Universal Health Care Precautions

1. UNIVERSAL/STANDARD PRECAUTIONSBLOODBORNE PATHOGENS Dr.T.V.Rao MD

2. What are Universal Precautions Universal precaution are control guidelines designed to protect workers from exposure to Diseases spread by Blood and other Body fluids. CDC

3. Universal precautions means Observing “Universal Precautions” means you consider all human blood and certain human fluids infectious for all blood borne pathogens.

4. Why Universal HealthPrecautions. The concept of Universal Health Precautions emphasizes that all our patients should be treated as though they have potential blood born infections, and can infect the caring health care workers. ( CDC )

5. The blood borne pathogens that pose the most serious health risks • Hepatitis B virus (HBV) • Hepatitis C virus (HCV) • Human Immunodeficiency Virus (HIV)

6. Human Materials/Tissues considered Highly Infectious 1 Blood 2 Semen 3 Vaginal secretions 4 C S F 5 Synovial fluids 6 Amniotic fluid 7 All other body fluids

7. Exposure occurs through contact with infected body fluids

8. Our Role to protect follow Universal Precautions • Perform all tasks using safe work practices • Use appropriate personal protective equipment. • Use engineering controls

9. Who is at risk for sharps injury? • Workers performing finger sticks • Lab workers • Housekeepers/janitorial staff • Medical waste contractor

10. Not Infectious unless contaminated with Blood or Body fluids. • Feces, • Nasal secretions, • Sputum, • Sweat, • Tears, • Urine / Vomitus, • Saliva unless blood stained.

11. Blood Vomit Saliva Stool (feces) Urine Drainage from nose or sinuses Drainage from cuts, scrapes, wounds or sores Secretions from mucous membranes Sputum (mucus from lungs) Vaginal secretions Semen These Body Fluids Include:

12. Universally, treat every child’s body fluid as if it were infected. Precaution – Use foresight and plan ahead to avoid exposure Protect Yourself…

13. Work practices that increase the risk of a sharps injury • Recapping needles • Transferring a body fluid between containers • Opening blood tubes • Failing to dispose of used sharps properly in a puncture-proof sharps container

14. Universal Precaution Steps • Gloves (Personal Protective Equipment) • Decontamination • Hand Washing • Waste Disposal

15. Use of Gloves Use of a pair of disposable plastic gloves can protect if chances of contact with Blood or Body fluid is anticipated / inevitable.

16. Step 1: Gloves... Always wear gloves when … • Direct contact with body fluids is anticipated (nosebleeds, bleeding abrasions, etc.) • Handling clothes soiled by urine, feces, vomit or blood • Diapering children

17. Step 2: Handwashing • The MOST IMPORTANT STEP in Preventing the spread of disease! • Use liquid soap and warm water. • Wash vigorously for 10 – 15 seconds. • Rinse under warm running water. • Turn off faucet with paper towel.

18. Why HAND WASHING ? • There is no Health precaution like Hand washing. • Washing with simple toilet soap - reduces the rate of transmission of common infections including the HIV.

19. How to Wash our hands

20. Indications for Hand Washing • In prolonged contact with patient. • Before taking care of Immune supressed,New born infants, patients in ICU / ICCU, Dialysis Units, Burn’s Units. • Before and after touching wounds. • When Microbial contamination of Hands, likely to occur when in contact with mucous membranes, body fluids, and other secretions contaminated with Blood, and serous fluids.

21. What to be used for hand washing • In most circumstances Non medicated soaps and detergents are effective in removing most transient contaminants. • In demanding circumstances, in handling potentially harmful infections, use Ethyl or Isopropyl alcohol. • Detergent formulations containing Chlorhexidine Povidone,or Hexachlorophene are effective in prevention of spread of infections.

22. Words of Wisdom on HandWashing Soap, water and Common sense are still be Best Antiseptics William Osler

23. Use of Mask, Cap, Eye Wear • Will certainly protect us from splashes of Blood or Body fluids. • Don't underestimate the importance of Use of Cap and Mask. • It equally protects our patients.

24. Uses of Cap and Mask Stringent use of Mask and Cap can save several Lives in the Hospital

25. Use of Foot wear • Wearing foot wear covering entire sole protects the entry of Microbes from the contaminated floors with Blood and Body fluids. • Remember many of us have cracks on our feet.

26. Use of Impervious Gown A simple thin Plastic apron underneath the linen is of great help in preventing the soaking our inner clothes and exposure to harmful microbes.

27. Disposal of Needles and Sharps • All used needles and sharps should be deposited in thick walled puncture resistant containers. • Bending, Reshaping, should be prohibited. • Do not recap the needles to avoid needle stick injures, • All used Disposable syringes and needles should be discarded into Bleach solution at the work station before final disposal.

28. Dealing with Used Needle Shredding continues to be Important Method Of dealing with used Needle

29. Dealing with Needle stickInjuries • Consider all Needle stick injuries as a serious health hazard in the era of AIDS • All events of Needle stick injuries to be reported to the supervisory staff. • Wash the injured areas with soap and water. • Encourage bleeding if any. • Prophylaxis for prevention of HIV/HBV is top priority. • Anti retroviral prophylaxis, if necessary should started within 2 hours, ( if injury is from HIV positive or high risk group).

