretions4 C S F4 C S F5 Synovil fluids5 Synovil fluids6 Amniotic fluid6 Amniotic fluid7 All other body fluids7 All other body fluids

Not Infectious unless contaminated Not Infectious unless contaminated with Blood or Body fluids.with Blood or Body fluids.

Feces,Feces,Nasal secretions,Nasal secretions,Sputum,Sputum,Sweat,Sweat,Tears,Tears,Urine / Vomitus,Urine / Vomitus,Saliva unless blood stained.Saliva unless blood stained.

HAND WASHINGHAND WASHING

There is no Health precaution like Hand washing.There is no Health precaution like Hand washing. Washing with simple toilet soap - reduces the rate Washing with simple toilet soap - reduces the rate

of transmission of common infections including the of transmission of common infections including the HIV.HIV.

How to Wash our handsHow to Wash our hands

Indications for Hand WashingIndications for Hand Washing

In prolonged contact with patient.In prolonged contact with patient. Before taking care of Immune supressed,New Before taking care of Immune supressed,New

born infants, patients in ICU / ICCU, Dialysis born infants, patients in ICU / ICCU, Dialysis Units, Burn’s Units.Units, Burn’s Units.

Before and after touching wounds.Before and after touching wounds. When Microbial contamination of Hands, likely to When Microbial contamination of Hands, likely to

occur when in contact with mucous membranes, occur when in contact with mucous membranes, body fluids, and other secretions contaminated body fluids, and other secretions contaminated with Blood, and serous fluids.with Blood, and serous fluids.

What to be used for hand washingWhat to be used for hand washing

In most circumstances Non medicated soaps In most circumstances Non medicated soaps and detergents are effective in removing most and detergents are effective in removing most transient contaminants. transient contaminants.

In demanding circumstances, in handling In demanding circumstances, in handling potentially harmful infections, use Ethyl or potentially harmful infections, use Ethyl or Isopropyl alcohol.Isopropyl alcohol.

Detergent formulations containing Chlorhexidine Detergent formulations containing Chlorhexidine Povidone,or Hexachlorophene are effective in Povidone,or Hexachlorophene are effective in prevention of spread of infections.prevention of spread of infections.

Words of Wisdom on HandWords of Wisdom on HandWashingWashing

Soap, water and Soap, water and

Common sense are still Common sense are still be Best Antisepticsbe Best Antiseptics

William OslerWilliam Osler

Use of GlovesUse of Gloves

Use of a pair of Use of a pair of disposable plastic disposable plastic

gloves can protect if gloves can protect if chances of contact chances of contact with Blood or Body with Blood or Body

fluid is fluid is anticipated/inevitable.anticipated/inevitable.

Use of Mask, Cap, Eye WearUse of Mask, Cap, Eye Wear

Will certainly protect Will certainly protect us from splashes of us from splashes of Blood or Body fluids.Blood or Body fluids.

Don't underestimate Don't underestimate the importance of Use the importance of Use of Cap and Mask.of Cap and Mask.

It equally protects our It equally protects our patients.patients.

Uses of Cap and MaskUses of Cap and Mask

Stringent use of MaskStringent use of Mask

and Cap can save and Cap can save several Lives in the several Lives in the

HospitalHospital

Use of Foot wearUse of Foot wear

Wearing foot wear covering entire sole Wearing foot wear covering entire sole protects the entry of Microbes from the protects the entry of Microbes from the contaminated floors with Blood and Body contaminated floors with Blood and Body fluids.fluids.

Remember many of us have cracks on our Remember many of us have cracks on our feet.feet.

Use of Impervious GownUse of Impervious Gown

A simple thin Plastic apron underneath the A simple thin Plastic apron underneath the linen is of great help in preventing the linen is of great help in preventing the

soaking our inner clothes and exposure to soaking our inner clothes and exposure to harmful microbes.harmful microbes.

Disposal of Needles and SharpsDisposal of Needles and Sharps

All used needles and sharps should be All used needles and sharps should be deposited in thick walled puncture deposited in thick walled puncture resistant containers.resistant containers.

Bending, Reshaping, should be prohibited.Bending, Reshaping, should be prohibited.Do not recap the needles to avoid needle Do not recap the needles to avoid needle

stick injures,stick injures,All used Disposable syringes and needles All used Disposable syringes and needles

should be discarded into Bleach solution should be discarded into Bleach solution at the work station before final disposal.at the work station before final disposal.

Dealing with Used NeedleDealing with Used Needle

Shredding continues to Shredding continues to be Important Methodbe Important Method

Of dealing with usedOf dealing with used

NeedleNeedle

Dealing with Needle stickDealing with Needle stickInjuriesInjuries

Consider all Needle stick injuries as a serious Consider all Needle stick injuries as a serious health hazard in the era of AIDShealth hazard in the era of AIDS

All events of Needle stick injuries to be reported All events of Needle stick injuries to be reported to the supervisory staff.to the supervisory staff.

