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OBGECTIVESOBGECTIVES What the risk of exposure?What the risk of exposure? How we can prevent the exposure?How we can prevent the exposure? If the exposure is already done, what If the exposure is already done, what

is the exposure management plan? is the exposure management plan?

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What are What are BloodborneBloodborne Pathogens?Pathogens?

Microorganisms that may be present in human Microorganisms that may be present in human blood and other potentially infectious materials blood and other potentially infectious materials (OPIM) that may cause disease in humans.(OPIM) that may cause disease in humans.

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Diseases Caused by Diseases Caused by BloodborneBloodbornePathogensPathogens

MalariaMalaria SyphilisSyphilis Viral Hemorrhagic Viral Hemorrhagic

Fevers Fevers –– West NileWest Nile

ArboviralArboviral infections infections ––La Crosse, St. LouisLa Crosse, St. Louis

BrucellosisBrucellosis CreutzfeldtCreutzfeldt--Jakob Jakob

DiseaseDisease

HIV / AIDSHIV / AIDS Hepatitis BHepatitis B Hepatitis CHepatitis C

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Bloodborne Pathogen ExposuresBloodborne Pathogen Exposures

Puncture from contaminated needles, Puncture from contaminated needles, broken glass, or other sharpsbroken glass, or other sharps

Contact between nonContact between non--intact skin and intact skin and infectious body fluidsinfectious body fluids cut/abrasion, scratch, acne, sunburncut/abrasion, scratch, acne, sunburn

Direct contact between mucous Direct contact between mucous membranes and infectious body fluidsmembranes and infectious body fluids splash in the eyes, nose, or mouthsplash in the eyes, nose, or mouth

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MucousMembrane . Cutaneous

TYPES OF EXPOSURE

Percutaneous Exposure

High Risk Exposure

Moderate Risk Exposure

Low Risk Exposure

INJURY

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Most Needle Stick Injuries occur Most Needle Stick Injuries occur during the following activities during the following activities

Recapping, bending, or breaking needles;Recapping, bending, or breaking needles;5252%% Inserting a needle into a test tube or specimen Inserting a needle into a test tube or specimen

container and missing the target;container and missing the target;1515%% Injury from a person carrying unprotectedInjury from a person carrying unprotected

sharps;Sharpssharps;Sharps that are present in unexpected that are present in unexpected places, like linens: places, like linens: 1313%%

During complex surgical During complex surgical procedures;Handlingprocedures;Handling or or disposing of waste that contains used sharps, disposing of waste that contains used sharps, 1212%%

Patients moving suddenly during Patients moving suddenly during injectionsinjections::88%%٧٧

Exposure PreventionExposure Prevention The single most effective The single most effective

measure to control the measure to control the transmission of transmission of BloodborneBloodbornePathogens is:Pathogens is:

Standard PrecautionsStandard Precautions

Treat all human blood and other Treat all human blood and other potentially infectious materials like potentially infectious materials like they are infectious for Hepatitis B they are infectious for Hepatitis B and HIVand HIV

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Standard PrecautionsStandard Precautions Hand washing and proper use of PPE.Hand washing and proper use of PPE.

Regular cleaning and decontamination of work Regular cleaning and decontamination of work surfaces with a cleaning agent labeled as surfaces with a cleaning agent labeled as effective against HBV/HIV&HCV.effective against HBV/HIV&HCV.

Vaccination against HepatitisVaccination against Hepatitis--B.B. Proper Sharp Waste disposal.Proper Sharp Waste disposal.

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VACCINATIONVACCINATION

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Safer SharpsSafer Sharps

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Continuous training and education Continuous training and education of Health Care Personnel in all of Health Care Personnel in all hospital departments on Proper hospital departments on Proper Sharp Disposal.Sharp Disposal.

KKHKKH--IFC / SharpIFC / Sharp

1212

Avoid rushing when handling needles and sharps.Avoid rushing when handling needles and sharps. Dispose all needles and other sharps promptly. These Dispose all needles and other sharps promptly. These

items should not be left on food trays or inadvertently items should not be left on food trays or inadvertently deposited in trash containers.deposited in trash containers.

DO NOTDO NOT rere--cap needles.cap needles. Place used disposable items in Place used disposable items in puncture resistant puncture resistant

biohazard containersbiohazard containers for disposal.for disposal. In the event recapping is unavoidable, the In the event recapping is unavoidable, the oneone--handed handed

scoop techniquescoop technique or a needle recapping device shall be or a needle recapping device shall be used.used.

Sharps waste shall be contained in “Sharps waste shall be contained in “Sharps Sharps ContainersContainers” which are rigid and puncture resistant.” which are rigid and puncture resistant. 1313

To safely recap needles use To safely recap needles use ““the onethe one--handhand”” techniquetechnique

Step Step 11 Place the cap on a flat surface, then remove Place the cap on a flat surface, then remove

your hand from the cap.your hand from the cap.