30. Avoid Needle Stick Injuries

31. Protect Yourself (continued) • Promptly dispose of used sharps in appropriate sharps disposal containers • Report all occupational exposures promptly to ensure that you receive appropriate follow-up care • Tell your employer about real or potential hazards you observe • Participate in training related to infection prevention • Get a Hepatitis B vaccination

32. Accidental Exposure • Alert your supervisor. • Complete employee injury report. • Follow-up with District’s Worker’s Comp medical provider for confidential evaluation.

33. Handling Occupational Exposures • Employee should immediately report the expose to a supervisor • Immediately wash skin with soap and water • Apply first aid to the wound

34. Hazards of Needle stickInjuries HIV , HBV and HCV viral infections can spread by Needle stick Injuries Nursing staff are at greater risk Several Injuries are preventable

35. Decontamination of Hospital Linen • All the linen contaminated with Blood or Body fluids should be soaked in 1: 100 bleach solution for 30 minutes. • Advised Autoclaving, as the most ideal procedure for decontaminating Linen

36. Spillage of Blood/Body fluids • A common health hazard in the working environment. • Never wipe the spillage with working wet mop. Always cover the spills with paper and pour 1 % Hypochlorite or Bleaching powder to decontaminate the spills with HIV/HBV virus.

37. Care of Endoscopes • Endoscopes are delicate/precious instruments. • Follow the instruction of Manufacturers. • It is commonly cleaned with 2 % Glutaraldehyde solution. • Specified time schedules to be followed to decontaminate for HIV. • Mycobacterium needs even > 2 hours for decontmination.

38. Decontamination of Metal Instruments • Hold all contaminated instruments with Gloved hands. • Subject all metal instruments to washing with soap and water. • Treat all contaminated instruments with 2% Glutaraldehyde. For at least 30 minutes. • Many consider sterilizing in Hot air oven if not sharp instruments.

39. Anesthetic Tubing's and otherEquipment's • Since they are in intimate contact with Human secretion need utmost attention in decontamination. • Treat all Non disposable as highly hazardous, if used without safe practices can infect the next patient undergoing procedures. • Soaking in 2 % Glutaraldehyde is common practice in Developing world.

40. Pregnant Health Care Workers • Not at more risk than other, Health care workers. • Should adopt Universal Health Precautions with more dedication, • If neglected the Unborn is at grave risk of attaining congenital infections. • The Laboratory supervisors should monitor/ guide the HCW’s for adherence to scientific practices.

41. Safe Work Habits (continued) • Place all contaminated waste in an appropriately labeled container and transport in a leak proof, puncture-proof outer container • Disinfect all work surfaces and items before and after testing with 10% bleach solution or EPA approved disinfect

42. Operating on HIV/High risk groups • It is a concern all should be cared equally. • HIV infected carries the risk of being neglected at the time of crisis. • Law many not change for equality but motivated health workers should bring in change of attitude. • Adherence of Universal Health precaution bring in safety to all HCW. • Follow the precautions even in Non HIV patients as some of our patients are in window period and more dangerous than truly positive with Serotesting.

43. Caution on Operating HIVSero Negative Patients • Universal precaution apply to all our patients irrespective of Blood tests we undertake. • We handle so many patients in emergency situation with out any details. • Education on Universal precautions participation of you and educating your subordinates/Juniors will make a lot of Difference in the work Environment.

44. Precaution for Invasive Procedures • All HCW’s who participate in invasive procedures must routinely use appropriate barrier precautions. • All Health care workers who perform/assist vaginal, and cesarean deliveries should wear gloves and gowns when handling, the placenta, and the new born, till blood and amniotic fluid has been removed from infants. • Amniotic fluid is rich in HIV/HBV virus, in infected mothers.

45. Handling Dentistry Patients Blood,Saliva,Gingival fluid from all Dental patients should be considered infective, Dental, workers should wear surgical mask, gloves and eye wear

46. Caring Bleeding Patients • Primary health care workers who handle the patients in Emergencies, and Accidents to be trained in basic principles of Universal Health care precautions. • Mouth to Mouth resuscitation is life saving in the Critically injured accident victims. May be neglected because of fear of HIV infection. • If the situation warrants, Bleeding from mouth can be wiped out with clean cloth, or Handkerchief, and still one can do resuscitation.

47. Importance of Vaccination in Hepatitis B Infection. • We have > 400 Million carriers with Hepatitis B infections. • Every HCW is at risk of Contacting infection. • Vaccination is safe -Genetically Engineered vaccination remains the great hope for prevention, apart from Major component of Universal precautions.

48. Vaccination for HBV infection • All HCW’s must take at least three doses of Vaccine, At 0 – 1 – 6 months. without discontinuationof the schedule. • All Health care workers many not attain equal response. • High risk HCW’s should undergo estimation of anti HB s ( antibodies ) to know whether they were well protected.

49. Problem of HBV vaccines in the Developing world • Who pays for the Vaccine. • Many who work in unorganized sector, do not get Institutional support of Vaccine. • Life, at risk if Infected with HBV • More Awareness to be brought in by Managers of the Hospitals, to promote to vaccinate their Employees.

50. Waste Disposal • Bag and tie after segregation as per codes • Place in second bag and tie again (double bag technique) • Place all sharps (used needles) in sharps container. • Wash hands after removing gloves.