HOSPITAL ACQUIRED INFECTION CONTROL

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HOSPITAL ACQUIRED INFECTION CONTROL

• Dr. B. D. Benroy
• Program Officer (STD)
• Kerala State AIDS Control Society
• Trivandrum

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Occupational Blood-borne Exposures Relative Risk
of Seroconversion with Percutanous Injury
From CDC. MMWR 200150 (RR11)1-42.
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HIV HCW Documented Seroconversions
Percutaneous
N 50
Mucocutaneous
From CDC. MMWR 199847No. RR-7.
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Risk of infection with HIV

• Percutaneous exposure 0.3
• Mucus membrane exposures 0.09
• Non-intact skin reported
• Fluids reported
• Most exposures do not result in infection

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Occupational transmission world wide (1999)
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Categories infected (world 1999)
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Type And Amount Of Fluid

• Blood
• Fluids containing blood
• Potentially infectious fluid / tissue
• Semen
• Vaginal Secretions
• Human Breast milk
• CSF
• Synovial
• Pleural
• Peritoneal
• Pericardial
• Amniotic

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Virtually no risk (except when mixed with blood)

• Tears Sweat Saliva
• Feces Nasal secretions
• Sputum Urine Vomitus
• No environmental transmission reported
• HIV inactivated quickly outside the body
• Does not multiply outside the body
• Infectivity is lost quickly following drying

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Factors that affect transmission

• Type of injury
• Hollow bore needles
• When needle is being placed inside a vein or
  artery
• Severity of injury
• Deep injury
• Amount of blood involved
• Amount of virus in patients blood

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CDC GUIDLINES

• 1987
• BLOOD BODY FLUIDS OF ALL PATIENTS POTENTIALLY
  INFECTIOUS

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UNIVERSAL PRECAUTIONS

• BARRIER PROTECTION
• HAND WASHING
• SAFE TECHNIQUE
• SAFE HANDLING OF SHARP
• SAFE HANDLING OF SPECIMEN
• SAFE HANDLING OF SPILLS
• USE OF DISPOSIBLE
• IMMUNISATION WITH HEP-B VACCINE

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BARRIER PROTECTION

• Gloves-
• Use well fitting, disposable / autoclaved
• Change if visibly contaminated / breached
• Remove before handling telephones, performing
  office work, leaving workplace

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BARRIER PROTECTION

• Facial protection When splashing or spraying of
  blood / blood fluids expected
• Gowns/Special uniforms in high risk areas
• Occlusive bandage breach of skin
• All skin defects must be covered with water
  proof dressing.

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HAND WASHING

• An ideal safety precaution
• Washing with soap and water
• Hands must be washed-
• Immediately after contamination
• Before eating, drinking, leaving the workshop
• After removing gloves
• At completion of days work

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Hand wash
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Sharps policy

• Reduce use
• Selection of devices
• Care in use
• Disposal

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Handling of sharps

• Dispose your own sharps yourself.
• Never pass used sharps to another person.
• During exposure-prone procedures, minimize the
  risk of injury by ensuring that the operator has
  the best possible visibility. E.g. by positioning
  the patient, adjusting good light source and
  controlling bleeding.

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Handling of sharps

• Protect fingers from injury by using forceps
  instead of fingers for guiding suturing.
• Never recap, bend or break disposable needles.
• Place used needles and syringes in a rigid
  puncture resistant container
• Destroy using needle destroyer.

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Chemical disinfectants effective in inactivating
HIV

• Ethanol 70 3-5 min
• Povidone iodine 2 15 min
• Formaline 4 30min
• Gluteraldehyde 2(cidex)30min
• Hydrogen peroxide 6 30min

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SAFE HANDLING OF SPECIMEN
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MANAGEMENT OF BLOOD SPILLS

• Spill on floor/ work surface should be covered
  with paper towel / blotting paper / newspaper /
  absorbent cotton.
• 1 Bleach solution should be poured on an the
  spill and covered with paper for 30 minutes
• All the paper / cotton should be removed with
  gloved hands

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Occupational Exposure

• Contact of blood with skin
• mucous membrane
• non intact skin
• Percutaneous injury

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On Exposure

• Wash needle stick injuries and cuts with soap and
  water
• Flush splashes to nose, mouth or skin with water
• Irrigate eyes with clean water, saline or sterile
  irrigates

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POST EXPOSURE PROPHYLAXIS

• Assess risk of infection versus toxic side
  effects of drugs
• PEP decision to be based on
• (1) Degree of exposure to HIV
• (2) HIV status of the source of exposure

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HIV Seroconversion in Health Care Workers

• Primary HIV Infection
• - Experienced in 81 of HCWs
• - Occurred median 25 days after exposure
• Seroconversion
• - Exposure to seroconversion median 46 days

From CDC. MMWR 199847No. RR-7.
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Risk Factors for HIV Seroconversion in HCWs

• Risk Factor Adjusted Odds Ratio
• Deep Injury 15.0
• Visible Blood on Device 6.2
• Terminal Illness in Source Patient 5.6
• Needle in Source Vein/Artery 4.3
• PEP with Zidovudine (AZT) 0.2

All Risk Factors were significant (P lt 0.01)

NEJM 19973371485-90.
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Basic and Expanded Post-Exposure Prophylaxis
Regimens
Source MMWR 50, RR-11, .2001
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Factors affecting acquisition of infection after
an occupational exposure

• Prevalence of infection in the specific
  population
• Frequency of activities capable of transmitting
  the infectious agent
• Nature and efficacy of transmission of exposure
• Virus present in the contaminated fluid and the
  viral load
• Availability and efficacy of post-exposure

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Treatment policies on occupational exposure to HIV

• Universal Precautions in place
• Vaccination of HCW for hepatitis B
• Development of National Guidelines for PEP
• Address list for hospitals providing PEP
• Post-Exposure Prophylaxis Hotline
• Hospital registry for occupational exposure
• National registry for occupational exposure

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Standard Precautions

• All patients to be treated as potential carriers
  of blood borne pathogens
• Use of appropriate personal protective equipments
• Careful handling of sharps and avoiding sharp
  injury
• Proper disposal of sharps and infectious waste.

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Essential steps for PEP

• Identification of the accident
• Training to recognize accidental exposure to
  blood
• Foresee/prepare arrangements
• 24 hours a day
• Identify resource persons
• among hospital personnel to help exposed person
  (E.R.?/Inf. Dis. Ward?)
• Identify prescriber
• to evaluate risk, decide on treatment to be
  offered and follow up the patient

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Treatment policies on occupational exposure to HIV

• Programme of PEP
• Drug
• HIV testing
• Counselling
• Clinical monitoring, including follow up and
  treatment of adverse effects
• Serological follow up over 3-6 months

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THANK YOU