Step Step 22 With one hand, hold the syringe and use the With one hand, hold the syringe and use the

needle to “scoop up” the cap.needle to “scoop up” the cap.

Step Step 33 When the cap covers the needle completely, When the cap covers the needle completely,

use the other hand to secure the cap on the use the other hand to secure the cap on the needle hub. Be careful to handle the cap at the needle hub. Be careful to handle the cap at the bottom only (near the hub). bottom only (near the hub).

1414

Sharps containers shall be labeled as “Sharps containers shall be labeled as “sharps waste”sharps waste” and and biohazardousbiohazardous with international with international biohazardousbiohazardous symbol.symbol.

Sharp containers shall be filled up to three quarters and taped Sharp containers shall be filled up to three quarters and taped closed or tightly lidded.closed or tightly lidded.

Sharps containers are placed in yellow bags by housekeeping Sharps containers are placed in yellow bags by housekeeping personnel for storage and then processing.personnel for storage and then processing.

Sharps waste is disposed of in sharps containers as close to site Sharps waste is disposed of in sharps containers as close to site of use as possible.of use as possible.

InIn--patient roomspatient rooms shall have wall mounted shall have wall mounted “Sharps Container “Sharps Container system “system “ which is kept near the patient’s bed and is securely which is kept near the patient’s bed and is securely locked. Other direct patient care areas shall have wall mounted locked. Other direct patient care areas shall have wall mounted “Sharps Container”“Sharps Container” system and/or rigid puncture resistant system and/or rigid puncture resistant containers having the containers having the biohazardousbiohazardous symbol printed on. symbol printed on.

KKHKKH--IFC / Sharp Injuries Prevention / IPP NO: IFC / Sharp Injuries Prevention / IPP NO: 012012

1515

1616

1717

1818

1919

DEVELOP EXPOSURE DEVELOP EXPOSURE MANGEMENT PLAN, MANGEMENT PLAN, EDUCATE & TRAIN EDUCATE & TRAIN THE STAFF AND THE STAFF AND MONITORING THE MONITORING THE STAFF COMPLAINCE.STAFF COMPLAINCE.

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PLAN

IMMEDIATE CARE OF INJURY

INCIDENCEDOCUMENTATION

Risk Risk ReductionReduction

RISK ASSESMENTMANGEMENTOF EXPOSEDHCWS

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The employee concerned should immediately wash The employee concerned should immediately wash away the contaminating fluid. If blood away the contaminating fluid. If blood or body fluids or body fluids get in the mouth, spit out and then rinse mouth with get in the mouth, spit out and then rinse mouth with water several times.water several times.

If there is a puncture wound, wash with soap and If there is a puncture wound, wash with soap and water and disinfected by Alcohol or Betadine.water and disinfected by Alcohol or Betadine.

If the eyes are contaminated (may be more dangerous If the eyes are contaminated (may be more dangerous than an NSI) rinse well with tap water or salinethan an NSI) rinse well with tap water or saline..

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Should be in detail with completion of the Should be in detail with completion of the appropriate form.appropriate form.

Report should include details of the incident ,date & Report should include details of the incident ,date & time of incident , people involved ,any witnesses to time of incident , people involved ,any witnesses to the incident.the incident.

All occupational exposures must be fully All occupational exposures must be fully documented to meet relevant legal requirement. documented to meet relevant legal requirement.

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The exposedHCWsThe sourceThe injury

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Percutaneous Exposure to BloodPercutaneous Exposure to Blood

Highest RiskHighest Risk Increased RiskIncreased RiskNoNo

Increased RiskIncreased Risk

BOTHLarge vol. of bl.

+High titre ofHBV,HCV,HIV

EITHERLarge vol. of bl.ORHigh titre ofHBV,HCV,HIV

NEITHERLarge vol. of bl.NORHigh titre ofHBV,HCV,HIV

INJURY

٢٥٢٥

The source

HBsAg HCV-Ab HIV-Ab٢٦٢٦

The exposedHCWs

HBsAgAnd

Anti-HBsAbHCV-Ab HIV-Ab

٢٧٢٧

SOURCE SOURCE is is ––veve for HBV,HCV, HIV.for HBV,HCV, HIV.

SOURCE of SOURCE of unknown infectiousunknown infectious or or unable to be testedunable to be tested..

SOURCE is SOURCE is +ve+ve or likel to be +ve.or likel to be +ve.٢٨٢٨

Source is Source is ––ve for HBV,HCV,HIVve for HBV,HCV,HIV

Anti-HBs Ab Titre

< 10 IU /ML> 10 IU /ML

NON IMMUNEIMMUNEPOST-EXPORUE PROPHYLAXIS٢٩٢٩

Source of unknown infectious status Source of unknown infectious status or unable to be testedor unable to be tested

If after every effort has been made to ascertain If after every effort has been made to ascertain the HBV ,HCV ,HIV status of the source ,the the HBV ,HCV ,HIV status of the source ,the status is uncertain then the relative risk of the status is uncertain then the relative risk of the source being + source being + veve , must be inferred when , must be inferred when giving recommendations concerning giving recommendations concerning prophylactic measures.prophylactic measures.

