This document provides guidelines for managing occupational exposure to bloodborne viruses (BBVs) such as hepatitis B, hepatitis C, and HIV. It discusses primary prevention through vaccination and standard precautions. It also outlines procedures for exposure incidents, including washing the exposure site, reporting the incident, evaluating the exposure and source, testing exposed individuals, and providing post-exposure prophylaxis when indicated. Counseling is recommended for exposed individuals. Employment implications for those infected with BBVs are also reviewed.
Hospital acquired infections: The different common sources of infection, their routes of spread and the growing antimicrobial resistance. Also includes a discussion on hospital Infection prevention and control guidelines and the universal and standard precautions.
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
Hospital acquired infections: The different common sources of infection, their routes of spread and the growing antimicrobial resistance. Also includes a discussion on hospital Infection prevention and control guidelines and the universal and standard precautions.
Central-Line-Associated Bloodstream Infections (CLABSI) pause a major health problem in hospitalized patients. This disease is associated with people with a central line/tube inserted through the skin into the large vein, which can be used to give medicines, fluids, nutrients, or blood products to patients in critical conditions. The disease occurs when microbes enter through the central line invading the bloodstream.
Fumigation is a process of gaseous sterilisation which is used for killing of micro-organisms and prevention of microbial growth in air, surface of wall or floor.
Definition of Isolation, Need of isolation, Types of Isolation, Mode Of Transmission Of Disease, Modes of Isolation, Types of precautions, Universal / standard precautions, Transmission based precautions, Advantages of Isolation, Disadvantages of Isolation, Isolation Ward in Hospital, Isolation Room in Hospital, Disease Wise Periods of Isolation Recommended etc.
A short brief on 'Hospital Acquired Infections' (HAI) or 'Nosocomial Infection' (NI) for M Phil, MPH and Advance Course in Hospital Management/ Administration
Needle stick injury and hazards of needle stickNCRIMS, Meerut
Needlestick injuries are wounds caused by sharps that accidentally puncture the skin.
Needlestick injuries are a hazard for people who work with hypodermic syringes and other needle equipment.
These injuries can occur at any time when people use, disassemble, or dispose of needles.
Fumigation is a process of gaseous sterilisation which is used for killing of micro-organisms and prevention of microbial growth in air, surface of wall or floor.
Definition of Isolation, Need of isolation, Types of Isolation, Mode Of Transmission Of Disease, Modes of Isolation, Types of precautions, Universal / standard precautions, Transmission based precautions, Advantages of Isolation, Disadvantages of Isolation, Isolation Ward in Hospital, Isolation Room in Hospital, Disease Wise Periods of Isolation Recommended etc.
A short brief on 'Hospital Acquired Infections' (HAI) or 'Nosocomial Infection' (NI) for M Phil, MPH and Advance Course in Hospital Management/ Administration
Needle stick injury and hazards of needle stickNCRIMS, Meerut
Needlestick injuries are wounds caused by sharps that accidentally puncture the skin.
Needlestick injuries are a hazard for people who work with hypodermic syringes and other needle equipment.
These injuries can occur at any time when people use, disassemble, or dispose of needles.
lecture submitted to healthcare workers ( physicians,dentists,nurses,lab.technicians) to explain the best methods to avoid transmission of hepatitis through health practices
Current managent of hepatitis B - Session 1NimzingLadep
This is the first of 3 sessions in the module covering a comprehensive overview of the management of hepatitis B virus infection. It discusses the introduction, presentation, symptoms and signs, as well as management of acute hepatitis B.
Chair, Paul Kwo, MD, AGAF, FACG, FAASLD, prepared useful Practice Aids pertaining to hepatitis B for this CME/MOC activity titled “HBV Is Primary! Your Role in the ‘Call to Action’ to Eliminate Viral Hepatitis By 2030.” For the full presentation, downloadable Practice Aids, and complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/3EYVafQ. CME/MOC credit will be available until March 21, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
1. Management of Occupational
Exposure to BBV
Dr. Faisal Al Hadad
Consultant of Family Medicine & Occupational Health
(ABFM, SBFM, MSc Occupational Health (UK
Incharge of Occupational Health
PSMMC
2. Outline
Primary
Prevention of Blood-borne infections
Management
of exposure to blood or body fluid
Management
of exposure to blood or body fluid
infected with BBV
Employment
infections
Implications of blood-borne
3. Primary Prevention of Bloodborne Infections
Vaccination
Standard
Precautions:
1) Hand hygiene
2) Use of personal protective equipment (e.g., gloves)
3) Safe injection practices
4) Safe handling of potentially contaminated equipment or
surfaces in the patient environment
5) Respiratory hygiene/cough etiquette.
