Management of blood exposure and needle stick injuries
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Transcript of Management of blood exposure and needle stick injuries
Dr. Moustapha A. Ramadan
Fellow of Community Medicine Department
Faculty of Medicine
Alexandria University
Means pathogenic microorganisms that are present in human blood and can cause disease in humans.
These pathogens include, but are not limited to, HIV (Human Immune-deficiency Virus), HBV (Hepatitis B virus), and HCV (Hepatitis C Virus).
Means specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact
with blood or other potentially infectious materials
that result from procedures or activities done in health-care settings.
3 million exposures per year in healthcare workers
37% of Hepatitis B
39% of Hepatitis C
4.4% of HIV
are due to needlestick injuries (50% of hospitalized patients in sub-Saharan Africa are HIV +)
Virus Chance of HCW Infection
HBV 6 – 30 out of 100 people
HCV 3 – 10 out of 100 people
HIV 1 out of 300 people
Most exposures do not result in infection.
The risk of infection vary with :
The pathogen involved
The type of exposure
The amount of blood involved in the exposure
The amount of virus in the patient's blood at the time of exposure
1% of hospital healthcare personnel have evidence of HCV infection
CDC had received reports of 57 documented cases and 138 possible cases of occupationally acquired HIV infection among healthcare personnel in the United States since reporting began in 1985 till 2001
Of the CDC documented cases of occupational transmission of HIV, 90% were from contaminated hollow- bore needles that pierced the skin
OSHA mandates HBV vaccination
17,000
800
This regulation had the greatest impact in eliminating HBV
transmission among healthcare workers
Elimination or substitution of sharps:eliminate unnecessary injections, needleless IV systems
Engineering ControlsA-D syringes, safer needle devices
Administrative and Work Practice Controls
Universal Precautions, no recapping, provision & placement & removal of sharps containers
Personal Protective Equipmentgloves, masks, gowns,
LeastEffective
MostEffective
Does not harm the recipient,
Does not expose the provider to any avoidable risk,
Does not result in any waste that is dangerous for other people
Have sharp disposal container available
Do not recap needles
Do not manually remove the used needle from the syringe
Do not walk around the immunization area carrying syringes
Do not set needle/syringe down
Do not manually sort medical waste
Leak-proof
Puncture-proof
Clearly labeled with warning (easy for the
community to understand)
Do not overfill (only 3/4 is safe)
Do not transfer contents to other container
UnsafeSafe
If an exposure occurs,
What should I do?
• Wash injuries and cuts with soap and water
• Flush splashes to the nose, mouth, or skin with water
• Irrigate eyes with clean water or saline
• Remove contaminated clothing ( if necessary)
No scientific evidence shows that squeezing the wound will reduce the risk of transmission of a blood borne pathogen.
Prompt reporting of the exposure incident to the In-charge person or supervisor
The incident report should include:
1. Time and date of incident
2. Location/ department
3. Source patient
4. Description of the incident
Fear of being punished or fired
Lack of awareness of risk of infection
Lack of assurance of confidentiality
Emphasis on patient care (unable to leave patient care area for follow-up)
No employee training on reporting procedures
No post-exposure treatment/prophylaxis available
Mechanism of injury
Site of injury
Amount and type of blood/body fluid
Infectious status of source patient
Susceptibility of exposed person
Immediate action taken
Hepatitis B Virus
Employee Status HBsAg Positive HBsAg Negative Unknown
Unvaccinated HB Ig and initiate vaccine
Initiate vaccine Initiate vaccine
Previously vaccinated
No PEP No PEP No PEP
Know non responder
HB Ig and re vaccinate or HB Ig 2 doses
No PEP If know high risk, treat as HBs Ag positive
Antibody response unknown
Test for anti HBsIf adequate no PEPIf inadequate HB ig and vaccine booster
No PEP Test for anti HBsIf adequate no PEPIf inadequate Administer vaccine booster and recheck titre in 1-2 months
HB IG should be administered as soon as possible ( within 24 hours of exposure)
If vaccine is indicated, it should be administered as soon as possible ( within 24 hours of exposure)
HB IG and vaccine can be administered simultaneously but at a separate sites.
Hepatitis C Virus:
IG and antiviral agents are not recommended for PEP after exposure to HCV positive blood.
Perform a baseline testing for anti HCV and ALT activity
Perform a follow up testing (4-6 months).
HIV:
If testing the source patient is delayed PEP should start while awaiting the result.
Serological testing for HIV at baseline, 6 week, 3 month, 6 month following exposure to identify seroconversion
Risk assessment:
No
Yes
No
Yes
No
Yes
Yes
High Risk Incident
High Risk Body Fluid
High Risk Source
Prescribe PEPRefer to ID physicianEvaluate drug toxicity
PEP not indicatedReassure
Medications:
Start within hours after exposure
Combination therapy of 2 drug Truvada and Isentress is recommended
Counseling:
Refrain from blood/tissue donation
Sexual intercourse should be protected
Pregnant women should be advised against breast feeding
Razors and toothbrushes should not be shared
Prompt reporting is essential because, in some cases, post exposure treatment may be recommended and it should be started as soon as possible.
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