RISK OF HIV TRANSMISSION TO HEALTH CARE WORKERS AND UNIVERSAL BLOOD AND BODY FLUID PRECAUTIONS

BY M.N.RAMA KRISHNA, MD Dy.CMO(Splst),AH,RG

UNIVERSAL PRECAUTIONS CAN BE BROADLY COVERED UNDER: Hand washing.

Protective clothing. Good work practices. Decontamination of spills. Proper disposal of patient care articles/body fluids. Management of Accident at injuries/exposures. Training and education of staff. Specific protective measures.

AIMS OF UNIVERSAL PRECAUTIONS To protect the Health care worker himself. To prevent spread of infection from one patient to other patient. To protect other Co-Health Care Worker (HCW).

HIV CAN BE INACTIOVATED BY : Boiling Ethanol Glutaraldehyde (CIDEX) Sodium Hypochlorite solution 1% Formaldehyde 3% Isopropyl alcohol 35% Lysol 2.5% Savlon 5% Dettol 4%

HAND WASHING
Hands and other skin surfaces should be washed immediately and thoroughly with simple soap and water if contaminated with blood and other body fluids.

PROTECTIVE CLOTHING (Gloves, masks, eye protector and gowns)

Health care worker should wear gloves for all direct contact with blood & body fluids. When injuries from sharp instruments are possible, extra heavy-duty rubber gloves should be used.

MASK & PROTECTIVE EYE WEAR These should be worn during procedures where generation of drop-lets of blood & body fluids are expected in order to prevent exposure to mucous membranes of mouth, nose and eyes. GOWNS/APRONS Should be worn during procedures that are likely to generate splashes of blood and body fluids. Double gowns with an impermeable plastic apron should be worn in case of known HIV /hepatitis B +ve cases.

GOOD WORK PRACTICES Use disposables as far as possible. Never try to recap used disposable needles (Commonest cause of needle prick). Cuts and abrasions on skin of Health care worker (HCW) should be covered with waterproof dressing. HCW with exudative lesions should not be allowed in patient care. Eating, drinking & smoking at work place is to be prohibited. Dont store eatables in Lab/Ward refrigerators. Avoid touching eyes, nose and mouth at work place. Avoid sharing of articles between patients. HCW should avoid touching doorknobs, lift-buttons, phones, pen, taps etc., with contaminated hands/gloves.

PRECAUTIONS IN LABORATORY Always wear gloves while handling blood and other body fluids. Always collect and transport only in screw cap leak proof containers/bottles. Take care to avoid contamination of outer surface of container/ bottle while transporting samples. Mouth pipetting should be avoided. All open wounds on hands and arms of lab worker should be covered with waterproof dressing. Hands should always be washed with soap and water immediately after exposure to lab specimens.

DECONTAMINATION OF BLOOD & BODY FLUID SPILLS

Cover the spill with gauge/cotton/cloth. Pour disinfectant fluid over the spill starting peripherally to the center. Leave the disinfectant fluid for at least 10 Mts. Clean the area after wearing gloves.
DISPOSAL OF SHARPS AND NEEDLES

Never try to recap used disposable needles. All used needles and sharps should be cut and disinfected in 1% Sodium Hypo chlorite solution then thrown in puncture proof container and finally incinerated/deeply buried.

MOUTH TO MOUTH RESUSCITATION

Always create barrier by using gauze piece while giving mouth to mouth resuscitation.

COLLECTION OF BLOOD SPECIMENS

Always use gloves while drawing blood. Soiling of linen should be avoided. Dry cotton swab should be given to patient to press over the vene-puncture site. Elbow must be flexed to keep the cotton swab in place. Soiled cotton swabs & dressing pads should be placed in the RED colored plastic bag with biohazard symbol. Blood must be carefully and gently plunged from the syringe into the specimen vial. Care must be taken to avoid leakage/breakage/spills. The vacutainer system is best. Samples of known HIV/HBV should be labeled as High Risk.

OTHER SPECIMENS

Other specimens like urine, stool, sputum, body fluids, tissues etc are to be handled in the same way as above wearing gloves.
All the linen with blood/body fluids should preferably be dipped into 1% Sodium Hypochlorite solution for Hr. before washing.

HANDLING OF SOILED LINEN

MANAGEMENT OF PARENTERAL AND MUCOUS MEMBRANE EXPOSURE OF PERSONNEL TO BLOOD AND BODY FLUIDS

Allow the accidental wound to bleed. Promptly wash the exposed surface with tap water. Clean the area with soap & water. In case the splashing of blood/body fluids into the eyes, wash the eye gently with water/saline keeping the eyes open. If the blood gets into the mouth spit it out and rinse your mouth several times. Any of the above incidences should be notified to the Physician for risk assessment and treatment

PEP (Post Exposure Prophylaxis) : It refers to the comprehensive management given to minimize the risk of infection following potential exposure to blood-borne pathogens (HIV, HBV, AND HCV) Risk of Infection after needle stick from a patient with the infection: HBV 30 % (30 in 100) HCV - 3 % (3 in 100) HIV - 0.3 % (3 in 1000)

OCCUPATIONAL EXPOSURE PROTOCOL 1. 2. 3. 4. 5. 6. 7. Do not put injured part in mouth or squeeze Remain calm First aid wash and irrigate the site Dispose the sharp appropriately Report to the appropriate authority Get evaluated for PEP and baseline testing for HIV PEP should be started within 2 hours of exposure, and not later than 72 hours 8. PEP must be taken for 4 weeks (28 days) 9. Follow up HIV testing ( 6weeks, 3 months, 6 months) 10. Follow-up counseling and care

OCCUPATIONAL EXPOSURE TO HIV Crisis management : Remain Calm Dispose the sharp : Appropriately First Aid : For Skin if skin is broken after a needle-stick or sharp instrument 1. Immediately wash the wound and surrounding skin with water and soap, do not scrub 2. Do not use antiseptics or skin washes ( bleach/chlorine / alcohol / povidone iodine) After a splash of blood or body fluids To unbroken skin : wash the area immediately Do not use antiseptics 2. For the Eye : Irrigate exposed eye immediately with water or normal saline Sit in a chair, tilt head back and ask a colleague to gently pour water or normal saline over the eye. If wearing contact lenses, leave them in place while irrigating as they form a barrier over the eye and will help protect it. The eye is cleaned, remove the contact lenses and in the normal manner. Do not use soap or disinfectant on the eye

3. For

Mouth : Split fluid out immediately Rinse the mouth thoroughly, using water or saline and spit again. Repeat this process several times Do not use soap or disinfectant in the mouth Report : To the appropriate authority as soon as possible Get evaluated for PEP and baseline testing for HIV PEP should be started within 2 hours of exposure, and not later than 72 hours, PEP must be taken for 4 weeks ( 28 days) Basic Regimen : - Zidovudine / Stavudine (AZT or d4T) 300mg Bd + Lamivudine (3TC) 150mg BD

Hope all of you know now how to protect yourselves during patient care