1. DR.VIBHA BHARGAVA

2. The Story of Ranjita Raje
 A 26 year-old nurse with occupationally acquired AIDS
 Detected accidentally, in a routine check up
 In 2002, approached the Municipal Nursing and Paramedical
Staff Union for help
 Initially, hospital management promised to consider the
demand, but in 2003 refused to take her back
Could this have been prevented ?
Is she entitled to compensation?
And, is Ranjita entitled to costs of
treatment?

3. Healthcare Worker Safety
While safety is mandated in all walks of life, is healthcare worker
safety amongst our highest concerns?

4. How the Healthcare Worker gets
Exposed to Blood and Body Fluids
 Percutaneous Exposure to blood or other body fluids by
 Needle stick
 Through a cut with a contaminated object
 Mucocutaneous Exposure through blood/body fluid splash on
 non-intact skin
 wounds and/or mucosa (eye, ear, nose)

7.  The majority of needlesticks occur when
health care workers:
 Dispose of needles
 Administer injections
 Draw blood
 Recap needles
 Handle trash and dirty linens
Source: Chiarello, 1992

8. When Do Needlesticks Happen?

9. Common Pathogens Transmitted by
Exposure to Blood and Body Fluids
 Corynebacterium diphtheriae
 Dengue
 Hepatitis B
 Hepatitis C
 Hepatitis G
 Herpes simplex
 Herpes zoster
 HIV
 Malaria
 Mycobacterium tuberculosis
 Plasmodium falciparum
 Staphylococcus aureus
 Streptococcus pyogenes
 Syphilis

10. 0%0%
5%5%
10%10%
15%15%
20%20%
25%25%
30%30%
35%35%
0.30%
1%-10%
9%-30%
Hepatitis B Virus Hepatitis C Virus HIV
Antiretroviral Therapy Guidelines for HIV-Infected Adults and Adolescents
Including Post-exposure Prophylaxis – NACO, May 2007
Risk of Transmission of Infection Following
Exposure to Blood and Body Fluids

11. Occupational Risk of Hepatitis
C:
 HCV - major cause of chronic liver
disease
 No vaccine
 No effective post-exposure prophylaxis
 85% of HCV infected people develop
chronic infection
Source: CDC, 1997; NIH, 1997

12. Global Incidence Rates of Exposure
to Blood and Body Fluids
 Data collection done through EPINet software (Exposure
Prevention Information Network)
 Developed by Professor Janine Jagger at International
Healthcare Worker Safety Centre, University of Virginia,
in association with BD
 Allows collation of data - How and where exposures are
occurring → helps to develop targeted prevention
strategies
 Before & after data to measure effectiveness of
prevention strategies

13. Health Care Workers Exposed to Blood and
Body Fluids – by Category
Staff physicians (6%)
Residents (9%)
Respiratory
therapists (2%)
OR Nurses (5%)
Other assistants (4%)
Phlebotomists (5%)
Laboratory (4%)
Technicians (5%)
Others (8%)
Students (2%)
House keeping and laundry (4%)
International Health Care Worker Safety Center, Univ. of Virginia
EPINet USA - 87 institutions - 1993-2001 - incidents:25,577
Nurses ( 55%)

14. Patient’s room (34%)
Right outside
patient’s room
(2%)
Emergency
Room (8%)
ICU (7%)
OR (23%)
Outpatient clinics (6%)
Procedure rooms (5%)
Laboratory (3%)
Disposal area (2%)
Clinic (1%)
Other (9%)
EPINet US - 87 institutions, 1993-2001, incidents: 25,577
International Health Care Worker Safety Center, Univ. of Virginia
Health Care Workers Exposed to Blood and
Body Fluids – by Area of Deployment

15. Health Care Workers with HIV acquired at workHealth Care Workers with HIV acquired at work
Numberofcases
Cumulative cases * 1992Cumulative cases * 1992--20012001
( BD introduced Safe IV catheters in US in mid nineties )( BD introduced Safe IV catheters in US in mid nineties )
Source: U.S. Centers for Disease Control and Prevention. For years 1992 through 1999: HIV/AIDS Surveillance Report, year-end reports.
For 2000-2001: Fact Sheet: Health Care Workers with HIV/AIDS, pub’d on-line at: www.cdc.gov/hiv/pubs/facts/hcwsurv.htm.

