PRECAUTIONS FOR HBs AG

1. Precautions for HBsAg
positive patient in operation
theatre
-RIYA SANJAY BAGHELE
-NAGPUR

2. Precautionsfor the HBsAg positivepatients
• There has been much discussion about the protection of staff operating of HBsAg
positive patients.
• The HBsAg status of the patient should be determined before the operation (with
patient’s consent). The theatre or labour ward staff should be informed so that
appropriate precautions can be made. It is advisable to schedule the patient at the
end of the operating list.
• All staff should wear protective clothing – double gloves, plastic aprons and eye
protection are recommended. Appropriate footwear should be worn to avoid contact
with splashed blood or body fluids.
• Equipment and staff should be kept to a minimum. Where possible avoid using
equipment which is difficult to sterilize, use as much disposable instruments as
possible. Inexperienced staff should be excluded.
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3. Precautionsfor HBsAgpositivepatientin ot
• All disposable items used during the operation eg. Administration sets, IV cannulae,
should be disposed of in the sharps container. The sharps container should be sealed
and disposed of as soon as possible after the procedure. All instruments should be
sent to the CSSD or TSSU after the operation. They should clearly be labelled as high
risk. Non-disposable items should not be incinerated as they can be sterilized. Linen
should be sent to the laundry marked as “infected linen”. There is no need for
incineration. Disposable suction tubing is preferred, where this is not available, the
tubing should be autoclaved after use.
• After the operation, all disposable, incinerable waste should be removed in clearly
labelled colour-coded bags. Surfaces should be washed with warm water and
detergent. Walls should be washed up to ahnd height with water and detergent. Blood
and body fluid spillages should be spotted with hypochlorite.
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4. Precautionsfor Hbsagpositivepatients in ot
• Heat -stable equipment should be sent for sterilization and
labelled “high risk”. Respiratory equipment should be disinfected
by heat or glutaraldehyde. Larger machines should be wiped with
warm water and detergent to remove organic contamination.
This is sufficient unless heavy soiling has occurred. In that
instance, they should be wiped with hypochlorite.
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5. General InfectionControl Measures
• Apply good basic hygiene practices with regular hand washing
• Cover existing wounds or skin lesions with waterproof dressings
• Avoid invasive procedures if suffering from chronic skin lesions on hands
• Avoid contamination of person by appropriate use of protective clothing
• Protect mucous membrane of eyes mouth and nose from blood splashes
• Prevent puncture wounds, cuts and abrasions in the presence of blood
• Avoid sharps usage where possible
• Institute safe procedures for handling and disposal of needles and other sharps
• Institute approved procedures for sterilization and disinfect surfaces
• Clear up spillages of blood and other body fluids promptly and disinfect surfaces
• Institute a procedure for the safe disposal of contaminated waste
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6. Spillageof bloodand bodyfluids
• Spillages should be dealt with as quickly as possible with latex gloves. The spillage
should be covered with hypochlorite granules (presept) or paper towels soaked with
hypochlorite solution (1000 to 10000 ppm). At least 2 minutes of contact time should be
allowed before the spillage is cleared and disposed of as clinical waste The surface is
then washed with warm water and detergent.
• Intravenous procedure must be performed with great care by an experienced
practitioner. Gloves and plastic aprons should be worn; eye protection is optional. A
closed system (Vacutainer) is recommended but if a hypodermic needle and syringe is
used, the whole unit must be discarded in a sharps container. Do not resheath needles.
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7. Staff protectionand immunization
• All staff working with category A patients (HBV, HIV) must be immunized against HBV.
Staff should have adequate training in the care of patients who are HIV or HBV
positive. Clear policies of safety, covering inoculation accidents must be available. All
inoculation accidents must be recorded and documented. Frequent lectures are
essential to allay fear and promote good moral.
• NEEDLE STICK INJURES : If a non-immunized member of staff sustains a needle-
stick injury from a e Ag positive HBV carrier, he should be offered HBIG and a course
of vaccine. If the source is not eAg positive, then a course of vaccine alone would be
sufficient. If the source is known to be HIV-positive, then AZT may be administered
within 24 hours of exposure and counseling should be offered.
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