Universal Precautions: Need and practice

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Universal PrecautionsNeed and practice
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• A set of precautions to protect health care
  worker from occupational exposure

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Occupational exposure

• Exposure to potentially infectious body
  substances
• Percutaneous injury
• Contact with mucus membranes
• Contact with non intact skin
• Lab contact with live virus

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Blood borne pathogens

• HIV
• Hepatitis B
• Hepatitis C

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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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Risk of acquiring Hepatitis B infection after
needle stick injury

• Source HB e Ag pos
• 40 60

• HB e Ag neg
• 20 40

Can survive in dried blood for about 7 days
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Occupational transmission world wide (1999)
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Categories infected (world 1999)
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Potentially infective body fluids

• Blood
• Any fluid containing blood
• Semen
• Vaginal fluid

Less risk CSF Synovial, pleural, peritoneal,
pericardial, amniotic fluid
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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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To prevent transmission

• Comprehensive approach mainly aimed at modifying
  behavior
• Personal protection Universal precautions
• Sharps policy
• Post exposure management

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Universal Precautions

• Based on procedure and anticipated risk of
  exposure
• Consider
• All patients potentially infected
• Blood and tissue similarly infected
• Needles contaminated

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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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Use appropriate personal protection

• Gloves Mask
• Apron Eye wear
• Foot wear
• Handle used items with care for reuse or
  disposal
• Dispose infected waste safely

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Sharps policy

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

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Is it feasible in India

• Yes
• All necessary items now available
• Cost effective
• What is lacking? The will

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What needs to be done

• A written policy Administrative
• Increase awareness Administrative
• Provide material Administrative
• Implement Administrative
• Compliance Staff

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• Employer must provide
• safe working environment
• Moral and legal

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STANDARD PRECAUTIONS

• Blood is the single most important source of
  HIV, HBV and other blood borne pathogens in the
  occupational setting.
• All other body fluids containing visible blood
• Semen and vaginal secretions
• Cerebrospinal fluid Synovial fluid
• Pleural fluid Peritoneal fluid
• Pericardial fluid Amniotic fluid
• Breast milk Saliva during
• 
  dentistry

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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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PROTECTIVE CLOTHING

• Gloves
• Use well fitting, disposable / autoclaved
• Change if visibly contaminated / breached
• Remove before handling telephones, performing
  office work, leaving workplace
• Facial protection When splashing or spraying of
  blood / blood fluids expected
• Gowns/Special uniforms in high risk areas
• Occlusive bandage
• All skin defects must be covered with water proof
  dressing.

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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.
• 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
• Or 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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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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PEP drug regime

• Zidovudine 300mgs BD Lamivudine 150mgs BD for 4
  weeks
• Indinavir 800ms TID for 4 weeks added when there
  is higher risk