Transcript Occupational Hazards of Health Care Personnel-I

Occupational Hazards of Health
Care Personnel-I
Healthcare workers are exposed to many job hazards:
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Infections
Needle injuries
Back injuries
Allergy-causing substances
Violence 
Stress
Healthcare workers are exposed to many job hazards:
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Infections
Needle injuries
Back injuries
Allergy-causing substances
Violence
Stress
Organization for infection control
• To control nosocomial infection
-risk factors for health care–associated
infections (HAIs) should be known
-so that interventions to prevent HAIs can be
implemented.
Healthcare workers are exposed to many job hazards:
• Infections:
A-Blood-born
B-Respiratory infections...
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Infection Control
• Every year, many lives are lost because of the spread of
infections in hospitals. Health care workers can take steps to
prevent the spread of infectious diseases.
• These steps are part of infection control:
• Proper hand washing –hand hygiene is the most effective way
to prevent the spread of infections in hospitals. Covering
coughs and sneezes
• Staying up-to-date with immunizations
• Using gloves, masks and protective clothing
• Making tissues and hand cleaners available
• Following hospital guidelines when dealing with blood or
contaminated items
Blood-born disease
http://www.osha.gov/SLTC/etools/hospital
/hazards/univprec/univ.html#OPIM
• OSHA: Occupational safety and health administration
regulations
http://www.osha.gov/SLTC/etools/hospital/hazards/uni
vprec/univ.html#OPIM
• Employee exposure to bloodborne pathogens from blood
and Other Potentially Infectious Materials (OPIM) by
Universal Precautions.
• Bloodborne pathogens are pathogenic microorganisms that
are present in human blood and can cause disease in humans.
• Some infections that can be transmitted through contact with
blood and body fluids include:
– HIV, Hepatitis A, B, C, Staph and Strep infections, Gastroenteritissalmonella, and shigella, Pneumonia, Syphilis, TB, Malaria, Measles,
Chicken Pox, Herpes, Urinary tract infections, and Blood infections.
The greatest risks are from HIV and Hepatitis B and C.
OSHA: Occupational safety and health
administration regulations
• The Bloodborne Pathogens Standard allows for hospitals to use acceptable
alternatives [OSHA Directive CPL 02-02-069] to universal precautions:
• Alternative concepts in infection control are called Body Substance
Isolation (BSI) and Standard Precautions. These methods define all body
fluids and substances as infectious. These methods incorporate not only
the fluids and materials covered by the Bloodborne Pathogens Standard
but expands coverage to include all body fluids and substances.
• The CDC recommends Standard Precautions for the care of all
patients, regardless of their diagnosis or presumed infection
status.
• Standard Precautions apply to 1) blood; 2) all body fluids,
secretions, and excretions, except sweat, regardless of
whether or not they contain visible blood; 3) non-intact skin;
and 4) mucous membranes. Standard precautions are
designed to reduce the risk of transmission of microorganisms
from both recognized and unrecognized sources of infection
in hospitals.
– Standard precautions includes the use of: hand washing, appropriate
personal protective equipment such as gloves, gowns, masks,
whenever touching or exposure to patients' body fluids is anticipated.
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Transmission-Based Precautions (i.e., Airborne Precautions, Droplet Precautions, and
Contact Precautions), are recommended to provide additional precautions beyond Standard
Precautions to interrupt transmission of pathogens in hospitals.
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Transmission-based precautions can be used for patients with known or suspected to be
infected or colonized with epidemiologically important pathogens that can be transmitted by
airborne or droplet transmission or by contact with dry skin or contaminated surfaces. These
precautions should be used in addition to standard precautions.
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Airborne Precautions used for infections spread in small particles in the air such as chicken pox.
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Droplet Precautions used for infections spread in large droplets by coughing, talking, or sneezing
such as influenza.
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Contact Precautions used for infections spread by skin to skin contact or contact with other surfaces
such as herpes simplex virus.
Airborne Precautions, Droplet Precautions, and Contact Precautions. May be combined for
diseases that have multiple routes of transmission. When used either singularly or in
combination, they are to be used in addition to Standard Precautions.
Workplace Transmission
Professions at risk of exposure:
contact with someone bleeding or
responsible for the cleanup of
blood and other infections
materials.
