universal health care precautions
DESCRIPTION
Universal health care precautionsTRANSCRIPT
UNIVERSAL/STANDARD
PRECAUTIONS
BLOODBORNE
PATHOGENS
Dr.T.V.Rao MD
What are Universal Precautions
Dr.T.V.Rao
Universal precaution are control guidelines designed to protect
workers
from exposure to Diseases spread by Blood and other Body
fluids.
CDC
Universal precautions means
Observing “Universal Precautions”
means you consider all human
blood and certain human fluids
infectious for all blood borne
pathogens.
Why Universal Health
Precautions.
Dr.T.V.Rao
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 )
The blood borne pathogens that pose the
most serious health risks
Hepatitis B virus
(HBV)
Hepatitis C virus
(HCV)
Human
Immunodeficiency
Virus (HIV)
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
Dr.T.V.Rao
Exposure occurs through contact with
infected body fluids
Our Role to protect follow
Universal Precautions
Perform all tasks
using safe work
practices
Use appropriate
personal protective
equipment.
Use engineering
controls
Who is at risk for sharps injury?
Workers performing finger sticks
Lab workers
Housekeepers/janitorial staff
Medical waste contractor
Not Infectious unless contaminated
with Blood or Body fluids.
Dr.T.V.Rao
Feces,
Nasal secretions,
Sputum,
Sweat,
Tears,
Urine / Vomitus,
Saliva unless blood stained.
These Body Fluids Include:
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
Protect Yourself…
Universally, treat
every child’s body
fluid as if it were
infected.
Precaution – Use
foresight and plan
ahead to avoid
exposure
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
Universal Precaution Steps
Gloves (Personal
Protective
Equipment)
Decontamination
Hand Washing
Waste Disposal
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
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
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.
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.
Dr.T.V.Rao
How to Wash our hands
Dr.T.V.Rao
Indications for Hand Washing
Dr.T.V.Rao
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.
What to be used for hand
washing
Dr.T.V.Rao
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.
Words of Wisdom on Hand
Washing
Soap, water and
Common sense are still
be Best Antiseptics
William Osler
Dr.T.V.Rao
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. Dr.T.V.Rao
Uses of Cap and Mask
Stringent use of
Mask and Cap
can save several
Lives in the
Hospital
Dr.T.V.Rao
Use of Foot wear
Dr.T.V.Rao
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.
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
Disposal of Needles and Sharps
Dr.T.V.Rao
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.
Dealing with Used Needle
Shredding continues to
be Important Method
Of dealing with used
Needle
Dr.T.V.Rao
Dealing with Needle stick
Injuries
Dr.T.V.Rao
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).
Avoid Needle Stick Injuries
Dr.T.V.Rao
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
Accidental Exposure
Alert your supervisor.
Complete employee injury report.
Follow-up with District’s Worker’s Comp medical provider for confidential evaluation.
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
Hazards of Needle stick
Injuries
Dr.T.V.Rao
HIV , HBV and HCV viral infections
can spread by Needle stick Injuries
Nursing staff are at greater risk
Several Injuries are preventable
Decontamination of Hospital
Linen
Dr.T.V.Rao
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
Spillage of Blood/Body fluids
Dr.T.V.Rao
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.
Care of Endoscopes
Dr.T.V.Rao
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.
Decontamination of Metal
Instruments
Dr.T.V.Rao
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.
Anesthetic Tubing's and other
Equipment's
Dr.T.V.Rao
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.
Pregnant Health Care Workers
Dr.T.V.Rao
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.
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
Operating on HIV/High risk groups
Dr.T.V.Rao
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.
Caution on Operating HIV
Sero Negative Patients
Dr.T.V.Rao
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.
Precaution for Invasive Procedures
Dr.T.V.Rao
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.
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
Dr.T.V.Rao
Caring Bleeding Patients
Dr.T.V.Rao
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.
Importance of Vaccination in Hepatitis B
Infection.
Dr.T.V.Rao
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.
Vaccination for HBV infection
Dr.T.V.Rao
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.
Problem of HBV vaccines in the
Developing world
Dr.T.V.Rao
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.
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.
Never forget to take Hepatitis B
Vaccine if You are a HCW
Dr.T.V.Rao
Created for benefit of Medical and Paramedical
Health care workers in the
Developing world
Dr.T.V.Rao, MD
E mail : [email protected]
Dr.T.V.Rao