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New microsoft office power point presentation

  1. 1. Dr. Deepak Gupta
  2. 2. Occupational Exposures and Sharps Management
  3. 3.  What is an occupational exposure?  A blood or body fluid exposure that occurs as a consequence of a work-related activity  There are two types of blood and body fluid exposure: ▪ Percutaneous exposure (penetrates the skin) e.g. needlestick injury (NSI) or cut with a sharp object such as a scalpel blade ▪ Non-percutaneous or mucocutaneous exposure (contact of mucous membrane or non-intact skin with blood or body fluids) e.g. blood splash to the eye
  4. 4.  What about human bites and scratches that break the skin?  For human bites, clinical evaluation must include the possibility that both the person bitten and the person who inflicted the bite were exposed to blood borne pathogens ▪ Transmission of HIV infection by this route has been reported rarely, but not after an occupational exposure.  The risk of transmission of a blood borne virus via a scratch is highly unlikely
  5. 5.  Why do I need to be concerned if I have an occupational exposure?  An occupational exposure potentially exposes healthcare workers to blood and other body fluids (except sweat), that may contain blood borne viruses ▪ Human ImmunodeficiencyVirus (HIV) ▪ Hepatitis BVirus (HBV) ▪ Hepatitis CVirus (HCV)  Contaminated sharps pose the greatest risk to healthcare workers of occupational exposure to blood borne viruses
  6. 6.  How does transmission of a blood borne virus occur from a contaminated sharp?  Transmission requires transfer of blood- containing material by injection or via sharp instruments through unbroken skin  The risk of transmission is influenced by: ▪ Organism ▪ Volume of blood ▪ Status of source ▪ Status of staff member
  7. 7.  What is the risk of transmission following a NSI to a positive source?  HIV ▪ 0.3%  HBV If healthcare worker susceptible (i.e. non-immune) ▪ 1% - 6% if the source is hepatitis B surface antigen (HBsAg)-positive ▪ 22% - 31% if the source is HBsAg- and HBeAg-positive  HCV ▪ 1.8% (range: 0% - 7%)
  8. 8.  Who is at risk of an occupational exposure?  All healthcare workers who have the potential for exposure to infectious materials (e.g. blood, tissue, and specific body fluids, as well as medical supplies, equipment or environmental surfaces contaminated with these substances) e.g: ▪ Nurses ▪ Doctors ▪ Laboratory staff ▪ Technicians ▪ Therapists ▪ Support personnel e.g. housekeeping, maintenance ▪ Dental staff ▪ Contractual staff ▪ Students
  9. 9.  Where, when and how do NSI occur?  Where? ▪ Inpatient units ▪ Operating rooms ▪ Emergency Department ▪ Procedure Room  When and How? ▪ During use ▪ After use and before disposal (including recapping) ▪ During or after disposal ▪ After appropriate disposal ▪ After inappropriate disposal
  10. 10.  What types of devices are involved in NSI?  Analysis of the results of a 10-year study at a large Queensland tertiary referral hospital revealed that two hollow-bore devices were implicated in over 90% of NSI 1 ▪ Disposable needle/syringes ▪ Steel-winged (butterfly) needles  Other types of hollow-bore needles include: ▪ Intravenous (IV) catheter stylets ▪ Multi-sample blood collection (‘vacutainer’) needles ▪ Arterial blood collection syringe needles ▪ Aspiration needles ▪ Injector pen needles
  11. 11.  Policies and procedures including NSI management  Standard Precautions including personal protective equipment (PPE)  Hepatitis B vaccination  Education programs  Modifications to work practices including alternatives to using needles  Safe handling of sharps  Sharps disposal systems i.e. puncture-resistant containers  Injury prevention features/safety devices  Active  Passive
  12. 12.  The person who has used the sharp is responsible for its immediate safe disposal following use, preferably at the point of use.
  13. 13.  Needles should not be recapped, bent or broken by hand, removed from disposable syringes or otherwise manipulated by hand.
  14. 14.  In the case of inappropriately disposed sharps, a sharps container should be taken to the location, the sharp handled and disposed of in a manner to avoid injury, and hands washed following disposal.  Report inappropriate disposal
  15. 15. A Percutaneous piercing wound;  typically set by a needle point  but possibly also by other sharp instruments or objects.
  16. 16. An occupational exposure is defined as:  a needle stick,  sharp puncture wound or  a splash to mucous membranes (i.e., mouth or eye) with blood or body fluids while caring for your clients.
  17. 17. High-risk procedures  All invasive procedures  Blood taking  Suturing  Giving injections  Inappropriate disposal of sharps.
