safety measures in hcw
DESCRIPTION
safety measures and importance in all health care workersTRANSCRIPT
Safety Measures of Health Care Providers in Trauma
Dr. Soma Sekhara ReddyEmergency medicine
Objectives• Introduction
• Types of injuries / exposures
• Health hazards behind needle prick
• Safety precautions and prophylaxis
• Impending threat
• Conclusion
Introduction• H C Ps , especially E.D. personnel , surgeons
are more vulnerable for infection when carrying out their jobs.
• E.D. staff – 2 fold risk
“Bloodborne Infections in Emergency Medicine” revised in October 2000; April 2004; and April 2011
• Fortunately we have
- safety precautions
- prophylactic measures
- treatment options
Types of injuries
• Needle stick injuries
• Contact of blood and OPIMs
• Human bite injuries
Needle stick injuries
• Most common occupational health accident
• E.D – high risk
• Hollow > solid needle
• Interns and resident doctors are at higher risk for HIV infection
Incidence in different H C Ps
Nurse43%
Technician15%
Student4%
Dental1%
Housekeeping/Maintenance
3%
Clerical / Admin
1%
Other5%
Physician28%
Incidence in different jobs
During Sharps Disposal
13%
During Clean Up9%
In Transit to Disposal
4%
Handle/Pass Equipment
6%
Improper Disposal
9%
Access IV Line5%
Transfer/Process Specimens
5%
Recap Needle6%
Collision W/Worker or
Sharp10%
Manipulate Needle in Patient
28%
Other5%
STATISITICS – Tertiary hospital
YEAR 2010 2011 2012 (UPTO JUNE )
Total no. of NSI 47 56 26
Doctors 6 7 2
E.D 10 10 1
Health hazards behind NSI Most common• HBV
• HCV
• HIV
Other possible
• CMV , EBV , PARVO VIRUS
• Treponema
• Yersinia
• Plasmodium
• Other hepatic viruses
VIRUS
HBV
HCV HIV
Risk 5 – 40 % 3 – 10 % 0.2 – 0.5 %
Vaccination Available no no
P E P Vaccine + Ig no
2/ 3 drug regimen
Prevention very good -
good
HCV
• HCV + HIV (studies by BERGER , Institute of medical virology)
• As there is no vaccination and PEP for HCV only option available is follow up and treatment .
• Chronic carrier state , liver cirrhosis and cancer is more than HBV
Contact of blood and body fluids• Always possible and also preventable.
• More risk if abraded skin or wounds get exposed
• Mucous membrane > skin
• Immediately wash with soap and water or plenty of plain water in case of mucus membranes
Bite injuries• Rare but possible
• Potentially serious infection caused by rapid growth of bacteria in broken skin
• Bacteria – Streptococci Staphylococci Eikenella corrodens Anaerobes
Bite injuries - continued
• 15 to 30 percent cases – infected
• Infections that begin < 24 hours –Necrotising fascitis
• Wash immediately with soap and water
• If hands are involved – I.V. antibiotics are necessary
Universal Safety Precautions• Personal protective equipment
– Gloves: always wear whenever using the needle
– Gowns : Especially non permeable if available
– Mask, protective eyewear ,face shield,foot wear: wear when splashes or droplets are likely .
vaccination
• Most important precautionary measure
• Prior HBV vaccination
• Know the immune status
• Unfortunately not available for HCV and HIV
Safety measures to avoid NSI
• Avoid needle whenever safe alternative available
• Avoid needle recapping
• Plan for safe handling and disposal before beginning of any procedure
• Report all NSIs and prompt others to do the same
• Educate your subordinates / colleagues / employers about risk of NSIs.
What to do..
• Hold the affected limb down and get it to bleed
• Don’t squeeze
• Wash immediately with soap and water / sterilite
• Report immediately to infection control board
• Check the viral status of the source
Impending threat – under reporting
• Acc. To WHO study Avg no. of injuries – 0.2 to 4.7 injuries /1 hcw /1 yr
In India > 3 injuries / 1 hcw / 1 year
• But injuries reported is far less than actual incidence
• Developed countries – nearly 40 %
• India - > 70 %
• More from physicians rather than nursing staff
• Many are junior residents , internees and nursing students
Original article from community medicine -safdarjung hospital , New delhi, INDIA
• MIMS Statistics : -
- 129 injuries were reported / 30 months
- 21 doctors got injured
• Is this statistics actual incidence / incidents reported ?
• Whether actual incidence is low / under reporting is high?
What happens if same trend continues…?
conclusion
• Every HCP should follow existing regulations and guidelines
• When exposed immediately get evaluated and PEP to be taken if indicated
• All HCPs should receive HBV vaccine and should be tested for immunity after vaccination
• All contacts with blood and OPIM should be considered as potential HIV exposures.
• NSIs are omnipresent.
• Every incidence of injury should be notified to assure the follow up and further care.
Additional information
• University of Virginia’s International Health Care Workers Safety Center and its EPINet needle stick injury data collection system: www.med.virginia.edu/~epinet
• www.cdc.gov/niosh• OSHA Web page: www.osha.gov;for needle
stick information, www.osha-slc.gov/SLTC/needlestick/index.html
References
• Original article from community medicine -safdarjung hospital , New delhi, INDIA.
• HealthLink BC File #97, April 2011 , England
• ACEP Board of Directors titled, “HIV and Bloodborne Infections in Emergency Medicine” , U.S.
• Occupational Safety and Health Administration (OSHA)
• Centers for Disease Control and Prevention
• National Institute for Occupational Safety and Health – NIOSH , U.S.
• ITLS text book
Thank you