Infection Control Overview: HIV and other Blood-Borne

PathogensSession 2: Infection Control Basics

2: Infection Control Overview - HIV Slide 2

Learning Objectives

This session deals with the control of HIV and other blood-borne pathogens

By the end of session 2, participants will be able to:

Protect themselves and others from HIV and other blood-borne pathogens

Describe what to do after a needle prick or if blood and/or body fluids get into the eyes or mouth

Provide input to the Hospital Infection Control Committee (HICC) on infection control procedures

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Discussion: Hepatitis B Immunisation

Are you familiar with the current policy for Hep B vaccination before and after exposure?

What is the procedure involved for a new hospital employee under this policy?

What are the contraindications for the Hep B vaccination?

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Protecting Yourself from Blood-Borne Pathogens

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Protecting Yourself from Blood-Borne Pathogens (cont’d) Wear gloves

Don’t recap needles

Complete 3 doses of Hep B vaccine

Eliminate unnecessary injections

Dispose of sharps immediately after use to minimise handling that increases risk of needlesticks

Substitute safer devices or tools whenever possible

Report needlesticks

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Protecting Yourself from Blood-Borne Pathogens (cont’d)Which pathogen is most likely to be transmitted from

a needle used on an infectious patient?

HIV

HEP B

HEP C

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HIV: 3 Infections per 1,000 Sticks with a HIV+ Needle

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Hepatitis C: 18 Persons per 1,000Needle-sticks 0000000000000000000000000000000000000000000000000000000000000000

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Hepatitis B is Most Infectious

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Why is Hep B Virus More Infectious than HIV? Viral concentration per mL

Virulence factor

Incubation period

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Protect Yourself! Get a Hepatitis B Vaccination and keep your Vaccine Record

3 doses of Hepatitis B vaccine protect most people for a lifetime

The next dose at this facility will be given on _______________

Will you be there with your staff?

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Prevention of Injury Due to Sharps is Critical

In some hospitals in India, staff report 1-2 sharps injuries per person per year

Do you know how, when, with what device and to whom most sharps injuries occur?

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Exercise 2.1: Sharps Injury Role Play

Instructions:

Divide into groups of 5

Decide who will play the roles of supervisor, health worker, and observer

The health care worker will pretend that they have just received a sharps injury

The supervisor should interview the worker about the injury using worksheet 2.1 as a guide

The observer will report back to the larger group on what took place

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Discussion: Sharps Reporting Form

Is this Proforma sufficient for reporting sharps injuries? Why or why not?

What changes could be made to current reporting procedures to make it easier to report injuries?

Why do you think injuries are not always reported?

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What do We Mean by “Sharps”

Needles and syringes

Glass capillary tubes

Glass ampoules

Vacutainer needles

Suture needles, IV introducers and IV flushes

Test tubes and glass apparati used in lab

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Eliminate Needle use When Possible

Do not use an injection or IV medicine when an oral medicine will do!

Do not place a venting needle into an IV; this increases the risk of contamination and needlesticks

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Substitute Metal or Plastic for Glass when Possible

Staff are discussing using metal tubes for pulmonary drainage rather than glass to help prevent accidents

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Sharps Injuries are Likely to Occur…

During recapping needles

During blood draws

During IV insertion & removal

When handling needles (taking them apart, picking up a dirty syringe, dumping containers, etc.)

When disposing of sharps

During waste collection and processing

During breakages

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Safe Handling of Sharps

Wear gloves when drawing blood or handling sharps—double glove for surgery

Don’t recap!

Don’t bend or break needles

Never place used sharps on tables, beds, furniture

Put used sharps immediately into a sharps container

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Disposal of Sharps: The Ideal

Immediately after use, put sharps in a leak- proof and puncture-proof container

The container should be within arm’s length

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Sharps Disposal at GHTM

Needle destroyer

Disposal of sharps in blue bins

What are some potential problems with the current sharps disposal system?

