Patcharasarn Linasmita MD HRH Princess Maha Chakri ...
Transcript of Patcharasarn Linasmita MD HRH Princess Maha Chakri ...
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