4. Hepatitis B Vaccination
Any
person who performs tasks involving contact with
blood, blood-contaminated body fluids, other body
fluids, or sharps should be vaccinated against hepatitis B.
HCP
who have contact with patients or blood and are
at ongoing risk for percutaneous injuries should be
tested 1–2 months after completion of the 3-dose
vaccination series for anti-HBs
Booster
doses of hepatitis B vaccine are not necessary,
and periodic serologic testing to monitor antibody
concentrations after completion of the vaccine series is
not recommended.
5. Hepatitis B Vaccination
Non-responders
to vaccination who are HBsAg-negative:
- Considered susceptible to HBV infection
- Should be counseled regarding precautions to prevent
HBV infection
- Should obtain HBIG prophylaxis for any known or
probable parenteral exposure to HBsAg-positive blood.
6. Case Study
Nora is a 35 year-old Registered Nurse
experienced a needle-stick injury during
.night shift
What is the risk of HBV, HCV and HIV
?transmission
?What should Nora do in respect to this event
7. Risk of HBV, HCV and HIV Transmission
after Occupational Percutaneous Exposure
• HBV risk varies depending on e-antigen status of source
person
– If e-antigen positive, risk is up to 30%
– If e-antigen negative, risk is 1-6%
• HCV risk is 1.8% (range of 0 - 7%)
• HIV risk is 0.3% (range of 0.2 - 0.5%)
8. Management of Occupational
Exposure to Blood or Body fluid
Treatment
of exposure site : wash exposure site with
water ± soap. No evidence exists that using antiseptics
or squeezing the wound reduces the risk of BBV
transmission.
Inform
supervisor about the incident
Complete
Report
the exposure incident report
the incident to Preventive Medicine during
working hours and the A/E out of working hours.
9. Exposure Incident Report
Date and time of exposure
Details of the procedure being performed including where and how the
exposure occurred.
Details of the exposure including type and amount of fluid and the severity of
exposure (e.g. depth of injury, whether fluid was injected, skin integrity)
Details about the exposure source
- Infectious status
- Stage of the disease, HX of antiretroviral therapy and viral load if the source
is HIV-infected,
Details about the exposed person (Hepatitis B vaccination and vaccine
response status)
Details about counseling, post-exposure management, and follow-up.
10. Management of Exposure in
Preventive Medicine
Reviewing the exposure incident report
Evaluation of the exposure incident
Evaluation of the exposure source
Baseline screening of the exposed person for BBV
Follow up testing of the exposed person
Post-exposure prophylaxis
Counseling
11. Evaluation of the Exposure Incident
Factors to consider in assessing the need for follow up of
occupational exposures:
Type of body substance:
- Blood
- Fluids containing blood
- Potentially infectious fluid or tissue (semen; vaginal secretions; and cerebrospinal, synovial,
pleural, peritoneal, pericardial, and amniotic fluids)
- Direct contact with concentrated virus
Route of exposure:
- Percutaneous injury
- Mucous membrane exposure
- Nonintact skin exposure
- Bites resulting in blood exposure
Amount of exposure
12. Evaluation of the Exposure Source
The
person whose blood or body fluid is the source of an
occupational exposure should be evaluated for BBV
infection.
Information
available in the medical record at the time of
exposure or from the source person, might confirm or
exclude BBV infection.
If
the infectious status of the source is unknown, the source
person should be informed of the incident and tested for
serologic evidence of BBV infection.
Informed
consent must be obtained and confidentiality of the
source person should be maintained at all times.