• physicians and nurses (health
center),
• police officers,
• athletic trainers,
• maintenance workers
• environmental services workers.
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Bloodborne pathogens may be present in
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Blood
Semen
saliva
vaginal secretions
cerebrospinal fluid
synovial fluid
pleural fluid
peritoneal fluid
pericardial fluid
amniotic fluid
any body fluid visibly
contaminated with blood
– any unidentifiable body fluid.
Entrance of these pathogens
• by an accidental injury with a sharp object
contaminated with infectious materials such
as
– needles, glass, or anything which can pierce,
puncture, or cut skin.
• Transmission may also occur by
– transferring the infectious material to the mouth,
eyes, nose, or open skin.
EXPOSURE CONTROL PLAN
A. Purpose
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The purpose of the Exposure Control Plan is to
eliminate workplace exposure to contaminated
blood and other infectious body fluids.
B. Definitions
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1. Engineering Controls
are physical or mechanical systems provided to
eliminate hazards at their source.
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providing
handwashing facilities,
eye stations
sharps containers,
waste containers,
biohazard labels in designated locations.
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2. Work Practice Controls
Work practice controls are specific procedures
to be followed to reduce exposure to
bloodborne pathogens or infectious materials.
Personal Protective Equipment
• Equipment that protects
from contact with
potentially infectious
materials will be provided at
no cost to the employee.
• The type of protective
equipment depends on the
degree of exposure and
could include gloves, mask,
eye shield, gown, shoe
covers, cap, and CPR
microshield
How can occupational exposures be
prevented?
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Many needlesticks and other cuts can
be prevented by using safer
techniques
– for example, not recapping needles
by hand,
– disposing of used needles in
appropriate sharps disposal
containers
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Using appropriate barriers
– such as gloves,
– eye and face protection,
– gowns when contact with blood
Labels should display this
universal biohazard symbol.
Can prevent many exposures to the eyes,
nose, mouth, or skin.
Always check
your gloves for
damage before
using them
IF AN EXPOSURE OCCURS
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Immediately following an exposure
to blood:
– Wash needlesticks and cuts with
soap and water
– Flush splashes to the nose, mouth,
or skin with water
– Irrigate eyes with clean water,
saline, or sterile irrigants
– No scientific evidence shows that
using antiseptics or squeezing the
wound will reduce the risk of
transmission of a bloodborne
pathogen.
– Using a caustic agent such as
bleach is not recommended.
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Safety & Health
Bloodborne Pathogens
Accident Report
Report the exposure to the department
(e.g., occupational health, infection
control) responsible for managing
exposures.
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Prompt reporting is essential
– in some cases, postexposure
treatment may be recommended
and it should be started as soon as
possible.
– Discuss the possible risks of
acquiring HBV, HCV, and HIV and the
need for postexposure treatment
with the provider managing your
exposure.
– You should have already received
hepatitis B vaccine, which is
extremely safe and effective in
preventing HBV infection.
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A.
Name:_________________________________________________
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Last Name
First Name
Middle Name
Social Security Number
/ /
Race
Sex M Q
Age
Date of
Birth / /
F Q
Address:
_______________________________________________________
___________
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Home Phone #:
Work Phone #:
B.
Name of person
whose blood contacted:
Last
Name
First Name
Middle Name
Social Security Number
/ /
Race
Sex M Q
Age
Date of Birth / /
FQ
Address:
Home Phone #:
C.
Incident:
Location of Incident:
Remarks:
Work Phone #:
POST-EXPOSURE EVALUATION AND FOLLOW-UP:
• a confidential medical evaluation
• documenting the circumstances
of exposure,
• identifying and testing the source
individual
• testing the exposed employee's
blood if he/she consents,
• post-exposure prophylaxis,
• counseling
• evaluation of reported illnesses.
• If not vaccinated: hepatitis B
vaccination following the
exposure.
– Test worker
– if source anti-HCV positive
• Anti-HCV and ALT at baseline
and 4-6 months later
• For earlier diagnosis, HCV RNA
at 4-6 weeks
• Refer infected worker to specialist
for medical evaluation and
management
Bloodborne Diseases
are caused by Bloodborne pathogens
• are microorganisms
such as viruses or
bacteria
• are carried in blood
and can cause disease
OSHA: Occupational safety
and health administration
regulations
• Types of pathogens
– malaria, syphilis, and
brucellosis
– Hepatitis B (HBV),HCV
and the Human
Immunodeficiency Virus
(HIV) are the 3 diseases
specifically addressed by
the OSHA Bloodborne
Pathogen Standard
Healthcare personnel who have received hepatitis B vaccine and developed
immunity to the virus are at virtually no risk for infection.
