universal precations for health care workers
DESCRIPTION
Lecture for medical students, , doctors or ant health care workers. It gives details how a medico can protect one self while caring for patients. Without discrimination.TRANSCRIPT
Are we at risk of HIV?
Dr Madhu OswalSAMVAD HIV HELPLINE
Muktaa Charitable Foundation
Procedures we perform in the clinic set-up
- General Examination of patients PV exam, P/A exam, oral cavity- Giving IM injection- Giving IV injection- Drawing blood for lab investigation• Minor Procedures – Catheterization, pap smear, IUD insertion, ascitis fluid tapping, etc. • Minor Surgeries – Suturing, I& D, removing corn,lipoma, taking biopsy, etc.
Procedures we perform in the Hospital set-up
• All as above, plus (all that we do in clinic)- Ryles tube insertion- Plural tapping- CSF tapping- Suction- Intubation
• In operation Theatres- Invasive procedures- Vaginal delivery
Duties your assistant/Nurses/Aaya/mama perform
• Handling bio-medical waste• Cleaning soiled surfaces• Washing soiled linen – clothes, bed
sheets, etc.• Handling vomitus, urine, stools, suction
material• Handling lab specimen – sputum, blood,
urine, etc.• Cleaning toilets, bathrooms, urinals, bed
pan, suction jar, etc.
What Extra-precautions should we take when we deal with HIV
+ve patients?
NONE
Universal precautionsUP means-EVERYONE, EVERYWHERE,ALWAYS,
UP applies to – blood, semen, vaginal secretons, cerebro-spinal fluid, ascitic fluid, pericardial fluid & amniotic fluid
UP does not apply to urine, stools, saliva, tears, sputum, vomitus – if not blood stained or contaminated with blood
How much is the risk?
• HBV- 4%• HCV- 1.8%• HIV - 0.4%
HIV is an very fragile virus. Then why ‘phobia’ about HIV?
5.
Estimated Pathogen-Specific Seroconversion Rate Per Exposure for Occupational Needlestick Injury
AETC http://depts.washington.edu/hivaids
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AETC http://depts.washington.edu/hivaids
Type of Exposure Involved in Transmission of HIV to Health Care Workers
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P<0.01 for all associations
0.06-0.520.19Use of Zidovudine for PEP
2.0-165.6Terminally Ill Source Patient
1.7-124.3Device Used in Artery or Vein
2.2-216.2Visibly Bloody Device
6.0-4115Deep Injury
Confidence IntervalOdds RatioRisk Factor
Risk Factors for HIV Transmission with Occupational Exposure to HIV-Infected Blood
UNIVERSAL PRECAUTIONS- 4 components
• Hand Hygiene• Barriers• Care of sharps and needles• Sterilization and disinfection
Hand Washing
Before- Examining patient Removal of glove Before wearing glove
After- Examining a patient Contact potentially contaminated body secretions/excretions, instruments routine surgical scrub After removing glove
Too simple to be important but Most Important
Gloves, apron, goggles, etc
• For protection of HCW from infection from the patient.
• For protection of patient from infection from HCW or other source.
• Be judicious in use of gloves.• Utility gloves, sterile gloves, non-
sterile gloves.
Handling needles and sharps
- Disposable needles- Do not RECAP – 80%- Do not BEND- Do not BREAK- Cut the needle in a puncture resistant
container- Use hands- free technique while
passing ‘sharp’ instruments.
Things/Instruments we need to reuse or dispose off safely
• Decontamination
• Disinfection – removing and reducing some agents of infection
• Sterilization – Killing all organisms including spores
Dis-infection- Cleaning with soap and water- Heat – boiling for a minute kills all
organism. For spores – 20 - Chemical - Sodium Hypochlorle 1%
- Glutaarlderyde 2%(Sterylium) - Ethyl alcohol – 70%
(Hospital spirit) - Chlorhexidine – 3%(Savlon) -Iodine tinc-3%
-Iodophores 7.5-10%(Betadine)
Sterilization
Dry Heat – (Incirinators) – destroy soiled dressings, biomedical, waste, equipments
Autoclave – For equipment which can tolerate heat – clothes, dressing, instruments, apparatus, etc.
Ethylene oxide- Respirator, HL machine
Gamma radiation – Suture material, catheters, gloves, etc.
What to do if one gets a pinprick/exposure?
Do not Panic!!!- Do not squeeze the wound or suck.- Allow the wound to bleed freely. - Wash the puncture site with soap & water- Confirm the serostatus of the source case
If negative – do nothingIf positive – know your sero-status at baseline
- Assess the risk(with the help of an HIV expert)
- Seek for PEP, if necessary with 6 hrs, not later than 72 hrs
Decision-making Tools for PEP
• Source code (SC)– Risk assessment of the source patient– SC 1, SC 2, SC Unknown
• Exposure code (EC)– Risk assessment of exposure type– EC 1, EC 2, EC 3
Step 1: Does This personNeed HIV PEP?
Source patient
HIV +HIV - Unknown / Unwilling to get tested*
PEP
High back-ground risk
Low back-ground risk
No PEP No PEP
*CDC recom: usually PEP unnecessary; consider use if source patient is high risk
HIV Negative HIV Positive
Asymptomatic/high CD4 = HIV SC 1
Advanced disease, primary infection or low
CD4 =HIV SC 2
HIV Status Unknown or Source Unknown
= HIV SC Unknown
No PEP
Step 2: Determine HIV Status Code of Source (HIV SC)
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Expanded (3 Drugs)Expanded (3 Drugs)More Severe
Expanded (3 Drugs)Basic (2 Drugs)Less Severe
HIV+ Class 2HIV+ Class 1
Source Infection StatusExposure Type
Step 4: Determine PEP Regimen (2)
Less Severe: Solid needle, superficial injury More Severe: Large-bore hollow needle, deep punture,
visible blood on device, or needle used in patient's artery or vein
HIV Class 1: Asymptomatic or HIV RNA less than 1500 copies/ml
HIV Class 2: Symptomatic HIV infection, AIDS, acute seroconversion, or known high HIV RNA
Step 4: Determine PEP Regimen
HIV SC EC PEP Recommendation
1 1 PEP may not be warranted
2 1 Consider basic regimen
1 2 Recommend basic regimen
2 2 Expanded regimen recommended
1 or 2 3 Expanded regimen recommended
Unknown If EC is 2 or 3 and a risk exists, consider PEP basic regimen
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HIV Post Exposure Prophylaxis
2 drug regimenZidovudine plus lamivudine (combivir)
Stavudine plus Lamivudine
Tenofovir plus lamivudine
3 drug regimenLPV/r or Indinivr or Nelfinavir plus NRTI backbone
Efavirez plus NRTI backbone
Consider resistance potential of source patient
Don’t use NVP (hepatotoxicity)
ARE WE AT RISK?
YESIF WE DISCRIMINATE
THANKS
Contact InfoDr Madhu [email protected]