Patcharasarn Linasmita MDHRH Princess Maha Chakri Sirindhorn Medical Center

Srinakharinwirot University

Self protection Prevention of transmission

Hand hygiene Personal Protective Equipment Safe work practice

▪ Needle/sharp object

▪ Mucous membrane

▪ Aerosol generating procedure

Post exposure prophylaxis Vaccine

Visible? Spore? etc..

Percutaneous exposure

~ 0.3% (95%CI 0.2 – 0.5)

Mucous membrane exposure

~ 0.09% (95%CI 0.006 – 0.5)

Exposure to fluid other than blood

~ Too low to be estimated

Documented risk

▪ Blood, semen, vaginal secretions, other body fluids contaminated with visible blood

Undetermined risk

▪ cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids

Feces Nasal secretions Saliva gastric secretions/vomitus Sputum Sweat Tears Urine

HIV ~ 0.3%HCV ~ 1.8 - 3% HBV ~ 30%

• Encourage the wound to bleed, ideally by holding it under running water

• Wash the wound using running water and plenty of soap

• Don’t scrub the wound while you’re washing it

• Don’t suck the wound

• Dry the wound and cover it with a waterproof plaster or dressing

http://www.nhs.uk/chq/Pages/2557.aspx?CategoryID=72

http://www.wikihow.com/Deal-With-a-Needle-Stick-Injury-at-Work

Encourage bleeding at the site of puncture. Do this by running cool water over the bleeding area for several minutes.

Wash the wound. Gently cleanse the site of the needle stick or sharps entry with plenty of soap after you have bled the wound and flooded the site.

• Do not scrub the wound while you're washing it. This can make the injury worse.

• Never try to suck the wound.

Dry the wound and cover it with a waterproof plaster or dressing`

Percutaneous exposure

~ 0.3% (95%CI 0.2 – 0.5)

Mucous membrane exposure

~ 0.09% (95%CI 0.006 – 0.5)

Exposure to fluid other than blood

~ Too low to be estimated

Documented risk

▪ Blood, semen, vaginal secretions, other body fluids contaminated with visible blood

Undetermined risk (…possible…)

▪ cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids

Feces Nasal secretions Saliva gastric secretions/vomitus Sputum Sweat Tears Urine

HIV ~ 0.3%HCV ~ 1.8 - 3% HBV ~ 30%

Flush splashes of blood and needle contents on other parts of your body with water. If the contents of the needle splashed to nose, mouth, face or other skin areas, wash them well with soap.

Exposure of intact skin to contaminated blood has notbeen identified as a risk for HIV transmission

First aid Reporting of Exposure Clinical Evaluation and Baseline Testing of

Exposed HCP Evaluation for the need of PEP for HIV Follow-up of HCP Exposed to HIV

Exposure

ปฐมพยาบาล

แจง้ผูบ้งัคบับญัชา

น า้ /สบู ่/ 70%

alcohol / betadine

ประเมนิความเสีย่ง

พจิารณาใหย้าป้องกนั

Details of the procedure and injury Exposure source

▪ AntiHIV, HBsAg, AntiHCV

▪ HIV risk

▪ Hx of treatment

Exposed person

▪ HBV vaccination?

▪ AntiHIV, AntiHBs, HBsAg, AntiHCV

▪ (CBC, ALT)

benefits of PEP

risks of PEP

exposure

time

Post-exposure Prophylaxis

Within 24 – 72 h

HIV: Antiretroviral (3 agents)

x 4 weeks

HBV: Vaccine / HBIG (0.06 ml/kg)

Universal precautions+

Body substance isolation

respiratory hygiene / cough etiquette safe injection practices infection control practices for special lumbar

puncture procedures

Contact

▪ Direct

▪ Indirect

▪ fomite

Droplet

▪ droplet

▪ Indirect contact

▪ fomite

Airborne

in addition to Standard Precautions Contact precautions Droplet precautions

▪ Physical proximity of <3 feet has been associated with an increased risk for transmission of infections via the droplet route

Airborne precautions

Diarrhea

▪ Clostridium difficile

▪ Rotavirus

Multidrug-resistant (MDR) bacteria Herpes simple virus Infected ulcer with drainage Ebola

