Studies from dept. of community medicine, safdarjung hospital , delhi on occupational health hazards and Indian express journal on oocupational injuries of HCP s.
Safety measures in hcw
Safety Measures of Health CareProviders in TraumaDr. Soma Sekhara ReddyEmergency medicine
Objectives• Introduction• Types of injuries / exposures• Health hazards behind needle prick• Safety precautions and prophylaxis• Impending threat• Conclusion
Introduction• H C Ps , especially E.D. personnel , surgeonsare more vulnerable for infection whencarrying out their jobs.• E.D. staff – 2 fold risk“Bloodborne Infections in Emergency Medicine” revised in October 2000;April 2004; and April 2011
Types of injuries• Needle stick injuries• Contact of blood and OPIMs• Human bite injuries
Needle stick injuries• Most common occupational health accident• E.D – high risk• Hollow > solid needle• Interns and resident doctors are at higher risk forHIV infection
Incidence in different H C PsNurse43%Technician15%Student4%Dental1%Housekeeping/Maintenance3%Clerical /Admin1%Other5%Physician28%
Incidence in different jobsDuring SharpsDisposal13%During Clean Up9%In Transit toDisposal4%Handle/PassEquipment6%ImproperDisposal9%Access IV Line5%Transfer/ProcessSpecimens5%Recap Needle6%CollisionW/Worker orSharp10%ManipulateNeedle in Patient28%Other5%
Health hazards behind NSI Most common• HBV• HCV• HIV Other possible• CMV , EBV , PARVO VIRUS• Treponema• Yersinia• Plasmodium• Other hepatic viruses
VIRUS HBV HCV HIVRisk 5 – 40 % 3 – 10 % 0.2 – 0.5 %Vaccination Available no noP E P Vaccine + Ig no 2/ 3 drugregimenPrevention very good - good
HCV• HCV + HIV(studies by BERGER , Institute of medical virology)• As there is no vaccination and PEP for HCV only optionavailable is follow up and treatment .• Chronic carrier state , liver cirrhosis and cancer is more thanHBV
Contact of blood and body fluids• Always possible and also preventable.• More risk if abraded skin or wounds get exposed• Mucous membrane > skin• Immediately wash with soap and water orplenty of plain water in case of mucusmembranes
Bite injuries• Rare but possible• Potentially serious infection caused by rapidgrowth of bacteria in broken skin• Bacteria – StreptococciStaphylococciEikenella corrodensAnaerobes
Bite injuries - continued• 15 to 30 percent cases – infected• Infections that begin < 24 hours –Necrotising fascitis• Wash immediately with soap and water• If hands are involved – I.V. antibiotics are necessary
Universal Safety Precautions• Personal protective equipment– Gloves: always wear whenever using the needle– Gowns : Especially non permeable if available– Mask, protective eyewear ,face shield,foot wear:wear when splashes or droplets are likely .
vaccination• Most important precautionary measure• Prior HBV vaccination• Know the immune status• Unfortunately not available for HCV and HIV
• Plan for safe handlingand disposal beforebeginning of anyprocedure
• Report all NSIs and prompt others to do thesame• Educate your subordinates / colleagues /employers about risk of NSIs.
What to do..• Hold the affected limb down and get it to bleed• Don’t squeeze• Wash immediately with soap and water / sterilite• Report immediately to infection control board• Check the viral status of the source
Impending threat – under reporting• Acc. To WHO studyAvg no. of injuries – 0.2 to 4.7 injuries /1 hcw /1 yrIn India > 3 injuries / 1 hcw / 1 year• But injuries reported is far less than actual incidence
• Developed countries – nearly 40 %• India - > 70 %• More from physicians rather than nursing staff• Many are junior residents , internees and nursingstudentsOriginal article from community medicine -safdarjung hospital , New delhi, INDIA
• MIMS Statistics : -- 129 injuries were reported / 30 months- 21 doctors got injured• Is this statistics actual incidence / incidents reported ?• Whether actual incidence is low / under reporting ishigh?
conclusion• Every HCP should follow existing regulations andguidelines• When exposed immediately get evaluated andPEP to be taken if indicated• All HCPs should receive HBV vaccine and shouldbe tested for immunity after vaccination
• All contacts with blood and OPIM should beconsidered as potential HIV exposures.• NSIs are omnipresent.• Every incidence of injury should be notified toassure the follow up and further care.
Additional information• University of Virginia’s International HealthCare Workers Safety Center and its EPINetneedle stick injury data collection system:www.med.virginia.edu/~epinet• www.cdc.gov/niosh• OSHA Web page: www.osha.gov;for needlestick information, www.osha-slc.gov/SLTC/needlestick/index.html
References• Original article from community medicine -safdarjung hospital , New delhi, INDIA.• HealthLink BC File #97, April 2011 , England• ACEP Board of Directors titled, “HIV andBloodborne Infections in Emergency Medicine”, U.S.• Occupational Safety and Health Administration (OSHA)
• Centers for Disease Control and Prevention• National Institute for Occupational Safety andHealth – NIOSH , U.S.• ITLS text book