Post exposure measures taken after blood or needle stick injuries in healthcare facility and how to pevent

1. Dr. Moustapha A. Ramadan
Fellow of Community Medicine Department
Faculty of Medicine
Alexandria University

2. Means pathogenic microorganisms that are
present in human blood and can cause disease
in humans.
These pathogens include, but are not limited to,
HIV (Human Immune-deficiency Virus), HBV
(Hepatitis B virus), and HCV (Hepatitis C
Virus).

3. Means specific eye, mouth, other mucous membrane,
non-intact skin, or parenteral contact
with blood or other potentially infectious materials
that result from procedures or activities done in
health-care settings.

4. 3 million exposures per year in healthcare workers
37% of Hepatitis B
39% of Hepatitis C
4.4% of HIV
are due to needlestick injuries (50% of hospitalized
patients in sub-Saharan Africa are HIV +)

5. Virus Chance of HCW Infection
HBV 6 – 30 out of 100 people
HCV 3 – 10 out of 100 people
HIV 1 out of 300 people

6. Most exposures do not result in infection.
The risk of infection vary with :
 The pathogen involved
 The type of exposure
 The amount of blood involved in the
exposure
 The amount of virus in the patient's blood at
the time of exposure

7. 1% of hospital healthcare personnel have evidence
of HCV infection
CDC had received reports of 57 documented cases
and 138 possible cases of occupationally acquired
HIV infection among healthcare personnel in the
United States since reporting began in 1985 till 2001
Of the CDC documented cases of occupational
transmission of HIV, 90% were from contaminated
hollow- bore needles that pierced the skin

10. OSHA mandates
HBV vaccination
17,000
800
This regulation had the greatest impact in eliminating HBV
transmission among healthcare workers

11.  Elimination or substitution of sharps:
eliminate unnecessary injections, needleless IV
systems
 Engineering Controls
A-D syringes, safer needle devices
 Administrative and Work Practice
Controls
Universal Precautions, no recapping, provision &
placement & removal of sharps containers
 Personal Protective Equipment
gloves, masks, gowns,
Least
Effective
Most
Effective

12. Does not harm the recipient,
Does not expose the provider to any avoidable
risk,
Does not result in any waste that is dangerous for
other people

13.  Have sharp disposal container available
 Do not recap needles
 Do not manually remove the used needle
from the syringe
 Do not walk around the immunization area
carrying syringes
 Do not set needle/syringe down
 Do not manually sort medical waste

14.  Leak-proof
 Puncture-proof
 Clearly labeled with warning (easy for the
community to understand)
 Do not overfill (only 3/4 is safe)
 Do not transfer contents to other container

15. Unsafe
Safe

16. If an exposure occurs,
What should I do?

17. • Wash injuries and cuts with soap and water
• Flush splashes to the nose, mouth, or skin with
water
• Irrigate eyes with clean water or saline
• Remove contaminated clothing ( if necessary)
No scientific evidence shows that squeezing the
wound will reduce the risk of transmission of a
blood borne pathogen.

18.  Prompt reporting of the exposure incident to
the In-charge person or supervisor
 The incident report should include:
1. Time and date of incident
2. Location/ department
3. Source patient
4. Description of the incident

19.  Fear of being punished or fired
 Lack of awareness of risk of infection
 Lack of assurance of confidentiality
 Emphasis on patient care (unable to leave patient care
area for follow-up)
 No employee training on reporting procedures
 No post-exposure treatment/prophylaxis available

20.  Mechanism of injury
 Site of injury
 Amount and type of blood/body fluid
 Infectious status of source patient
 Susceptibility of exposed person
 Immediate action taken

21. Hepatitis B Virus
Employee Status HBsAg Positive HBsAg Negative Unknown
Unvaccinated HB Ig and initiate
vaccine
Initiate vaccine Initiate vaccine
Previously
vaccinated
No PEP No PEP No PEP
Know non
responder
HB Ig and re
vaccinate or HB Ig 2
doses
No PEP If know high risk,
treat as HBs Ag
positive
Antibody response
unknown
Test for anti HBs
If adequate no PEP
If inadequate
HB ig and vaccine
booster
No PEP Test for anti HBs
If adequate no PEP
If inadequate
Administer vaccine
booster and recheck
titre in 1-2 months

22.  HB IG should be administered as soon as
possible ( within 24 hours of exposure)
 If vaccine is indicated, it should be
administered as soon as possible ( within 24
hours of exposure)
 HB IG and vaccine can be administered
simultaneously but at a separate sites.

23. Hepatitis C Virus:
IG and antiviral agents are not recommended for
PEP after exposure to HCV positive blood.
Perform a baseline testing for anti HCV and ALT
activity
Perform a follow up testing (4-6 months).

24. HIV:
 If testing the source patient is delayed PEP
should start while awaiting the result.
 Serological testing for HIV at baseline, 6 week,
3 month, 6 month following exposure to
identify seroconversion

25. Risk assessment:
No
Yes
No
Yes
No
Yes
Yes
High Risk Incident
High Risk Body Fluid
High Risk Source
Prescribe PEP
Refer to ID physician
Evaluate drug toxicity
PEP not indicated
Reassure

26. Medications:
 Start within hours after exposure
 Combination therapy of 2 drug Truvada and
Isentress is recommended

27. Counseling:
 Refrain from blood/tissue donation
 Sexual intercourse should be protected
 Pregnant women should be advised against
breast feeding
 Razors and toothbrushes should not be shared

28. Prompt reporting is essential because, in some
cases, post exposure treatment may be
recommended and it should be started as soon
as possible.

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