Universal precations for health care workers
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Transcript of Universal precations for health care workers
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Are we at risk of HIV?
Dr Madhu OswalSAMVAD HIV HELPLINE
Muktaa Charitable Foundation
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Procedures we perform in the clinic set-up
- General Examination of patients PV exam, P/A exam, oral cavity- Giving IM injection- Giving IV injection- Drawing blood for lab investigation• Minor Procedures – Catheterization, pap smear, IUD insertion, ascitis fluid tapping, etc. • Minor Surgeries – Suturing, I& D, removing corn,lipoma, taking biopsy, etc.
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Procedures we perform in the Hospital set-up
• All as above, plus (all that we do in clinic)- Ryles tube insertion- Plural tapping- CSF tapping- Suction- Intubation
• In operation Theatres- Invasive procedures- Vaginal delivery
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Duties your assistant/Nurses/Aaya/mama perform
• Handling bio-medical waste• Cleaning soiled surfaces• Washing soiled linen – clothes, bed
sheets, etc.• Handling vomitus, urine, stools, suction
material• Handling lab specimen – sputum, blood,
urine, etc.• Cleaning toilets, bathrooms, urinals, bed
pan, suction jar, etc.
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What Extra-precautions should we take when we deal with HIV
+ve patients?
NONE
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Universal precautionsUP means-EVERYONE, EVERYWHERE,ALWAYS,
UP applies to – blood, semen, vaginal secretons, cerebro-spinal fluid, ascitic fluid, pericardial fluid & amniotic fluid
UP does not apply to urine, stools, saliva, tears, sputum, vomitus – if not blood stained or contaminated with blood
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How much is the risk?
• HBV- 4%• HCV- 1.8%• HIV - 0.4%
HIV is an very fragile virus. Then why ‘phobia’ about HIV?
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5.
Estimated Pathogen-Specific Seroconversion Rate Per Exposure for Occupational Needlestick Injury
AETC http://depts.washington.edu/hivaids
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AETC http://depts.washington.edu/hivaids
Type of Exposure Involved in Transmission of HIV to Health Care Workers
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P<0.01 for all associations
0.06-0.520.19Use of Zidovudine for PEP
2.0-165.6Terminally Ill Source Patient
1.7-124.3Device Used in Artery or Vein
2.2-216.2Visibly Bloody Device
6.0-4115Deep Injury
Confidence IntervalOdds RatioRisk Factor
Risk Factors for HIV Transmission with Occupational Exposure to HIV-Infected Blood
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UNIVERSAL PRECAUTIONS- 4 components
• Hand Hygiene• Barriers• Care of sharps and needles• Sterilization and disinfection
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Hand Washing
Before- Examining patient Removal of glove Before wearing glove
After- Examining a patient Contact potentially contaminated body secretions/excretions, instruments routine surgical scrub After removing glove
Too simple to be important but Most Important
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Gloves, apron, goggles, etc
• For protection of HCW from infection from the patient.
• For protection of patient from infection from HCW or other source.
• Be judicious in use of gloves.• Utility gloves, sterile gloves, non-
sterile gloves.
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Handling needles and sharps
- Disposable needles- Do not RECAP – 80%- Do not BEND- Do not BREAK- Cut the needle in a puncture resistant
container- Use hands- free technique while
passing ‘sharp’ instruments.
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Things/Instruments we need to reuse or dispose off safely
• Decontamination
• Disinfection – removing and reducing some agents of infection
• Sterilization – Killing all organisms including spores
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Dis-infection- Cleaning with soap and water- Heat – boiling for a minute kills all
organism. For spores – 20 - Chemical - Sodium Hypochlorle 1%
- Glutaarlderyde 2%(Sterylium) - Ethyl alcohol – 70%
(Hospital spirit) - Chlorhexidine – 3%(Savlon) -Iodine tinc-3%
-Iodophores 7.5-10%(Betadine)
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Sterilization
Dry Heat – (Incirinators) – destroy soiled dressings, biomedical, waste, equipments
Autoclave – For equipment which can tolerate heat – clothes, dressing, instruments, apparatus, etc.
Ethylene oxide- Respirator, HL machine
Gamma radiation – Suture material, catheters, gloves, etc.
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What to do if one gets a pinprick/exposure?
Do not Panic!!!- Do not squeeze the wound or suck.- Allow the wound to bleed freely. - Wash the puncture site with soap & water- Confirm the serostatus of the source case
If negative – do nothingIf positive – know your sero-status at baseline
- Assess the risk(with the help of an HIV expert)
- Seek for PEP, if necessary with 6 hrs, not later than 72 hrs
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Decision-making Tools for PEP
• Source code (SC)– Risk assessment of the source patient– SC 1, SC 2, SC Unknown
• Exposure code (EC)– Risk assessment of exposure type– EC 1, EC 2, EC 3
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Step 1: Does This personNeed HIV PEP?
Source patient
HIV +HIV - Unknown / Unwilling to get tested*
PEP
High back-ground risk
Low back-ground risk
No PEP No PEP
*CDC recom: usually PEP unnecessary; consider use if source patient is high risk
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HIV Negative HIV Positive
Asymptomatic/high CD4 = HIV SC 1
Advanced disease, primary infection or low
CD4 =HIV SC 2
HIV Status Unknown or Source Unknown
= HIV SC Unknown
No PEP
Step 2: Determine HIV Status Code of Source (HIV SC)
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Expanded (3 Drugs)Expanded (3 Drugs)More Severe
Expanded (3 Drugs)Basic (2 Drugs)Less Severe
HIV+ Class 2HIV+ Class 1
Source Infection StatusExposure Type
Step 4: Determine PEP Regimen (2)
Less Severe: Solid needle, superficial injury More Severe: Large-bore hollow needle, deep punture,
visible blood on device, or needle used in patient's artery or vein
HIV Class 1: Asymptomatic or HIV RNA less than 1500 copies/ml
HIV Class 2: Symptomatic HIV infection, AIDS, acute seroconversion, or known high HIV RNA
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Step 4: Determine PEP Regimen
HIV SC EC PEP Recommendation
1 1 PEP may not be warranted
2 1 Consider basic regimen
1 2 Recommend basic regimen
2 2 Expanded regimen recommended
1 or 2 3 Expanded regimen recommended
Unknown If EC is 2 or 3 and a risk exists, consider PEP basic regimen
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HIV Post Exposure Prophylaxis
2 drug regimenZidovudine plus lamivudine (combivir)
Stavudine plus Lamivudine
Tenofovir plus lamivudine
3 drug regimenLPV/r or Indinivr or Nelfinavir plus NRTI backbone
Efavirez plus NRTI backbone
Consider resistance potential of source patient
Don’t use NVP (hepatotoxicity)
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ARE WE AT RISK?
YESIF WE DISCRIMINATE
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THANKS
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Contact InfoDr Madhu [email protected]