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RISK OF HIV TRANSMISSION TO HEALTH CAREWORKERS

AND

UNIVERSAL BLOOD AND BODY FLUIDPRECAUTIONS

BY

M.N.RAMA KRISHNA, MD

Dy.CMO(Splst),AH,RG

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UNIVERSAL PRECAUTIONS CAN BE

BROADLY COVERED UNDER:

Hand washing. Protective clothing.

Good work practices.

Decontamination of spills. Proper disposal of patient care articles/body

fluids.

Management of Accident at injuries/exposures.

Training and education of staff.

Specific protective measures.

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AIMS OF UNIVERSAL PRECAUTIONS

To protect the Health care worker himself.To prevent spread of infection from one patient to

other patient.

To protect other Co-Health Care Worker (HCW).

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HIV CAN BE INACTIOVATED BY :

Boiling

Ethanol

Glutaraldehyde (CIDEX)

Sodium Hypochlorite solution 1%

Formaldehyde 3% Isopropyl alcohol 35%

Lysol 2.5%

Savlon 5%

Dettol 4%

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HAND WASHING

Hands and other skin surfaces should be washed immediately

and thoroughly with simple soap and water if contaminatedwith blood and other body fluids.

PROTECTIVE CLOTHING

(Gloves, masks, eye protector and gowns)Health care worker should wear gloves for all direct contact

with blood & body fluids. When injuries from sharp instruments

are possible, extra heavy-duty rubber gloves should be used.

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MASK & PROTECTIVE EYE WEAR

These should be worn during procedures wheregeneration of drop-lets of blood & body fluids areexpected in order to prevent exposure to mucousmembranes of mouth, nose and eyes.

GOWNS/APRONS

Should be worn during procedures that are likely togenerate splashes of blood and body fluids. Doublegowns with an impermeable plastic apron should be worn

in case of known HIV /hepatitis B +ve cases.

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GOOD WORK PRACTICES

Use disposables as far as possible.

Never try to recap used disposable needles (Commonest

cause of needle prick). Cuts and abrasions on skin of Health care worker (HCW)

should be covered with waterproof dressing.

HCW with exudative lesions should not be allowed in

patient care. Eating, drinking & smoking at work place is to be

prohibited.

Dont store eatables in Lab/Ward refrigerators.

Avoid touching eyes, nose and mouth at work place. Avoid sharing of articles between patients.

HCW should avoid touching doorknobs, lift-buttons,phones, pen, taps etc., with contaminated hands/gloves.

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PRECAUTIONS IN LABORATORY

Always wear gloves while handling blood and other bodyfluids.

Always collect and transport only in screw cap leak proofcontainers/bottles.

Take care to avoid contamination of outer surface ofcontainer/ bottle while transporting samples.

Mouth pipetting should be avoided.

All open wounds on hands and arms of lab worker shouldbe covered with waterproof dressing.

Hands should always be washed with soap and waterimmediately after exposure to lab specimens.

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DECONTAMINATION OF BLOOD & BODY FLUID SPILLS

Cover the spill with gauge/cotton/cloth.

Pour disinfectant fluid over the spill starting peripherally to thecenter.

Leave the disinfectant fluid for at least 10 Mts. Clean the area after wearing gloves.

DISPOSAL OF SHARPS AND NEEDLES Never try to recap used disposable needles. All used needles and sharps should be cut and disinfected in

1% Sodium Hypo chlorite solution then thrown in punctureproof container and finally incinerated/deeply buried.

MOUTH TO MOUTH RESUSCITATION

Always create barrier by using gauze piece whilegiving mouth to mouth resuscitation.

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COLLECTION OF BLOOD SPECIMENS

Always use gloves while drawing blood. Soiling of linen should be avoided. Dry cotton swab should be given to patient to press over

the vene-puncture site.

Elbow must be flexed to keep the cotton swab in place. Soiled cotton swabs & dressing pads should be placed inthe RED colored plastic bag with biohazard symbol.

Blood must be carefully and gently plunged from thesyringe into the specimen vial. Care must be taken to

avoid leakage/breakage/spills. The vacutainer system is best. Samples of known HIV/HBV should be labeled as High

Risk.

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OTHER SPECIMENS

Other specimens like urine, stool, sputum, body fluids, tissues etc are tobe handled in the same way as above wearing gloves.

HANDLING OF SOILED LINEN

All the linen with blood/body fluids should preferably be dipped into 1%Sodium Hypochlorite solution for Hr. before washing.

MANAGEMENT OF PARENTERAL AND MUCOUS MEMBRANE

EXPOSURE OF PERSONNEL TO BLOOD AND BODY FLUIDS

Allow the accidental wound to bleed. Promptly wash the exposed surface with tap water. Clean the area with soap & water. In case the splashing of blood/body fluids into the eyes, wash

the eye gently with water/saline keeping the eyes open.

If the blood gets into the mouth spit it out and rinse yourmouth several times.

Any of the above incidences should be notified to thePhysician for risk assessment and treatment

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PEP (Post Exposure Prophylaxis) :

It refers to the comprehensive management given tominimize the risk of infection following potential exposure to

blood-borne pathogens (HIV, HBV, AND HCV)

Risk of Infection after needle stick from a patientwith the infection:

HBV 30 % (30 in 100)

HCV - 3 % (3 in 100)

HIV - 0.3 % (3 in 1000)

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OCCUPATIONAL EXPOSURE PROTOCOL

1. Do not put injured part in mouth or squeeze2. Remain calm

3. First aid wash and irrigate the site

4. Dispose the sharp appropriately

5. Report to the appropriate authority6. Get evaluated for PEP and baseline testing for HIV

7. PEP should be started within 2 hours of exposure, andnot later than 72 hours

8. PEP must be taken for 4 weeks (28 days)

9. Follow up HIV testing ( 6weeks, 3 months, 6 months)

10. Follow-up counseling and care

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OCCUPATIONAL EXPOSURE TO HIV

Crisis management : Remain Calm

Dispose the sharp : Appropriately

First Aid :

For Skin if skin is broken after a needle-stick or sharp instrument1. Immediately wash the wound and surrounding skin with water and

soap, do not scrub

2. Do not use antiseptics or skin washes ( bleach/chlorine / alcohol /povidone iodine)

After a splash of blood or body fluids

To unbroken skin : wash the area immediately

Do not use antiseptics

2. For the Eye :

Irrigate exposed eye immediately with water or normal saline

Sit in a chair, tilt head back and ask a colleague to gently pourwater or normal saline over the eye.

If wearing contact lenses, leave them in place while irrigating asthey form a barrier over the eye and will help protect it. The eye iscleaned, remove the contact lenses and in the normal manner.

Do not use soap or disinfectant on the eye

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3.For Mouth :

Split fluid out immediately

Rinse the mouth thoroughly, using water or saline and spit

again. Repeat this process several times

Do not use soap or disinfectant in the mouth

Report : To the appropriate authority as soon as

possible

Get evaluated for PEP and baseline testing for HIV

PEP should be started within 2 hours of exposure, and not later

than 72 hours, PEP must be taken for 4 weeks ( 28 days)

Basic Regimen :- Zidovudine / Stavudine (AZT or d4T) 300mg Bd

+

Lamivudine (3TC) 150mg BD

H ll f k h t

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Hope all of you know now how to

protect yourselves during patient

care

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