If concern exists that there is a high risk of the If concern exists that there is a high risk of the source being infected with HBV,HCV,HIV the source being infected with HBV,HCV,HIV the HCWs should be HCWs should be mangedmanged as in case of source as in case of source is +is +veve or likely to be +or likely to be +veve. .

٣٠٣٠

Source is Source is ++veve or likely to be +ve foror likely to be +ve forHBVHBV

Anti-HBs Ab Anti-HBc Ab

- Ve+VeNON IMMUNEIMMUNE

POST EXPOSURE PROPHYLAXIS٣١٣١

Postexposure

Prophylaxis

Immunogluline Vaccination Follow up

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Repeat HBs Ag at1 & 6 months

Clinical or serologicalEvidence of acute

hepatitis

No plasma,bl,body tissuedonation.Protect sexual partner.Highest riskpercuteneous exporure,modify WP.

Seek for clinical advise

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Source is +ve orlikely to be +ve for HCV

ConfirmatoryHCV-RNA byreal-time PCR

Screening HCV-IgG

+Ve-Ve -ve+ve

-No infection-Early infection-False -ve

-Current infection-past infection-False +ve

Confirms active HCV replication

Does not confirm

absence of HCV

replication٣٤٣٤

HCV-RNA by PCR repeatedAfter 2 months

HCV-IgG repeated after 6 to 9 months

Clinical or serologicalevidence of acute

hepatitis

Seek for clinical advise No plasma,bl,body tissue donation

Protect the sexual partner .

Hihgest risk percutaneous exposure,modify WP.

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Source +Source +veve or likely to be +or likely to be +veve for HIVfor HIVThe risk of transmission of infectionThe risk of transmission of infection

The average risk estimated for all types of The average risk estimated for all types of percutaneouspercutaneous exposure is exposure is 00..55%.%.

The overall risk estimate from The overall risk estimate from m.mm.m. exposure is . exposure is 00..0808%.%.

No evidence of HIV transmission via intact skin No evidence of HIV transmission via intact skin exposure.exposure.

Although HIV is present in a number of Although HIV is present in a number of bodliybodliyfluids, the incidence of transmission from fluids, the incidence of transmission from secretions not containing visible blood is low. secretions not containing visible blood is low.

٣٦٣٦

Source is Source is ++veve or likely to be or likely to be ++veve for for HIVHIV

PostexporuePostexporue Prophylactic treatment is Prophylactic treatment is indicated.indicated.

It must be commenced as soon as possible It must be commenced as soon as possible .preferably within hours rather than days ..preferably within hours rather than days .

It should be administrated for It should be administrated for 4 4 weeks.weeks. If PEP is offered & taken &the source is later If PEP is offered & taken &the source is later

determined to be HIV determined to be HIV --veve ,PEP should be ,PEP should be discontinued.discontinued.

٣٧٣٧

Repeated HIV screeningat 1 & 3 & 6 months

Until screening forseroconversion

is completed٣٨٣٨

All staff should be aware of the need to comply All staff should be aware of the need to comply with Infection Control Policy.with Infection Control Policy.

All staff should be aware of whom to contact for advice concerning occupational exposure.

All HCWs should be aware of immediate care of injuries &their rights & responsibilities following an occupational exposure.

٣٩٣٩

Standard precautions must be employed when Standard precautions must be employed when handling blood or bodily substanceshandling blood or bodily substances

All bodily fluids such as semen, vaginal All bodily fluids such as semen, vaginal secretions, CSF, synovial ,pleural ,peritoneal secretions, CSF, synovial ,pleural ,peritoneal ,pericardial should be consider potentially ,pericardial should be consider potentially infectious.infectious.

The use of needless or self sheathing devices must The use of needless or self sheathing devices must be encourage.be encourage.

Overstuffing sharps containers & recapping of Overstuffing sharps containers & recapping of needles must not be allowed .needles must not be allowed .

٤٠٤٠

The operating room & emergency room are The operating room & emergency room are particularly areas of high risk to HCWs.particularly areas of high risk to HCWs.

Gowns, gloves ,eye protection are recommended Gowns, gloves ,eye protection are recommended when procedures involving blood or bodily fluids when procedures involving blood or bodily fluids are likely to take place.are likely to take place.

A hands free technique ,where the same sharp A hands free technique ,where the same sharp item is never touched by more than one person at item is never touched by more than one person at the same time ,should be implemented in the the same time ,should be implemented in the operating room. operating room.

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