Dr.T.V.Rao MD

1Dr.T.V.Rao MD

�� The term health care worker refers to any person working

in health care settings and who has the potential for exposure to infectious materials including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces or contaminated air . They include, but are not limited to, physicians, nurses, Laboratory technicians, therapists, pharmacists, nursing assistants, laboratory personnel, autopsy personnel, emergency medical service personnel, dental personnel, students and trainees

Who Is a Health care Worker

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What are Universal Precautions

Universal precaution are control guidelines designed to protect workers from exposure to Diseases spread by Blood and other Body fluids.

CDC

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Why Universal HealthPrecautions.

The concept of Universal Health Precautions emphasizes that all our

patients should be treated as though they have potential blood born infections, and can infect the caring health care workers.

( CDC )

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MODES OF TRANSMISSION of MODES OF TRANSMISSION of MODES OF TRANSMISSION of MODES OF TRANSMISSION of

Infections in Health CareInfections in Health CareInfections in Health CareInfections in Health Care� Puncture wounds or cuts

� Contact (touch, splash, or spray) with blood or OPIM on:� mucous membrane

� non-intact skin

� cuts, abrasions, burns

� acne, rashes

� paper cuts, hangnails

� contaminated sharps

�

Human materials/Tissues considered Highly Infectious

1 Blood most infectious

2 Semen

3 Vaginal secretions

4 C S F

5 Synovial fluids

6 Amniotic fluid

7 All other body fluids

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Not Infectious unless contaminated with Blood or Body fluids.

� Feces,

�Nasal secretions,

� Sputum,

� Sweat,

� Tears,

�Urine / Vomitus,

� Saliva unless blood stained.

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Universal Precaution Steps

�Gloves (Personal Protective Equipment)

�Decontamination

�Hand Washing

�Waste Disposal

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Use of Gloves

Use of a pair of disposable plastic gloves can protect if chances of contact with Blood or Body fluid is anticipated / inevitable.

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Step 1 Gloves...

Always wear gloves when

�Direct contact with body fluids is anticipated (nosebleeds, bleeding abrasions, etc.)

�Handling clothes soiled by urine, feces, vomit or blood

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Step 2 …Gloves…

� One time use.

� If gloves not immediately available, use barrier such as paper towels.

� When removing, peel off hands and roll glove outside in.

� Discard gloves in lined waste container.

� Wash hands after removing gloves.

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HAND WASHING

�There is no Health precaution like Hand washing.

�Washing with simple toilet soap - reduces the rate of transmission of common infections including the HIV.

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How to Wash our Hands

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Indications for Hand Washing

�In prolonged contact with patient.

�Before taking care of Immune supressed,New born infants, patients in ICU / ICCU, Dialysis Units, Burn’s Units.

�Before and after touching wounds.

�When Microbial contamination of Hands, likely to occur when in contact with mucous membranes, body fluids, and other secretions contaminated with Blood, and serous fluids.

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What to be used for hand washing

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

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

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

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Use of Mask, Cap, Eye Wear

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

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

�Most important in collection of swabs in Influenza

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Uses of Cap and Mask

Stringent use of Mask and Cap can save several Lives in the Hospital

Eg Swine flu

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Use of Foot wear

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

�Remember many of us have cracks on our feet.

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Use of Impervious Gown

A simple thin Plastic apron underneath the linen is of great help in preventing the soaking our inner clothes and exposure to harmful microbes.

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Disposal of Needles and Sharps

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

�Bending, Reshaping, should be prohibited.

�Do not recap the needles to avoid needle stick injures,

�All used Disposable syringes and needles should be discarded into Bleach solution at the work station before final disposal.

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Dealing with Used Needle

Shredding continues to be Important Method

Of dealing with used Needle

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You can Discard the Used Disposable Needles and Syringes in Bleached Solution

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SHARPS CONTAINERSSHARPS CONTAINERSSHARPS CONTAINERSSHARPS CONTAINERS

MUST BE:MUST BE:MUST BE:MUST BE:�closable and puncture closable and puncture closable and puncture closable and puncture resistantresistantresistantresistant

�leak proofleak proofleak proofleak proof

�labeled or colorlabeled or colorlabeled or colorlabeled or color----codedcodedcodedcoded

�functionalfunctionalfunctionalfunctional

�sufficient in numbersufficient in numbersufficient in numbersufficient in number

�easily accessible easily accessible easily accessible easily accessible and and and and

maintainedmaintainedmaintainedmaintained in upright positionin upright positionin upright positionin upright position

�replaced per agency policyreplaced per agency policyreplaced per agency policyreplaced per agency policy

�NOT be overfilledNOT be overfilledNOT be overfilledNOT be overfilled

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Accidental Exposure

�Alert your supervisor.�Complete employee injury report.

�Follow-up with District’s Worker’s Comp medical provider for confidential evaluation.

