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HOSPITAL ACQUIRED INFECTION CONTROL

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Most exposures do not result in infection. Occupational transmission ... Irrigate eyes with clean water, saline or sterile irrigates. POST EXPOSURE PROPHYLAXIS ... – PowerPoint PPT presentation

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Title: HOSPITAL ACQUIRED INFECTION CONTROL


1
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.
4
HIV HCW Documented Seroconversions
Percutaneous
N 50
Mucocutaneous
From CDC. MMWR 199847No. RR-7.
5
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

6
Occupational transmission world wide (1999)
7
Categories infected (world 1999)
8
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

9
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

10
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

11
CDC GUIDLINES
  • 1987
  • BLOOD BODY FLUIDS OF ALL PATIENTS POTENTIALLY
    INFECTIOUS

12
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

13
BARRIER PROTECTION
  • Gloves-
  • Use well fitting, disposable / autoclaved
  • Change if visibly contaminated / breached
  • Remove before handling telephones, performing
    office work, leaving workplace

14
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

17
Hand wash
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Sharps policy
  • Reduce use
  • Selection of devices
  • Care in use
  • Disposal

20
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.

21
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

40
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

41
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

42
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.
43
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.
44
Basic and Expanded Post-Exposure Prophylaxis
Regimens
Source MMWR 50, RR-11, .2001
45
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46
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

47
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

48
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.

49
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

50
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

51
THANK YOU
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