HEPATITIS B AND C PROPHYLAXISNEEDLE STICK INJURY AND

PREVENTION

PRESENTER: SAPEEDEH AFZALROLL # 10GROUP: A

Hep B & C prophylaxis, needle stick injury, FJDC

ROA D

MAP

Hepatitis B and C prophylaxis› Pre-exposure prophylaxis› Post-exposure prophylaxis.

Needle stick injury› Prevention› Management

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POTENTIAL ROUTES OF TRANSMISSION OF BLOOD-BORNE

PATHOGENS

PATIENT DHCP

DHCP PATIENT

PATIENT PATIENT

HEPATITIS B VIRUS 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.

RISK FOR OCCUPATIONAL TRANSMISSION OF HBV

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%.

PRE-EXPOSURE PROPHYLAXIS

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.

PRE-EXPOSURE PROPHYLAXIS

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.

ADDITIONAL MEASURES FOR KNOWN HBV POSITIVE PATIENT

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).

POST-EXPOSURE PROPHYLAXIS

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.

POST-EXPOSURE PROPHYLAXIS

HEPATITIS C VIRUS 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.

RISK FOR OCCUPATIONAL

TRANSMISSION OF HCV 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%)

PRE-EXPOSURE PROPHYLAXIS

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.

ADDITIONAL MEASURES FOR KNOWN HCV POSITIVE PATIENT

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).

POST-EXPOSURE PROPHYLAXIS 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.

NEEDLE STICK INJURY 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 › In high-stress interventions (diagnostic or therapeutic

endoscopy in patients with gastrointestinal bleeding)

CDC ESTIMATES ~385,000 SHARPS INJURIES ANNUALLY AMONG HOSPITAL-BASED HEALTHCARE PERSONNEL

(>1,000 INJURIES/DAY)

INFECTIONS TRANSMITTED 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

PREVENTION 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.

EXAMPLES OF SAFER NEEDLE DEVICES

Self-sheathing system

Retractable technology.

Add on safety features

MANAGEMENT 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.

MANAGEMENT (continue….) 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.

REFERENCES: 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

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