• For a susceptible person:
– the risk from a single needlestick or cut exposure to HBV-infected blood
ranges from 6-30%
– depends on the hepatitis B e antigen (HBeAg) status of the source individual.
– Hepatitis B surface antigen (HBsAg)-positive individuals who are HBeAg
positive have more virus in their blood and are more likely to transmit HBV
than those who are HBeAg negative.
HDV
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Is composed of a RNA genome,
surrounded by an envelope of HBsAg.
• is now known to require a helper
function of HBV for its
transmission.
• HDV is coated with HBsAg which
is needed for release from the
host hepatocyte and for entry in
the next round of infection.
In the first, a susceptible individual is coinfected with HBV and HDV,
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a more severe form of acute hepatitis is
seen
Vaccination against HBV also prevents coinfection.
In the second, an individual chronically
infected with HBV becomes superinfected
with HDV.
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a second episode of clinical hepatitis and
accelerate the course of the chronic liver
disease,
cause overt disease in asymptomatic
HBsAg carriers
Protection against HDV
• HBV-HDV Coinfection
– Pre or postexposure prophylaxis to prevent HBV
infection
• HBV-HDV Superinfection
– Education to reduce risk behaviors among persons
with chronic HBV infection
AIDS (acquired immune deficiency syndrome)
• is caused by a virus called the human
immunodeficiency virus, or HIV.
– is very fragile and will not survive
very long outside of the human body
– It is primarily of concern to
employees providing first aid or
medical care in situations involving
fresh blood or other potentially
infectious materials. It is estimated
that the chances of contracting HIV
in a workplace environment are only
0.4%.
• Once a person has been infected with
HIV, it may be many years before AIDS
actually develops.
• HIV attacks the body's immune system.
The risk
• The average risk of HIV infection after a needlestick
or cut
– about 1 in 300
• The risk after exposure of the eye, nose, or mouth to
HIV-infected blood is estimated to be, on average,
0.1% (1 in 1,000).
• The risk after exposure of non-intact skin to HlVinfected blood is estimated to be less than 0.1%.
HCV
• The average risk for infection after a needlestick or cut
exposure to HCV infected blood is approximately 1.8%.
• The risk following a blood exposure to the eye, nose or mouth
is unknown, but is believed to be very small;
– HCV infection from blood splash to the eye has been reported.
• There also has been a report of HCV transmission that may
have resulted from exposure to nonintact skin, but no known
risk from exposure to intact skin.
• When infected chronic carrier state: approx 80%
Accidental puncture from contaminated needles and other sharps can result
in transmission of bloodborne pathogens.
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HBV and HIV are most commonly transmitted through:
Sexual Contact
Sharing of hypodermic needles
From mothers to their babies at/before birth
Accidental puncture from contaminated needles, broken
glass, or other sharps
• Contact between broken or damaged skin and infected
body fluids
• Contact between mucous membranes and infected body
fluids
Unbroken skin forms an impervious barrier against
bloodborne pathogens
Infected blood can enter your
system through:
• Open sores
• Cuts
• Abrasions
• Acne
• Any sort of damaged or
broken skin such as sunburn
or blisters
• Bloodborne pathogens may
also be transmitted through
the mucous membranes of
the
• Eyes
• Nose
• Mouth
• For example, a splash of
contaminated blood to your
eye, nose, or mouth could
result in transmission.
TREATMENT FOR THE EXPOSURE
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All healthcare personnel who have a
reasonable chance ofexposure to
blood or body fl uids should receive
hepatitis B vaccine.
Vaccination ideally should occur
during the healthcare worker’s
training period.
– should be tested 1-2 months after
the vaccination is complete to make
sure that vaccination has provided
immunity to HBV infection.
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Hepatitis B immune globulin (HBIG)
alone or in combination with vaccine
(if not previously vaccinated) is
effective in preventing HBV infection
after an exposure.