Wash the injured areas with soap and water.Wash the injured areas with soap and water. Encourage bleeding if any.Encourage bleeding if any. Prophylaxis for prevention of HIV/HBV is top Prophylaxis for prevention of HIV/HBV is top

priority.priority. Anti retroviral prophylaxis, if necessary should Anti retroviral prophylaxis, if necessary should

started within 2 hours, ( if injury is from HIV started within 2 hours, ( if injury is from HIV positive or high risk group).positive or high risk group).

Avoid Needle Stick InjuriesAvoid Needle Stick Injuries

Hazards of Needle stickHazards of Needle stickInjuriesInjuries

HIV HBV and HCV viral infections HIV HBV and HCV viral infections can spread by Needle stick Injuries can spread by Needle stick Injuries

Nursing staff are at greater riskNursing staff are at greater risk

Several Injuries are preventableSeveral Injuries are preventable

Decontamination of Hospital LinenDecontamination of Hospital Linen

All the linen contaminated with Blood or All the linen contaminated with Blood or Body fluids should be soaked in 1: 100 Body fluids should be soaked in 1: 100 bleach solution for 30 minutes.bleach solution for 30 minutes.

Advised Autoclaving, as the most ideal Advised Autoclaving, as the most ideal procedure for decontaminating Linenprocedure for decontaminating Linen

Spillage of Blood/Body fluidsSpillage of Blood/Body fluids

A common health hazard in the working A common health hazard in the working environment.environment.

Never wipe the spillage with working wet Never wipe the spillage with working wet mop.mop.

Always cover the spills with paper and pour Always cover the spills with paper and pour 1 % Hypochlorite or Bleaching powder to 1 % Hypochlorite or Bleaching powder to

decontaminate the spills with HIV/HBV decontaminate the spills with HIV/HBV virus.virus.

Care of EndoscopesCare of Endoscopes

Endoscopes are delicate/precious Endoscopes are delicate/precious instruments.instruments.

Follow the instruction of Manufacturers.Follow the instruction of Manufacturers. It is commonly cleaned with 2 % It is commonly cleaned with 2 %

Glutaraldehyde solution.Glutaraldehyde solution.Specified time schedules to be followed to Specified time schedules to be followed to

decontaminate for HIV.decontaminate for HIV.Mycobacterium needs even > 2 hours for Mycobacterium needs even > 2 hours for

decontmination.decontmination.

Decontamination of Metal Decontamination of Metal InstrumentsInstruments

Hold all contaminated instruments with Hold all contaminated instruments with Gloved hands.Gloved hands.

Subject all metal instruments to washing Subject all metal instruments to washing with soap and water.with soap and water.

Treat all contaminated instruments with Treat all contaminated instruments with 2% Glutaraldehyde. For at least 30 2% Glutaraldehyde. For at least 30 minutes.minutes.

Many consider sterilizing in Hot air oven if Many consider sterilizing in Hot air oven if not sharp instruments.not sharp instruments.

Anesthetic Tubing's and otherAnesthetic Tubing's and otherEquipmentsEquipments

Since they are in intimate contact with Since they are in intimate contact with Human secretion need utmost attention in Human secretion need utmost attention in decontamination.decontamination.

Treat all Non disposable as highly Treat all Non disposable as highly hazardous, if used without safe practices hazardous, if used without safe practices can infect the next patient undergoing can infect the next patient undergoing procedures.procedures.

Soaking in 2 % Glutarladehyde is Soaking in 2 % Glutarladehyde is common practice in Developing world.common practice in Developing world.

Pregnant Health Care WorkersPregnant Health Care Workers

Not at more risk than other, Health care Not at more risk than other, Health care workers.workers.

Should adopt Universal Health Should adopt Universal Health Precautions with more dedication,Precautions with more dedication,

If neglected the Unborn is at grave risk of If neglected the Unborn is at grave risk of attaining congenital infections.attaining congenital infections.

The Laboratory supervisors should The Laboratory supervisors should monitor/ guide the HCW’s for adherence to monitor/ guide the HCW’s for adherence to scientific practices.scientific practices.

Operating on HIV/High risk groupsOperating on HIV/High risk groups

It is a concern all should be cared equally.It is a concern all should be cared equally. HIV infected carries the risk of being neglected HIV infected carries the risk of being neglected

at the time of crisis.at the time of crisis. Law many not change for equality but motivated Law many not change for equality but motivated

health workers should bring in change of health workers should bring in change of attitude.attitude.

Adherence of Universal Health precaution bring Adherence of Universal Health precaution bring in safety to all HCW.in safety to all HCW.

