Hep B & C prophylaxis, needle stick injury, FJDC

 Hepatitis B and C prophylaxis

› Pre-exposure prophylaxis
› Post-exposure prophylaxis.

 Needle stick injury

› Prevention
› Management
PATIENT DHCP

DHCP PATIENT

PATIENT PATIENT

3
 Member of hepadnavirus family.
 42 nm enveloped virion with partially double-
stranded circular DNA.
 It contains 4 genes which encode 5 proteins.
› S gene encodes surface antigen.
› C gene encodes core & e antigen.
› P gene encodes polymerase.
› X gene X protein.
 The risk of developing clinical hepatitis if
the blood was both hepatitis B surface
antigen (HBsAg)-and HBeAg-positive was
22%–31%.

 By comparison, the risk of developing

clinical hepatitis from a needle
contaminated with HBsAg-
positive, HBeAg-negative blood was 1%–
6%.
 It is important that dentist and all workers are
vaccinated.

 Pre-exposure prophylaxis consists of

administration of a 3 dose series of hepatitis B
vaccine given over a 6-month period.
› Dose # 1 is time zero
› Dose # 2 given one month after dose #1
› Dose # 3 is given 6 months after dose #1

 Adolescents aged 11-15 years have the

option of a two-dose schedule with the
second dose given 4-6 months after the first
dose.
 STANDARD PRECAUTIONS

 Standard precautions are designed to reduce the risk of transmission of

microorganisms from known and unknown sources of infection
(blood, body fluids, excretions, secretions etc). These precautions apply
to the care of all patients regardless of their diagnosis or presumed
infection status.

 THE PRINCIPLES OF STANDARD PRECAUTIONS INCLUDE:

› Hand washing.
› Protective barriers i.e. the use, of personal protective
clothing, e.g. gloves, surgical masks, eye protection.
› Management of healthcare waste.
› Correct handling and disposal of needles and sharps.
› Effective cleaning, decontamination and sterilization of
equipment, instruments and environment (including blood
spillages).
› Use of appropriate disinfectants at the correct working dilution.
 Patients should be scheduled at the end of the list.

 Operators & assistants should wear 2 pair of

gloves, plastic gown, cap mask, protective eyewear.

 High volume suction should be used, rubber dam

should be applied to minimize the formation of
aerosols.

 All used instruments should be packed in a labeled

plastic wrap.

 After procedure, all equipments & surfaces should

be cleaned & decontaminated with disinfectant
(0.5% Na hypochlorite).
 Two types of products are available for
prophylaxis against HBV infection:

› Hepatitis B vaccine, which provides long-

term protection against HBV infection, is
recommended for pre-exposure and post-
exposure prophylaxis.

› HBIG, provides temporary protection

(i.e., three to six months) and is only
indicated in certain post-exposure settings.
 Member of flavivirus family.

 Enveloped virion, genome of single-stranded

RNA, no virion polymerase.

 It has 6 genotypes and multiple sub-

genotypes, resulting in a “hypervariable”
region in envelope glycoprotein.

 No particular vaccine available.

 HCV is not transmitted efficiently through
occupational exposures to blood.

 The average incidence of anti-HCV

seroconversion after accidental
percutaneous exposure from an HCV-
positive source is 1.8% (range: 0%–7%)
 No vaccine available.

 STANDARD PRECAUTIONS TO BE FOLLOWED:

› Hand washing.
› Protective barriers i.e. the use, of personal
protective clothing, e.g. gloves, surgical
masks, eye protection.
› Management of healthcare waste.
› Correct handling and disposal of needles and
sharps.
› Effective cleaning, decontamination and
sterilization of equipment, instruments and
environment (including blood spillages).
› Use of appropriate disinfectants at the correct
working dilution.
 Patients should be scheduled at the end of the list.

 Operators & assistants should wear 2 pair of

gloves, plastic gown, cap mask, protective eyewear.

 High volume suction should be used, rubber dam

should be applied to minimize the formation of
aerosols.

 All used instruments should be packed in a labeled

plastic wrap.

 After procedure, all equipments & surfaces should

be cleaned & decontaminated with disinfectant
(0.5% Na hypochlorite).
 No protective antibody response has been
identified following HCV infection.

(Experimental studies in chimpanzees with IG

containing anti-HCV failed to prevent
transmission of infection after exposure.)

 In the absence of PEP for

HCV, recommendations for postexposure
management are intended to achieve
early identification of chronic disease
and, if present, referral for evaluation of
treatment options.
THE ACCIDENTAL PUNCTURE OF THE SKIN BY A NEEDLE
DURING A MEDICAL INTERVENTION
Accidental contact with blood occurs especially in
the following situations:

› During re-capping
› During surgery, especially during wound closure
› During biopsy
› When an uncapped needle has ended up in bed
linen, surgery clothing etc
› When taking an unsheathed used needle to the waste
container
› During the cleaning up and transporting of waste material
› When using more complex collection & injection
techniques
› In A&E (Accident and Emergency) departments
CDC ESTIMATES ~385,000
SHARPS INJURIES
ANNUALLY AMONG
HOSPITAL-BASED
HEALTHCARE
PERSONNEL (>1,000
INJURIES/DAY)
 The major blood-borne pathogens of concern
associated with needle stick injury are:

› hepatitis B virus (HBV) 6-30%

› hepatitis C virus (HCV) ≈ 2%
› human immunodeficiency virus (HIV). 0.3%

 However, other infectious agents also have the

potential for transmission through needle stick injury.
These include:

› hepatitis D virus (HDV or delta agent, which is activated in

the presence of HBV) hepatitis G virus (GB virus or GBV-C)
› cytomegalovirus (CMV)
› Epstein Barr Virus (EBV)
› West Nile Virus (WNV)
› malarial parasites
 Employee training.

 Use devices with safety

features to isolate
sharps.
 Safe recapping
system.
 Do not recap needles or
scalpels & dispose them
through effective
disposal system.

 Plan for safe handling

and disposal of sharps
before using them.
 Self-sheathing
system
 Retractable
technology.
 Add on safety
features
 Report the incident immediately.

 Wash the area immediately under running water or use an

eye-washing bottle as appropriate.

 Make the wound bleed for three to four minutes whilst

continuing to wash the area. Dry area with paper towel.

 Cover the wound with a water-impermeable sticking plaster

and consider double gloving any hand injury if continuing
to work.

 The source patient should be identified and arrangements

made for a blood sample to be obtained, with informed
consent. This should be tested for the presence of the blood
borne viruses hepatitis B, hepatitis C and HIV.
 Arrangements should be made for blood samples to
be taken from the staff member (victim) with
informed consent. One sample is marked “for
storage” and is retained in the relevant laboratory.
The other is analyzed to determine the staff members
hepatitis B antibody level.

 Further assessment, treatment and follow up of the

staff member are performed in accordance with
current best practice. Arrangements should be in
place for speedy assessment and treatment.

 Counseling, reassurance and information may be

required and arrangements for accessing this should
be in place as appropriate.

 Appropriate records must be kept.

 http://depts.washington.edu/hepstudy/hepB/prevention/pe
p_oe/discussion.html

 ADA guidelines for infection control (second edition)

 WGO practice guideline: needle stick injury and accidental

exposure to blood

 Cdc:http://www.Cdc.Gov/hepatitis/HBV/PEP.Htm, NC
hepatitis B public health program manual/post-exposure
prophylaxis February 2012

 Recommendations for prevention and control of hepatitis c

virus (hcv) infection and hcv-related chronic disease U.S.
Department of health and human services centers for disease
control and prevention (cdc) Atlanta, Georgia