จบัราวก ัน้เตยีงแลว้

กต็อ้งลา้งมือดว้ย

Diphtheria, pharyngeal Haemophilus influenza meningitis, epiglottitis Haemophilus influenza pneumonia (infant,

children) Influenza Meningococcal infection Mumps Mycoplasma pneumonia Parvovirus B19 Pertussis Plague, pneumonic

Some are pathognomonic

Meningococcemia

Meningococcemia

Measles Monkeypox (+) Tuberculosis, pulmonary, laryngeal Tuberculosis, draining lesion (+) SARS (+) Smallpox (+) Varicella / chickenpox (+) Zoster, disseminated; (+)

N95▪ Respirator

▪ filters at least 95% of airborne particles

▪ not resistant to oil▪ R – somewhat resistant, P – oil proof

▪ Prevention of airborne transmission▪ Not for infected patients

Face Mask▪ For droplet precaution

▪ For patients with respiratory symptoms

One single case of an IDHC will heavily affect the overall routines of the hospital as a large number of workforce will be drawn into this extended care setting.

Serious threats to human health

▪ Severe symptoms

Required high level of care High case-fatality rate Often, no specific prophylaxis or treatment Often low incidence

Smallpox Ebola, Marburg Crimean Congo hemorrhagic fever Lassa, Lujo Highly pathogenic avian influenza Middle East Respiratory Syndrome Severe Acute Respiratory Syndrome

etc

PPE components Waste management Disinfection Incident management

etc

A variety of barriers and respirators used alone or in combination to protect▪ Mucous membranes

▪ Airways

▪ Skin

▪ Clothing

from contact with infectious agents Based on

▪ the nature of the patient interaction

▪ the likely modes of transmission

Gloves Isolation gowns Face protection

▪ Masks

▪ Goggles

▪ Face shields

Respiratory protection

▪ Respirator

Contact Precautions▪ Gown

▪ Gloves Generally apply to patients with

▪ Drug-resistance pathogens

▪ Presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure ulcers, or presence of ostomy tubes and/or bags draining body fluids

▪ Presence of generalized rash or exanthems

Droplet Precautions▪ Mask

▪ N95 respirator is not necessary

▪ Goggle or faceshield▪ If substantial spraying of respiratory fluids is anticipated

▪ Gloves & gown▪ If substantial spraying of respiratory fluids is anticipated

Generally apply to patients with▪ Respiratory viruses (e.g., influenza)

▪ Bordetella pertusis

▪ Neisseria meningitides, group A streptococcus (first 24h)

Airborne Precautions▪ Fit tested N95 (or higher level) respirator

▪ Goggle or faceshield, gloves and gown▪ If substantial spraying of respiratory fluids is anticipated

Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route: i.e.,

▪ Tuberculosis

▪ Measles

▪ Chickenpox

▪ Zoster

Primary transmission

▪ tuberculosis, measles, VZV

Secondary aerosolization

▪ Natural origin

▪ Vomiting, arterial bleeding

▪ Aerosol generating procedures

▪ Bronchoscopy, tracheal suction, nebulization

Chickenpox (Varicella)

Diphtheria Influenza Hepatitis A Hepatitis B Human

Papillomavirus (HPV)

Measles

Meningococcal Disease

Mumps Pneumococcal

Disease Rubella Shingles (Zoster) Tetanus Whooping Cough

(Pertussis)

https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf

Hepatitis B▪ 3-dose series (0, 1, 6)

Influenza▪ 1 dose annually

MMR (measles, mump, rubella)▪ 2 doses at least 28 days apart

Varicella (chickenpox)▪ 2 doses at least 28 days apart

Tetanus/diphtheria/pertussis▪ One-time dose of Tdap

▪ Td boosters every 10 years

HIV

▪ Antiretrovirus within 72 h

Hepatitis B

▪ HBIG within 24 h (maybe 7 days)

Measles

▪ MR or MMR within 72 h or IG within 6 days

Varicella

▪ Vaccine within 3 – 5 days

Influenza

▪ Chemoprophylaxis within 48 h

Meningococcal disease

▪ Chemoprophylaxis within 24 h (ideally)

▪ Maybe within 10-14 days

TB ??

▪ Treatment of latent infection