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Hazards of Needle stickInjuries

HIV , HBV and HCV viral infections can spread by Needle stick InjuriesNursing staff are at greater riskSeveral Injuries are preventable

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REPORTING AN INCIDENTREPORTING AN INCIDENTREPORTING AN INCIDENTREPORTING AN INCIDENT

�Date and time of incidentDate and time of incidentDate and time of incidentDate and time of incident

�Job classification Job classification Job classification Job classification ----

TechnicianTechnicianTechnicianTechnician

�Location in the worksite Location in the worksite Location in the worksite Location in the worksite

where incident occurredwhere incident occurredwhere incident occurredwhere incident occurred

�Work practice being Work practice being Work practice being Work practice being

followedfollowedfollowedfollowed

�Procedure being Procedure being Procedure being Procedure being

performedperformedperformedperformed

Minimal Information to ReportMinimal Information to ReportMinimal Information to ReportMinimal Information to Report

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MEDICAL EVALUATION POST EXPOSUREMEDICAL EVALUATION POST EXPOSUREMEDICAL EVALUATION POST EXPOSUREMEDICAL EVALUATION POST EXPOSURE

�Entitled to confidential

medical evaluation

�Personal decision about

blood testing

�Blood may be tested

only with consent

�Blood may be stored for

90 days, while

considering testing

� Interpretation of any test

results occurs with health

care provider

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BLOOD TESTINGBLOOD TESTINGBLOOD TESTINGBLOOD TESTING

� Blood may be tested for antibodies to:Blood may be tested for antibodies to:Blood may be tested for antibodies to:Blood may be tested for antibodies to:

� Human Immunodeficiency Virus Human Immunodeficiency Virus Human Immunodeficiency Virus Human Immunodeficiency Virus

(HIV)(HIV)(HIV)(HIV)

� Hepatitis C Virus (HCV)Hepatitis C Virus (HCV)Hepatitis C Virus (HCV)Hepatitis C Virus (HCV)

� Hepatitis B Virus (HBV)Hepatitis B Virus (HBV)Hepatitis B Virus (HBV)Hepatitis B Virus (HBV)

� Other diseaseOther diseaseOther diseaseOther disease----causing organismscausing organismscausing organismscausing organisms

� Source blood may also be tested with Source blood may also be tested with Source blood may also be tested with Source blood may also be tested with

consentconsentconsentconsent

� Results of tests of source blood will be Results of tests of source blood will be Results of tests of source blood will be Results of tests of source blood will be

made known to exposed personmade known to exposed personmade known to exposed personmade known to exposed person

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Dealing with Needle stickInjuries

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

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

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

�Anti retroviral prophylaxis, if necessary should started within 2 hours, ( if injury is from HIV positive or high risk group).

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Do not Recap Needles It can cause Needle Stick Injury

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Decontamination of Hospital Linen

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

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

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Spillage of Blood/Body fluids

� A common health hazard in the working environment.

� Never wipe the spillage with working wet mop.

Always cover the spills with Blotting paper and pour 1 % Hypochlorite or Bleaching powder to decontaminate the spills with HIV/HBV virus.

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Decontamination of Metal Instruments

�Hold all contaminated instruments with Gloved hands.

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

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

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

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Pregnant Health Care Workers

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

� Should adopt Universal Health Precautions with more dedication,

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

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

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Waste Disposal

� Bag and tie

� Place in second bag and tie again (double bag technique)

� Place all sharps (used needles) in sharps container.

�Wash hands after removing

gloves.

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Do Not Do It

�break, shear, bend or recap needles

� reach into used sharps containers

�pick up contaminated items, such as broken glass with bare hands

�use a vacuum cleaner to clean up contaminated items

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Do Not Do It

� pipette or mouth suction pipette or mouth suction pipette or mouth suction pipette or mouth suction blood or OPIMblood or OPIMblood or OPIMblood or OPIM

� eat, drink, smoke, apply eat, drink, smoke, apply eat, drink, smoke, apply eat, drink, smoke, apply cosmetics, or handle cosmetics, or handle cosmetics, or handle cosmetics, or handle contact lenses in areas of contact lenses in areas of contact lenses in areas of contact lenses in areas of potential occupational potential occupational potential occupational potential occupational exposureexposureexposureexposure

� store beverages or food store beverages or food store beverages or food store beverages or food in refrigerators, freezers, in refrigerators, freezers, in refrigerators, freezers, in refrigerators, freezers, or cabinets where or cabinets where or cabinets where or cabinets where blood, blood, blood, blood, other Samples are other Samples are other Samples are other Samples are preservedpreservedpreservedpreserved

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Operating on HIV/High risk groups

� It is a concern all should be cared equally.

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

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

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HIV HIV HIV HIV PREVENTIONPREVENTIONPREVENTIONPREVENTION

�There is no vaccine There is no vaccine There is no vaccine There is no vaccine

to prevent HIV to prevent HIV to prevent HIV to prevent HIV

infectioninfectioninfectioninfection

�Follow Universal Follow Universal Follow Universal Follow Universal

PrecautionsPrecautionsPrecautionsPrecautions

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Importance of Vaccination in Hepatitis B Infection.

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

�Every HCW is at risk of Contacting infection.

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

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Vaccination for HBV infection

� All HCW’s must take at least three doses of Vaccine, At 0 – 1 – 6 months. without discontinuation of the schedule.

� All Health care workers many not attain equal response.

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

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Problem of HBV vaccines in the Developing world

�Who pays for the Vaccine.

�Many who work in unorganized sector, do not get Institutional support of Vaccine.

�Life, at risk if Infected with HBV

�More Awareness to be brought in by Managers of the Hospitals, to promote to vaccinate their Employees.

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

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Every one is a Important Member of the Family

�Every health care worker is a Important member of the Family, one should take all possible Health Care precaution to save self and other Members of the Family

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�Created by Dr.T.V.Rao MD for ‘ e ‘ Learning resources for Medical and Paramedical Staff in the Developing

World� Email

� doctortvrao@gmail.com

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