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The decision to begin treatment is
based on several factors
– Whether the source individual is
positive for hepatitis B surface
antigen
– Whether you have been vaccinated
– Whether the vaccine provided you
immunity
HCV
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no vaccine against hepatitis C
no treatment after an exposure that
will prevent infection.
Neither immune globulin nor
antiviral therapy is recommended
after exposure.
For these reasons, following
recommended infection control
practices to prevent percutaneous
injuries is imperative.
Postexposure treatment:
• There is no postexposure treatment
that will prevent HCV infection.
• should be tested for HCV antibody
and liver enzyme levels (alanine
aminotransferase or ALT) as soon as
possible after the exposure
(baseline) and at 4-6 months after
the exposure.
• To check for infection earlier,
exposed worker can be tested for
the virus (HCV RNA) 4-6 weeks after
the exposure. Report any symptoms
suggesting hepatitis
HIV
• There is no vaccine against HIV. However, results from a small
number of studies suggest that the use of some antiretroviral
drugs after certain occupational exposures may reduce the
chance of HIV transmission.
• Postexposure prophylaxis (PEP) is recommended for certain
occupational exposures that pose a risk of transmission.
• However, for those exposures without risk of HIV infection,
PEP is not recommended because the drugs used to prevent
infection may have serious side effects.
• You should discuss the risks and side effects with your
healthcare provider before starting PEP for HIV.
How are exposures to blood from an individual whose infection
status is unknown handled?
• HBV–HCV–HIV
• If the source individual cannot be identified or tested,
decisions regarding
• follow-up should be based on the exposure risk and whether
the source is
• likely to be infected with a bloodborne pathogen. Follow-up
testing should be
• available to all personnel who are concerned about possible
infection through occupational exposure.
How soon after exposure to a bloodborne pathogen should treatment start?
HBV
• Postexposure treatment should begin as soon as possible
after exposure
– within 24 hours, and no later than 7 days.
HIV
• Treatment should be started as soon as possible
– within hours as opposed to days, after the exposure
• Starting treatment after a longer period (e.g., 1 week) may be
considered for exposures that represent an increased risk of
transmission.
Can pregnant healthcare personnel take the drugs recommended
for postexposure treatment?
HBV
• Yes. Women who are pregnant or breast-feeding can
receive the hepatitis B
• vaccine and/or HBIG.
HIV
• Pregnancy should not rule out the use of
postexposure treatment when it is warranted.
– Preganant person should understand what is known and
not known regarding the potential benefi ts and risks
associated with the use of antiviral drugs in order to make
an informed decision about treatment.
What precautions should be taken during the followup period?
HBV
• If you are exposed to HBV and receive postexposure treatment,
• it is unlikely that you will become infected and pass the infection on to others.
• No precautions are recommended.
HCV
• Because the risk of becoming infected and passing the infection on to others
• after an exposure to HCV is low, no precautions are recommended.
HIV
• During the follow-up period, especially the first 6-12 weeks when most infected persons are
expected to show signs of infection, you should follow recommendations
• for preventing transmission of HIV.
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not donating blood,semen, or organs and not having sexual intercourse.
If you choose to have sexual intercourse, using a condom consistently and correctly. In addition,
women should consider not breast-feeding infants during the follow-up period.
Exposure to HBV risk
HBV
Source is known to be HBsAg(+) or unknown
Injured person
Anti HbsAg (+)
> 10 No follow-up
Anti- HbsAg (-)
< 10
HBV vaccine is started
The same day to the other arm
HBIG
Finish the HBV vaccination
program
Exposure to HIV risk
HIV
Source is known to be HIV(+) or unknown
Confirmed HIV
seropositivity
Antiretroviralprophylaxis
On the day of exposure for evaluation Anti-HIV
6 weeks later Anti-HIV
3 months later Anti-HIV
6 months later Anti-HIV
Exposure to HCV risk
HCV
On the same day anti-HCV and ALT
6 weeks later ALT*
2 months later ALT*
3 months later anti HCV VE ALT*
4 months later anti HCV VE ALT*
6 months later anti-HCV
*In case of ALT positivity :HCV RNA by PCR
• Risk of Infection Following a Single HIV, HBV, or
HCV-Contaminated Needlestick or Sharp Instrument
Injury
(revised 5/09/01)
• HIV 0.25% - 0.4%
HBV 6% - 30%
HCV 0.4% - 1.8%