Nsi (2)


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  • Begin the slide in explaining about the need for safety, give examples of wearing helmets while driving, factory workers need personnel protective equipments and wearing safety belts in cars etc.
    Ask the group whether wearing helmet by scooter rider is important or not and why it is important explain about the sentiments of family members.
    In western world even dogs need to wear safety belts.-3minutes
  • Explain the various ways that the healthcare worker can get exposed to blood and body fluids.
    Give examples of IV cannulation when the stillete is removed blood comes in contact with person cannulating ask questions as to how many times has such things happened and what does the healthcare worker do if he/she comes in contact.
    Give further examples on syringes or any other sharps that the hospital uses and ask for experiences of the group.
    At any point of time do not give judgments or solutions for the problems but take down notes.
  • SLIDE 17: (The majority of needlesticks occur when)
    The five activities listed here are associated with the majority of needlestick injuries. When health care workers dispose of needles, administer injections, draw blood, recap needles, or handle trash and dirty linens, they are at greater risk for needlestick injuries. This may be the result of a combination of poorly designed devices and unsafe work practices.
  • SLIDE 18: (When do needlesticks happen?)
    About 20% of injuries occur before or during use. These injuries usually involve clean needles and present a lower risk to employees. Up to 70% of needlesticks occur after the needle has been used (is contaminated) and before disposal. The remaining ten percent of injuries occur during or after disposal.
    Three activities included in this 10 % are cleaning up after a procedure has been completed, carrying out trash, and washing dirty linens. These “downstream injuries” are particularly threatening to the worker because the source of the needle is generally unknown.
  • Though there are number of microorganisms which can cause multiple diseases when exposed, given here is a short list
    The most important of these are hepatitis-B, Hepatitis-C and HIV
    Emphasize the importance of all the diseases as there are so many which can lead to morbidity and reduction in number of work days.
  • SLIDE 28: (Occupational risk of HCV)
    What occupational risk does Hepatitis C pose to the health care worker?
    Hepatitis C virus infection is a major cause of chronic liver disease in the United States and worldwide. The virus, because of its similarity to HBV, presents an occupational risk to persons whose work activities involve handling human blood and body fluids (CDC, 1997). Some facts about Hepatitis C:
    Needlestick injuries are the most common cause of occupational HCV exposure (Hibberd, 1995).
    In 1995, an estimated 560 to 1120 cases of HCV infection occurred among health care workers who were occupationally exposed to blood (Alter, 1993).
    No vaccine is available for hepatitis C and no effective post-exposure prophylaxis is known at this time (CDC, 1997).
    Screening tests for hepatitis C antibodies are commercially available, but interpretation of the results, especially in a post-exposure situation, is limited by several factors:
    - A positive result does not distinguish between acute, chronic, or past infection, and a negative result does not indicate the absence of acute infection, only the absence of antibodies to HCV.
    - False positives are common in populations with a low prevalence of HCV.
    - The tests do not detect HCV antibodies in approximately 5% of people (CDC, 1997).
    [continued on next page]
    As many as 85% of all HCV-infected persons develop chronic infection. Persons with chronic hepatitis are at increased risk for cirrhosis and primary hepatocellular carcinoma. Hepatitis C is now the leading reason for liver transplantation in the United States (NIH, 1997).
  • SLIDE #33: (Safer needle devices)
    A safer needle device uses engineering controls to prevent needlestick injuries before, during, or after use through built-in safety features. The term, “safer needle device,” is broad and includes many different types of devices including those that have a protective shield over the needle and those that do not use needles at all. The common feature of effective safer needle devices is that they reduce the risk of needlestick injuries to health care workers.
  • SLIDE 44:(Safer needle devices)
    Safer needle devices are effective engineering controls and a variety of these devices are widely available. Health care workers in settings where safer needle devices have not been implemented may be at higher risk of sustaining a needlestick injury.
  • Nsi (2)

    2. 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. 3. Healthcare Worker Safety While safety is mandated in all walks of life, is healthcare worker safety amongst our highest concerns?
    4. 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)
    5. 5.  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
    6. 6. When Do Needlesticks Happen?
    7. 7. 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
    8. 8. 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
    9. 9. 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
    10. 10. 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
    11. 11. 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%)
    12. 12. 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
    13. 13. 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.
    14. 14. 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
    15. 15. 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
    16. 16. 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
    17. 17. 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
    18. 18. While there are financial implications, but at the end of the day, we cannot put a price to a precious human life Can we ?
    19. 19. 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.
    20. 20.  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.
    21. 21. Safer Needle Devices
    22. 22. 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.
    23. 23.  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. 
    24. 24.  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.
    25. 25.  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.