Dr.T.V.

Rao MD

Dr.T.V.Rao MD 1
 Who Is a Health care Worker


 The term health care worker refers to any person working
in health care settings and who has the potential for
exposure to infectious materials including body
substances, contaminated medical supplies and
equipment, contaminated environmental surfaces or
contaminated air . They include, but are not limited to,
physicians, nurses, Laboratory technicians, therapists,
pharmacists, nursing assistants, laboratory personnel,
autopsy personnel, emergency medical service personnel,
dental personnel, students and trainees

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

Dr.T.V.Rao MD 3
Why Universal Health
Precautions.


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 )

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 MODES OF TRANSMISSION of
Infections in Health Care
 Puncture wounds or cuts

 Contact (touch, splash, or
spray) with blood or OPIM
on:

mucous membrane

non-intact skin
 cuts, abrasions, burns
 acne, rashes
 paper cuts, hangnails

contaminated sharps
 Human materials/Tissues
considered Highly Infectious


1 Blood most
infectious
2 Semen
3 Vaginal secretions
4CSF
5 Synovial fluids
6 Amniotic fluid
7 All other body fluids

Dr.T.V.Rao MD 6
 Not Infectious unless contaminated
with Blood or Body fluids.


 Feces,
 Nasal secretions,
 Sputum,
 Sweat,
 Tears,
 Urine / Vomitus,
 Saliva unless blood
stained.

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 Universal Precaution Steps


Gloves (Personal
Protective
Equipment)
Decontamination
Hand Washing
Waste Disposal

Dr.T.V.Rao MD 8
 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.

Dr.T.V.Rao MD 9
 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

Dr.T.V.Rao MD 10
 Step 2 …Gloves…


 One time use.
 If gloves not immediately
available, use barrier such as
paper towels.
 When removing, peel off
hands and roll glove outside
in.
 Discard gloves in lined
waste container.
 Wash hands after removing
gloves.

Dr.T.V.Rao MD 11
 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.
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How to Wash our Hands

Dr.T.V.Rao MD 13


Dr.T.V.Rao MD 14
 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.
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 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.

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 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.
Most important in
collection of swabs in
Influenza

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 Uses of Cap and Mask

Stringent use of
Mask and Cap
can save several
Lives in the
Hospital
Eg Swine flu

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 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.

Dr.T.V.Rao MD 19
 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.
Dr.T.V.Rao MD 20
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.

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 Dealing with Used Needle

Shredding
continues to be
Important
Method
Of dealing with
used Needle
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You can Discard the Used Disposable Needles
and Syringes in Bleached Solution

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 SHARPS CONTAINERS
MUST BE:
closable
closable and puncture resistant
leak
leak proof
labeled
labeled or color-
color-coded
functional
functional
sufficient
sufficient in number
easily
easily accessible and
maintained in upright position
replaced
replaced per agency policy
NOT
NOT be overfilled
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Accidental Exposure
Alert your supervisor.
Complete employee
injury report.
Follow-up with
District’s Worker’s
Comp medical provider
for confidential
evaluation.

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 Hazards of Needle stick
Injuries


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

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 REPORTING AN INCIDENT


Minimal Information to Report
Date
Date and time of incident Work
Work practice being
Job
Job classification - followed
Technician
Location
Location in the worksite Procedure
Procedure being
where incident occurred performed

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 MEDICAL EVALUATION POST EXPOSURE
 Entitled to confidential

medical evaluation
 Personal decision about
blood testing
 Blood may be tested
only with consent
 Blood may be stored for
90 days, while
considering testing
 Interpretation of any test
results occurs with health
care provider
 BLOOD TESTING
 Blood may be tested for antibodies to:


Human Immunodeficiency Virus
(HIV)

Hepatitis C Virus (HCV)

Hepatitis B Virus (HBV)

Other disease-
disease-causing organisms
 Source blood may also be tested with
consent
 Results of tests of source blood will be
made known to exposed person
 Dealing with Needle stick
Injuries


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).
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Do not Recap Needles It can
cause Needle Stick Injury

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 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

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 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
Blotting paper and pour 1 %
Hypochlorite or Bleaching
powder to decontaminate
the spills with HIV/HBV
virus.

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 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.

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 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.

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 Waste Disposal


 Bag and tie
 Place in second bag and
tie again (double bag
technique)
 Place all sharps (used
needles) in sharps
container.
 Wash hands after
removing
gloves.
Dr.T.V.Rao MD 36
 Do Not Do It


 break, shear, bend or recap
needles
 reach into used sharps
containers
 pick up contaminated
items, such as broken
glass with bare hands
 use a vacuum cleaner to
clean up contaminated
items

Dr.T.V.Rao MD 37
 Do Not Do It


 pipette or mouth suction
blood or OPIM
 eat, drink, smoke, apply
cosmetics, or handle
contact lenses in areas of
potential occupational
exposure
 store beverages or food
in refrigerators, freezers,
or cabinets where blood,
other Samples are
preserved
Dr.T.V.Rao MD 38
 Operating on HIV/High risk groups


 It is a concern all should
be cared equally.
 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 Sero
testing.

Dr.T.V.Rao MD 39
 HIV PREVENTION


There
There is no vaccine
to prevent HIV
infection
Follow
Follow Universal
Precautions
 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.
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 Vaccination for HBV infection


 All HCW’s must take at
least three doses of Vaccine,
At 0 – 1 – 6 months. without
discontinuation of 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.

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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.
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Never forget to take Hepatitis B
Vaccine if You are a HCW

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 Every one is a Important
Member of the Family
Every health care


worker is a Important
member of the Family,
one should take all
possible Health Care
precaution to save self
and other Members of
the Family

Dr.T.V.Rao MD 45


Created by Dr.T.V.Rao MD for ‘ e ‘
Learning resources for Medical and
Paramedical Staff in the Developing
World
 Email
 doctortvrao@gmail.com

Dr.T.V.Rao MD 46