16. Indian Scenario on Incidence of
Blood and Body Fluid Exposure
1. Highlights of 1st
Published Indian EPINet Data – Indian
Journal of Medical Sciences, Dec 2010 – Authors
Murali Chakravarty, Sanjeev Singh, Anita Arora,
Sharmila Sengupta, Nita Munshi
 Data from 4 Indian Hospitals located in 4 major cities over
2 years
 Major sources of sharps injury:
 Needle on a disposable syringe - 42%
 Stylette of IV cannula - 9%
 Needle without syringes / on IV drip sets - 9%
 77% of the sharps injuries occurred, due to lack of safety
mechanisms in devices

17. Indian Scenario on Incidence
of Blood and Body Fluid
Exposure
2. Needlestick Injuries in a Tertiary Care Centre in Mumbai,
India – Journal of Hospital Infection, 2005 – Authors A.
Mehta, C. Rodrigues, S. Ghag, F. Dastur and S. Iyer
 Nursing staff is most highly affected upto 45%
 Use of safer devices should be considered as one of the main
approaches along with educational and immunisation programs
for reducing occupational infection risk
3. Needle stick injuries & the health care worker – the time to
act is now – Indian Journal of Medical Research, Mar 2010
– Author Camilla Rodrigues
 The incorporation of safer needle devices (SNDs) and better
utilization of safety devices such as needleless sets, safety
cannula, self-capping intravenous catheters, self retracting
lancets for blood glucose monitoring, auto disposable syringes
certainly help in reducing injuries

18. Direct Costs
 Cost of baseline and follow-up laboratory testing of
an exposed healthcare worker and testing the source
patient
 Cost of post-exposure prophylaxis (PEP) and other
treatment that might be provided
 These costs may range from Rs 15,000 to Rs 1
lakh/incidence of exposure to blood and body fluids
Financial Implications of Clinical Risk

19. Financial Implications of
Clinical Risk
Indirect Costs
 Emotional distress
 Lost productivity
 Healthcare provider time to evaluate and treat an employee
and the source patient
 Reduced quality of life
 Loss of precious human lives

20. While there are financial
implications, but at the end
of the day, we cannot put a
price to a precious human
life
Can we ?

22. All the staff must take
utmost care to avoid NSI
 Recapping of the needles is prohibited as this is
the most common cause of NSI. The needles
after use should immediately be discarded in the
Sharp Box.
 Follow standard precaution -To reduce the risk
of exposure to potentially infective material for
patients and health care workers.

23.  Hands must be washed thoroughly after
contact with blood or body fluids/substances,
secretions, excretions and contaminated
items, whether or not gloves are worn.
 Use Personal Protective barriers
 Staff members with cuts or abrasions on
exposed parts of the body must cover with a
water proof dressing at all times whilst on
duty.

25. Safer Needle Devices

27. Management of Needle stick injury
 Encourage the blood to flow freely by itself without
squeezing forcefully.
 The wound should be washed with plenty of running
water and soap. Do not scrub vigorously. (Alcohol based
hand rinses or foams 60% - 90% alcohol by weight, should be used
when water is not available.)
 Exposed mucous membranes should be flushed with
plenty of water; spit out, rinse with water and spit out
again if blood or body fluids gets into mouth; flush the
eyes preferably with sterile normal saline, or under the
eye-shower.

28.  Report to MO in Emergency immediately after the incident:
 Assessing the Significance of the Injury. This depends on:
 The nature and extent of the injury – did it draw blood?
 The nature of the item that caused the injury hollow or solid
needle.
 Hollow needles pose the greatest risk.
 The nature of the body substance involved – blood or blood
strained fluid have the greatest risk.
 The volume of the material the HCW contacted – was any blood
or body fluid injected.
 The HIV, HCV status of the Source if known.


29.  If status is unknown the following blood test
should be undertaken from the Source
individual:
 HIV
 HbsAg
 Anti-HCV
 In the Emergency, blood specimen will be
collected for the serological investigations,
viz HBsAg, HIV, HCV for the victim and for
the source, if not done recently.

30.  The EMO would initiate PEP, post-exposure
prophylaxis, unless the exposure to
blood/body fluids is ruled out.
 ART and/or HBIG and/or TT are given at the
discretion of the EMO. No PEP is required if
the exposure is limited to intact skin only.
 No PEP is required if the source blood is
confirmed Negative.