This document discusses safety measures for healthcare providers to prevent injuries and infections from needle sticks and exposure to blood and bodily fluids. It outlines the risks of various injuries and infections like hepatitis B, hepatitis C, and HIV. Universal safety precautions are recommended, including personal protective equipment like gloves, gowns, and eyewear. Vaccination against hepatitis B is the most important precaution. Proper handling and disposal of needles and reporting any exposures are also essential to prevent the transmission of bloodborne pathogens between healthcare workers and patients.

1. Safety Measures of Health Care
Providers in Trauma
Dr. Soma Sekhara Reddy
Emergency medicine

2. Objectives
• Introduction
• Types of injuries / exposures
• Health hazards behind needle prick
• Safety precautions and prophylaxis
• Impending threat
• Conclusion

3. Introduction
• H C Ps , especially E.D. personnel , surgeons
are more vulnerable for infection when
carrying out their jobs.
• E.D. staff – 2 fold risk
“Bloodborne Infections in Emergency Medicine” revised in October 2000;
April 2004; and April 2011

4. • Fortunately we have
- safety precautions
- prophylactic measures
- treatment options

5. Types of injuries
• Needle stick injuries
• Contact of blood and OPIMs
• Human bite injuries

6. Needle stick injuries
• Most common occupational health accident
• E.D – high risk
• Hollow > solid needle
• Interns and resident doctors are at higher risk for
HIV infection

7. Incidence in different H C Ps
Nurse
43%
Technician
15%
Student
4%
Dental
1%
Housekeeping/
Maintenance
3%
Clerical /
Admin
1%
Other
5%
Physician
28%

8. Incidence in different jobs
During Sharps
Disposal
13%
During Clean Up
9%
In Transit to
Disposal
4%
Handle/Pass
Equipment
6%
Improper
Disposal
9%
Access IV Line
5%
Transfer/Process
Specimens
5%
Recap Needle
6%
Collision
W/Worker or
Sharp
10%
Manipulate
Needle in Patient
28%
Other
5%

9. STATISITICS – Tertiary hospital
YEAR 2010 2011 2012
(UPTO JUNE )
Total no. of NSI 47 56 26
Doctors 6 7 2
E.D 10 10 1

12. Health hazards behind NSI
 Most common
• HBV
• HCV
• HIV
 Other possible
• CMV , EBV , PARVO VIRUS
• Treponema
• Yersinia
• Plasmodium
• Other hepatic viruses

13. VIRUS HBV HCV HIV
Risk 5 – 40 % 3 – 10 % 0.2 – 0.5 %
Vaccination Available no no
P E P Vaccine + Ig no 2/ 3 drug
regimen
Prevention very good - good

14. HCV
• HCV + HIV
(studies by BERGER , Institute of medical virology)
• As there is no vaccination and PEP for HCV only option
available is follow up and treatment .
• Chronic carrier state , liver cirrhosis and cancer is more than
HBV

15. 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 or
plenty of plain water in case of mucus
membranes

16. Bite injuries
• Rare but possible
• Potentially serious infection caused by rapid
growth of bacteria in broken skin
• Bacteria – Streptococci
Staphylococci
Eikenella corrodens
Anaerobes

17. 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

18. 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 .

19. vaccination
• Most important precautionary measure
• Prior HBV vaccination
• Know the immune status
• Unfortunately not available for HCV and HIV

20. Safety measures to avoid NSI
• Avoid needle whenever safe alternative
available
• Avoid needle recapping

22. • Plan for safe handling
and disposal before
beginning of any
procedure

24. • Report all NSIs and prompt others to do the
same
• Educate your subordinates / colleagues /
employers about risk of NSIs.

25. 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

26. Impending threat – under reporting
• Acc. To WHO study
Avg no. of injuries – 0.2 to 4.7 injuries /1 hcw /1 yr
In India > 3 injuries / 1 hcw / 1 year
• But injuries reported is far less than actual incidence

27. • Developed countries – nearly 40 %
• India - > 70 %
• More from physicians rather than nursing staff
• Many are junior residents , internees and nursing
students
Original article from community medicine -safdarjung hospital , New delhi, INDIA

30. • 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 is
high?

31. What happens if same trend
continues…?

32. conclusion
• Every HCP should follow existing regulations and
guidelines
• When exposed immediately get evaluated and
PEP to be taken if indicated
• All HCPs should receive HBV vaccine and should
be tested for immunity after vaccination

33. • All contacts with blood and OPIM should be
considered as potential HIV exposures.
• NSIs are omnipresent.
• Every incidence of injury should be notified to
assure the follow up and further care.

34. Additional information
• University of Virginia’s International Health
Care Workers Safety Center and its EPINet
needle stick injury data collection system:
www.med.virginia.edu/~epinet
• www.cdc.gov/niosh
• OSHA Web page: www.osha.gov;for needle
stick information, www.osha-
slc.gov/SLTC/needlestick/index.html

35. References
• Original article from community medicine -
safdarjung hospital , New delhi, INDIA.
• HealthLink BC File #97, April 2011 , England
• ACEP Board of Directors titled, “HIV and
Bloodborne Infections in Emergency Medicine”
, U.S.
• Occupational Safety and Health Administration (OSHA)

36. • Centers for Disease Control and Prevention
• National Institute for Occupational Safety and
Health – NIOSH , U.S.
• ITLS text book

37. Thank you