GUIDELIESREGARDING HIV& Other Blood borne Pathogens invascular/Intervention al Radiology..
… This presentation will review what iscurrently known about the level of risk ininterventional radiology & compare that towhat is known for surgery which is probablythe medical specialty with the greatest risk . Accordingly , this review will focus o theblood borne agents HIV , hepatitis B virus(HBV) ,& hepatitis C virus (HCV).
#Body fluids considered infectiousor potentially infectious include : Blood Semen fluid Cerebrospinal fluid Vaginal fluid Synovial fluid Pleural fluid Pericardial fluid peritoneal fluid Amniotic fluid*STOOL IS INCLUDED ONLY IF VISIBLE BLOOD IS PRESENT.
Transmission of blood borne pathogensin the health care setting has beendocumented to occur throughpercuteneous exposure, mucousmembrane exposure , or contact withnon intact skin .
The risk of blood borne pathogen transmissionduring an interventional radiology proceduredepends on *the likelihood of a sharps injury or other parenteral exposure occurring during a procedure. *the prevalence of infection in the population. *the likelihood of establishment of infection after a parenteral exposure.
For a given exposure, the risk ofsubsequent infection or seroconversionis likely to depend on several factors.*The type of exposure (coetaneous, mucous membrane, orpercutaneous) .*The type and amount of fluid in the inoculums.*The viral titer in the source individual’s blood at the time.*His/her stage of illness, whether or not he/she isreceiving antiviral medication.*The number and concentration of infected cells circulating inhis/her blood at the time.*For sharps injuries, the type of instrument is alsoimportant: hollow-bore needles pose a higher risk thanother sharp Instruments.
the risk of seroconversion after a singlepercutaneous or mucous membraneexposure to HIV has been estimated at0.3%– 0.4% HBV is much more easilytransmitted: the risk of infection after asingle parenteral exposure can be as highas 30% . HCV is not as infectious as HBV, but ismore so than HIV: the risk of infectionafter a single parenteral exposure was 2.7%in one report.
PROCEDURE SAFETY: RECOMMENDATIONS AND REGULATIONSBarrier Devices and Personal ProtectiveEquipment: Standard precautions for all interventional radiology procedures should include: (a) hand washing with a germicidal and veridical agent before and after each case (immediately after removing gloves. (b) wearing appropriate protective clothing, including gloves, transparent face shield or a mask plus goggles with side protectors, and coverage of all areas of nonintact skin with a fluid-impermeable material
( c) It may be prudent to change gloves after90 minutes of wear whether a perforation isapparent or not.(d)Double-gloving is recommended whenbreaks in the skin are noted, and someindividuals may elect to double gloveroutinely.(f)When there is a risk of splashing ofblood or body fluids, such as whenremoving a vascular catheter at the end ofa procedure, eye and face protectionshould be worn, as well as gloves.
Procedural Precaution 1. Recapping of needles or resheathing of scalpel blades by hand is to be avoided whenever possible. If this is not possible, one of the following methods must be used: a :one-handed technique wherein the cap is “scooped up” with the point of the exposed sharp instrument. B: two-handed technique wherein the cap is held with a clamp or other mechanical device, not the operator’s fingers. 2. Immediately after being used, all disposable sharp instruments that may be reused during a given procedure should be placed into stable plastic devices designed for use on procedure trays
3. Members of the operating team should communicate verballyregarding the use and location of all sharp instruments.4.Sharp instruments should not be handed directly from oneteam member to another. Rather, the “no touch” methodshould be used, in which the instrument is set down onto astable surface by one team member, who then withdrawshis/her hand before the instrument is picked up by a secondteam member.5. Suturing should be performed only by using needleholders, never by holding or grasping the needle in one’sfingers. Palpation to locate or guide the needle tip shouldnever be done.6.Shrp Containers must be replaced before they are three-quarters full, or whenever items protrude from theopening.
Equipment Precautions1.Closed flush and waste containment systems shouldbe used for angiography.2. Drainage of large fluid collections should be done withuse of closed drainage sets. 3. Self-sheathing or needleless intravenous systems should be used whenever possible. 4. Glass syringes should not be used unless plastic syringes are not suitable. 5. Luer-lock fittings are preferred over the Luer- slip type for all syringes, connecting tubing, drainage systems.
Specimen Handling Precaution1. Gloves must be worn at all times when handlingspecimens.2. Specimens must be placed in clearly marked, sealedcontainers, which are then transported inside asecond sealed container (such as a bag) that is labeled“biohazard.”3. Facial splash protection (face shield, or mask andgoggles) must be worn when fluid samples areinjected into containers or poured from containers.