Follow the precautions even in Non HIV patients Follow the precautions even in Non HIV patients as some of our patients are in window period as some of our patients are in window period and more dangerous than truly positive with and more dangerous than truly positive with Sero testing.Sero testing.

Caution on Operating HIVCaution on Operating HIVSero Negative PatientsSero Negative Patients

Universal precaution apply to all our patients irrespective Universal precaution apply to all our patients irrespective of Blood tests we undertake.of Blood tests we undertake.

We handle so many patients in emergency situation with We handle so many patients in emergency situation with out any details.out any details.

Education on Universal precautionsEducation on Universal precautions

participation of you and educating your participation of you and educating your subordinates/Juniors will make a lot of Difference in the subordinates/Juniors will make a lot of Difference in the

work Environment.work Environment.

Precaution for Invasive ProceduresPrecaution for Invasive Procedures

All HCW’s who participate in invasive All HCW’s who participate in invasive procedures must routinely use appropriate procedures must routinely use appropriate barrier precautions.barrier precautions.

All Health care workers who perform/assist All Health care workers who perform/assist vaginal, and cesarean deliveries should wear vaginal, and cesarean deliveries should wear gloves and gowns when handling, the placenta, gloves and gowns when handling, the placenta, and the new born, till blood and amniotic fluid and the new born, till blood and amniotic fluid has been removed from infants. has been removed from infants.

Amniotic fluid is rich in HIV/HBV virus, in Amniotic fluid is rich in HIV/HBV virus, in infected mothers.infected mothers.

Handling Dentistry PatientsHandling Dentistry Patients

Blood,Saliva,Gingival fluid from all Dental Blood,Saliva,Gingival fluid from all Dental patients should be considered infective, patients should be considered infective,

Dental, workers should wear surgical Dental, workers should wear surgical mask, gloves and eye wearmask, gloves and eye wear

Caring Bleeding PatientsCaring Bleeding Patients

Primary health care workers who handle the Primary health care workers who handle the patients in Emergencies, and Accidents to be patients in Emergencies, and Accidents to be trained in basic principles of Universal Health trained in basic principles of Universal Health care precautions.care precautions.

Mouth to Mouth resuscitation is life saving in the Mouth to Mouth resuscitation is life saving in the Critically injured accident victims. May be Critically injured accident victims. May be neglected because of fear of HIV infection.neglected because of fear of HIV infection.

If the situation warrants, Bleeding from mouth If the situation warrants, Bleeding from mouth can be wiped out with clean cloth, or can be wiped out with clean cloth, or Handkerchief, and still one can do resuscitation.Handkerchief, and still one can do resuscitation.

Importance of Vaccination in Importance of Vaccination in Hepatitis B Infection. Hepatitis B Infection.

We have > 400 Million carriers with We have > 400 Million carriers with Hepatitis B infections.Hepatitis B infections.

Every HCW is at risk of Contacting Every HCW is at risk of Contacting infection.infection.

Vaccination is safe -Genetically Vaccination is safe -Genetically Engineered vaccination remains the great Engineered vaccination remains the great hope for prevention, apart from Major hope for prevention, apart from Major component of Universal precautions.component of Universal precautions.

Vaccination for HBV infectionVaccination for HBV infection

All HCW’s must take at least three doses All HCW’s must take at least three doses of Vaccine, of Vaccine,

At 0 – 1 – 6 months. without discontinuation At 0 – 1 – 6 months. without discontinuation of the schedule. of the schedule.

All Health care workers many not attain All Health care workers many not attain equal response.equal response.

High risk HCW’s should undergo High risk HCW’s should undergo estimation of anti HB s ( antibodies ) to estimation of anti HB s ( antibodies ) to know whether they were well protected.know whether they were well protected.

Problem of HBV vaccines in the Problem of HBV vaccines in the Developing worldDeveloping world

Who pays for the Vaccine.Who pays for the Vaccine.Many who work in unorganized sector, do Many who work in unorganized sector, do

not get Institutional support of Vaccine.not get Institutional support of Vaccine.Life, at risk if Infected with HBVLife, at risk if Infected with HBVMore Awareness to be brought in by More Awareness to be brought in by

Managers of the Hospitals, to promote to Managers of the Hospitals, to promote to vaccinate their Employees.vaccinate their Employees.

Never forget to take Hepatitis B Never forget to take Hepatitis B Vaccine if You are a HCWVaccine if You are a HCW

Majority of OSHA CDC, and NIOSH Majority of OSHA CDC, and NIOSH guidelines are incorporated.guidelines are incorporated.

Created for benefit of Medical and ParamedicalCreated for benefit of Medical and Paramedical Health care workers in the Health care workers in the

Developing worldDeveloping worldDr.T.V.Rao, MD Dr.T.V.Rao, MD

E mail : tvraodoctor2000@yahoo.co.inE mail : tvraodoctor2000@yahoo.co.in