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Sharps Disposal (cont’d)

Disposal containers should be placed at all points of use

Disposal bin should be rigid and should be leak and puncture proof

Separate sharps from other waste so laundry workers or waste disposal staff do not get needlesticks

Empty sharps containers when they are ¾ full

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Danger!

Open containers of used needles like this put staff at risk each time they put a hand in to pick up one

Keep your ward free of used sharps

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Remember this Procedure…

If a needle pricks you or blood and/or body fluids enter your eye(s) or mouth

Wash wounds with soap and water

Flush eyes and mouth with water

Check the patient record to see if the patient is HIV+, HIV- , or untested

Check patient record for Hepatitis B or C infection

Call the medical duty officer immediately

NACO PEP Guidelines

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Determination of Exposure Code

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Determination of HIV Status Code

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Determination of PEP RecommendationEC HIV SC PEP Recommendation

1 1 Pep may not be warranted

1 2 Consider basic regimenExposure type poses a negligible risk for HIV transmission

2 1 Recommend basic regimenMost HIV exposures are in this category; no increased risk for HIV transmission has been observed but use of PEP is appropriate

2 2 Recommend expanded regimenExposure type represents an increased HIV transmission risk

3 1 or 2 Recommend expanded regimenExposure type represents an increased HIV transmission risk

  UNKNOWN If the source, (in the case of an unknown source), the setting where the exposure and the EC is 2 or 3, consider PEP basic regimen

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HIV Testing and Counselling

Post exposure

HIV testing done at intervals of immediately, at 6 weeks and 6 months accompanied by

Pre-test counselling

Post test counselling

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Drugs Recommended for Post Exposure Prophylaxis

Zidovudine – 300mg 12 hrly

Lamivudine – 150 mg 12 hrly

Indinavir – 800 mg thrice daily ( expanded regimen only)

For 28 days

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Treatment for HIV after Needlesticks (Post Exposure Prophylaxis) It is most effective if started 1- 2 hours after exposure

Can be given up to 72 hours after exposure

Should NEVER be given without medical follow-up and filing an incident report because of the serious side effects, and the need to try to prevent similar injuries

Must be taken for 28 days

Pregnant staff can take PEP drugs. Tell the duty officer if you might be pregnant so he can give appropriate medications

Staff member on PEP should avoid sex or practice safe sex (use condoms)

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Group Discussion: Help the InfectionControl Committee What is the current PEP policy and practice at

your facility? How soon after an injury should it be reported? What do you describe a significant exposure?

How should the confidentiality of the test report be maintained?

Where should an emergency stock of PEP drugs be stored?

Should the source patient be tested?

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NACO PEP Policy - Role of the Medical Officer

Decides if PEP is needed

Tests the source patient and staff for HIV, if test results are not available

Tests staff members who take PEP at six and 12 weeks for HIV, and monitors for side effects

Gives reporting form to the Superintendent

Keeps all information confidential

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When do you need to wear gloves?

Discussion: Personal Protective Equipment

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Gloves

Wear clean gloves when handing blood or body fluids

Wear clean gloves when serving food

Wear sterile gloves when handling sterile supplies, doing invasive procedures, suctioning, catheters, etc.

Wear surgical gloves for surgery

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Utility Gloves

Utility gloves are used repeatedly and have many germs

Do not use them to touch patients, patient care items, or anything near patents

Use the same utility gloves for the same tasks - use separate gloves for dirty and clean tasks

Utility gloves must be washed with detergent and bleach and left to dry at the end of the shift

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Summary: Steps to Protect Yourself from Blood-Borne Pathogens Wear gloves

Don’t recap needles

Complete 3 doses of Hep B vaccine

Eliminate unnecessary injections

Dispose of sharps immediately after use to minimise handling that increase risk of needlesticks

Substitute a safer substance or tool whenever possible

Report needlesticks immediately

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Key Points

HIV PEP should be in started within 1-2 hours and should be used for four weeks if needed

You can help others by being a good role model

Supervisors should tactfully correct staff if they are doing unsafe practices

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Hospital Infection Control Committee (HICC)

BREAK