  18. 18. High-risk procedures  Recapping needles (Most important)  Transferring a body fluid between containers.  Poor healthcare waste management practices
  19. 19. Risk factors for occupational exposure to body fluids include the following:  Failure to adhere to universal precautions  Using equipment designed without appropriate safety features  Performance of exposure-prone procedures
  21. 21. Guidelines  The post-exposure guidelines should address:  Immediate action  Follow-up action  Record keeping with standardized codes  Confidentiality
  22. 22. Guidelines  Bleed area for 3 – 5 minutes(controversial)  Wash site immediately with soap and running water  Disinfect area for 3 – 5 minutes with 10% iodized polyvidone (povidone iodine) diluted with 3 volumes of water or with a 0.5% chlorine bleach solution.
  23. 23. Guidelines  1:10 dilution of a 5% chlorine bleach solution or 1:6 dilution of a 3% chlorine bleach solution  Take a blood sample for baseline HIV, Hepatitis B surface antigen and Hepatitis C antibody status.
  24. 24. Guidelines  Pretest confidential counseling should be offered to the health care worker  If health care worker have not had Hepatitis B immunoglobulin vaccination, it should be considered
  25. 25. Guidelines  Generally PEP works best the first 3-24 hrs after the accident occurred.  It can also be started up to 72 hrs after the accident, but not effective after that.
  26. 26. Guidelines  Immediately encourage site bleeding while washing the wound and skin sites exposed to blood or body fluids.  Wash with soap and water or other antiseptics
  27. 27.  The need for tetanus and/or hepatitis B prophylaxis is based on medical history.  Health care workers should have been immunized against hepatitis B.  HepatitisA prophylaxis may (rarely) need to be considered depending on the source- patient situation.
  28. 28.  The need for HIV or chemoprophylaxis (antiretrovirals) is based on an assessment of the risk by using the 3-step process developed by the Centers for Disease Control and Prevention (CDC)
  29. 29. Step 1: Determine exposure code.  Is the source material blood, bloody fluid, other potentially infectious material, or an instrument contaminated with one of these substances? If not, there is no risk of HIV transmission? If yes, what type of exposure occurred?  If the exposure was to intact skin only, there is no risk of HIV transmission.
  30. 30. Step 1: Determine exposure code.  If the exposure was to mucous membrane or integrity-compromised skin, was the volume of fluid small (few drops, short duration) or large (several drops or major splash, long duration)? If small, the category is exposure code 1. If large, the category is exposure code 2.
  31. 31. Step 1: Determine exposure code  If the exposure was percutaneous, was it a solid needle or a superficial scratch (ie, less severe)?  If yes, the category is exposure code 2.
  32. 32. Step 1: Determine exposure code  Was it from a large-bore hollow needle, a device with visible blood, or  a needle used in a source patient's artery or vein (ie, more severe)?  If yes, the category is exposure code 3.
  33. 33. Step 2: Determine HIV status code.  What is the HIV status of the exposure source?  If HIV negative, no post exposure prophylaxis is needed.  If HIV positive, was the exposure low titer or high titer?
  34. 34. Step 2: Determine HIV status code.  Low-titer exposures are asymptomatic patients with high CD4 counts  These are HIV status code 1.
  35. 35. Step 2: Determine HIV status code.  High-titer exposures are patients with primary HIV infection, high or increasing viral load or low CD4 counts, or  AdvancedAcquired Immunodeficiency Syndrome (AIDS)
  36. 36. Step 2: Determine HIV status code  These are HIV status code 2.  If HIV status is unknown or the source is unknown, the HIV status code is unknown.
  37. 37. Step 3: Match exposure code with HIV status code  To determine if any post exposure prophylaxis is indicated.  Post exposure prophylaxis recommendation are as follows:
  38. 38. Exposure code 1 and HIV status code 1:  Post exposure prophylaxis may not be warranted.  Exposure type does not pose a known risk.  The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of post exposure prophylaxis
  39. 39. Exposure code 1 and HIV status code 2:  Consider the basic regimen.  Exposure type poses a negligible risk for HIV transmission.  A high HIV titer in the source may justify consideration of post exposure prophylaxis.
  40. 40. Exposure code 1 and HIV status code 2  The exposed health care worker and the treating clinician should decide whether the risk for drug toxicity outweighs the benefit of post exposure prophylaxis.
  41. 41. Exposure code 2 and HIV status code 1:  Recommend the basic regimen.  Most HIV exposures are in this category.  No increased risk for HIV transmission has been observed,  But use of post exposure prophylaxis is appropriate.
  42. 42. Created for benefit of Health care workers