13. Evaluation of the Exposure Source
Known exposure source
Test known sources for HBsAg, anti-HCV, and HIV antibody
Direct virus assays (e.g. tests for HIV RNA or HCV RNA) for routine screening
of source patients are not recommended
For sources whose infection status remains unknown, consider medical
diagnoses, clinical symptoms, and history of risk behaviors
Do not test discarded needles for bloodborne pathogens
Unknown exposure source
Evaluate the likelihood of exposure to a source at high risk for infection
14. Management of Exposure to HBV
Baseline screening of exposed person for HBV (HBsAg)
and immune status (anti-HBs).
Follow up testing if exposed person is not immune at time
of exposure:
- LFT at 6 weeks and 12 weeks
- HbsAg 12 weeks and 6 months
If exposed person is immune at time of exposure, followup for Hepatitis B is not indicated.
Post-exposure prophylaxis if indicated
16. Management of Exposure to HCV
For the person exposed to an HCV-positive source:
- Perform baseline testing for anti-HCV and ALT activity
- Perform follow-up testing (e.g., at 4–6 months) for anti-HCV and ALT
activity. If earlier diagnosis is desired, testing for HCV RNA may be
performed at 4–6 weeks.
If the source person is not infected with HCV, baseline testing or
further follow-up of the exposed person is not necessary.
Confirm all anti-HCV results reported positive by enzyme immunoassay
using supplemental anti-HCV testing (e.g. RIBA)
IG and antiviral agents are not recommended for PEP after exposure to
HCV-positive blood.
17. Management of Exposure to HIV
HCP
exposed to HIV should be evaluated within hours after
their exposure and should be tested for HIV at baseline.
HIV-antibody
testing should be performed for at least 6
months postexposure.
If
the source person is seronegative for HIV, baseline testing
or further follow-up of the exposed person normally is not
necessary.
HIV
testing should be performed on any exposed person
who has an illness compatible with an acute retroviral
syndrome.
20. HIV Post-exposure Prophylaxis
If
indicated, start PEP as soon as possible after an exposure.
Reevaluation
of the exposed person should be considered
within 72 hours postexposure, especially as additional
information about the exposure or source person becomes
available.
Administer
If
PEP for 4 weeks, if tolerated.
a source person is determined to be HIV-negative, PEP
should be discontinued.
21. Preferred Basic & Expanded Regimen
Basic
2-drugs PEP
- Zidovudine + lamivudine
- Tenofovir DF + emtricitabine
Expanded
3-drugs PEP
Basic regimen plus Lopinavir/ritonavir
22. Counseling for HCP Exposed to HBVor HCV-infected blood
Do not need to take any special precautions to prevent secondary
transmission during the follow-up period.
The exposed person does not need to modify sexual practices or
refrain from becoming pregnant.
If an exposed woman is breast feeding, she does not need to
discontinue.
They should refrain from donating blood, plasma, organs, tissue, or
semen.
23. Counseling for HCP Exposed to HIV
infected blood
Exposed HCP should be advised to use precautions to prevent secondary
transmission during the follow-up period:
- Exercise sexual abstinence or use condoms to prevent sexual transmission
and to avoid pregnancy
- Refrain from donating blood, plasma, organs, tissue, or semen.
- If an exposed woman is breast feeding, discontinuation of breast feeding
should be considered.
For exposures for which PEP is prescribed, HCP should be informed about
possible drug toxicities and the need for monitoring, and possible drug
interactions.
Exposed HCP should be advised to seek medical evaluation for any acute
illness suggestive of HIV infection during the follow-up period.
24. Employment Implications of Bloodborne Infection in RMH
Those
who are anti HCV+ve and PCR+ve should be
transferred to a non-high risk area.
Those
who are anti HCV+ve but PCR-ve can continue
their work since they are not dangerous .
Those
who are PCR-ve for two (2) consecutive tests,
one month apart, are considered free from Hepatitis C
Those
who received treatment for Hepatitis C and
declared cured with PCR-ve for six (6) months from
stopping the treatment are considered free from
Hepatitis C.
25. Employment Implications of Bloodborne Infection in RMH
Employees with positive HBsAg
If PCR is positive and viral load is more than 100,000 copies/ml
the employee should be prohibited from work in high-risk area
and transferred to a non-high risk area.
If PCR is negative or viral load is less than 100,000 copies/ml
twice one (1) month apart, the employee can continue working in
high-risk area, but should be followed up by PCR yearly.
Employees with positive HIV
Staffs who are HIV positive should be dealt with according to the
Government/RMH Policy .