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Blood borne occupational health risks

Blood borne occupational health risks. Terhi Heinäsmäki, MD March 10, 2004 Tartu, Estonia. A review: Occupational accidents in Helsinki, 1998. All contacts surgeons 81-135/ year obstetricians 77/ year ward doctors 31/ year emergency personnel 24/ year ambulance personnel 12/ year.

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Blood borne occupational health risks

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  1. Blood borne occupational health risks Terhi Heinäsmäki, MD March 10, 2004 Tartu, Estonia

  2. A review:Occupational accidents in Helsinki, 1998

  3. All contacts surgeons 81-135/ year obstetricians 77/ year ward doctors 31/ year emergency personnel 24/ year ambulance personnel 12/ year Penetrating injuries surgeons 8-13 / year obstetricians 4 / year ward doctors 1.8 / year emergency personnel 0.4 / year ambulance personnel 0.2 / year dentists 4-12/ year Occupational exposure to blood (USA)

  4. Management of Occupational Blood Exposures • Make sure that the exposure is not repeated • Provide immediate care to the exposure site • Determine risk associated with exposure • Give post-exposure prophylaxis (PEP) for exposures posing risk of infection transmission • Perform follow-up testing and provide counseling

  5. The risk of HIV-infection in exposure to HIV-infected blood • Penetrating injury • 0.3 % (20/6202) • exposure to mucous membranes 0.09 % • exposure to intact skin <0.09 % • Work-related HIV-infections in health care personnel in USA up to June 1996* • documented 51 • possible 108 • in Finland 0 * S ource: MMWR1995:44;929-933: case-control study

  6. Risk factors for HIV infection in health-care workers after percutaneous exposure to HIV-infected blood • Deep injury RR 16.1 • Visible blood on device RR 5.2 • Procedure involving needle placed directly in a vein or arteryRR 5.1 • Terminal AIDS in source patient RR 6.4 • Postexposure use of zidovudineRR 0.2 Source: MMWR1995:44;929-933: case-control study

  7. HIV-infective body fluids • blood and serum • semen • all bloody fluids • synovial fluid • pleural effusion • pericardial effusion • ascites • amniotic fluid • cerebrospinal fluid (CSF)

  8. Possible occupational risks for HIV-infection • Needle injuries • intravenous catheters, cannules • contaminated i.v drug needles and vials • Human bites • Blood on broken skin or on eczema • Blood on mucous membranes

  9. HIV post exposure prophylaxis • Less severe exposure, small amount of blood: 2 antiretrovirals • e.g. zidovudine+lamivudine • onset as soon as possible, preferably < 2 hours from exposure, up to 72 hours • 4-week regimen • Severe exposure, large amount of blood : 3 antiretrovirals • e.g. zidovudine+lamivudine +nelfinavir/ indinavir • 4-week regimen • Follow-up up to 6-12 months

  10. Hepatitis B • Infection through transfusion, sex, needles, transplacental • Hepatis B carrier state (HBs-Ag> 6kk) • infected as newborn 70-90% • adults 1-5% • 20-30% of carriers develop liver cirrhosis and 1-4% proceed to hepatoma • Recovered are immune for life • Effective vaccines available • Treatment available: interferon, lamivudine

  11. Hepatis B in laboratory terms • HBs-Ag • acute or chronic hepatitis B, infective • Hbe-Ag • acute or chronic hepatitis B, highly infective • Hbs-Ab • has recovered from hepatitis B (non-carrier) or vaccinated • HBc-Ab • has recovered from hepatitis B or recovering from it, infectivity depends on HBs-Ag

  12. Hepatis B -immunisation • Vaccine • manufactured in yeast using HBs-Ag as an antigen • three doses in 0,1 and 6 months • newborns 4 doses • Hyperimmunoglobuline (HBIG) • post exposure prophylaxis

  13. Hepatitis B post exposure prophylaxis I • Unvaccinated or no immunity • hepatitis B hyperimmunoglobuline • initiate hepatitis B vaccination • Known source, hepatitis B status not known • examine HBs-ag as soon as possible • Source unknown or not available for testing • initiate hepatitis B vaccination

  14. Hepatitis B post exposure prophylaxis II • Valid immunisation against HBV • all three doses given • HBs-Ab + confirms the immunity • no need for hyperimmunoglobuline • an extra dose of hepatitis B vaccine if the last dose was given more than five years ago • if HBs-Ab <10 IU/ml and confirmed HBs-Ag positive source, hyperimmunoglobuline

  15. Hepatitis C • Infection through needles, transfusion, transplacental • 85% remain carriers • Cirrhosis develops in 20 % in 20 years • No vaccination • Treatment available: interferon, ribavirin • Post exposure prophylaxis not used • Follow up of serology and liver enzymes

  16. Follow-up testing • From the source and exposed • HBs-Ag, (HBc-Ab), HCV-Ab, HIV-Ab • immediately, follow-up at 1, 3, and 6 months • HBs-Ab from the exposed, if given hepatitis B vaccine • HBsAb response to vaccine cannot be ascertained if HB immunoglobuline was received in the previous 3--4 months

  17. Needle stick injury from a virus carrier: probability of virus transmission • Hepatis B • Hbe-Ag-positive source 20-25 % • HBs-Ag- positive source 5 % • Hepatis C 1-5 % • HIV 0.3 %

  18. Occupational blood exposure • Real occupational risk is minimal • almost all exposures outside work • Safe working habits • do not recap the needle • separate container for sharp objects • safe techniques: sutures only with instruments, no blind handling of sharp objects etc • Protection • vaccination against hepatitis B • gloves (double), masks, gowns

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