Transcript 5130 KB - I-TECH

Infection Control Overview: HIV and
other Blood-Borne Pathogens
Session 2: Infection Control Basics
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
2: Infection Control Overview - HIV
Slide 2
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?
2: Infection Control Overview - HIV
Slide 3
Protecting Yourself from Blood-Borne
Pathogens
2: Infection Control Overview - HIV
Slide 4
Protecting Yourself from Blood-Borne
Pathogens (cont’d)

Wear gloves

Don’t recap needles

Complete 3 doses of Hep
B vaccine

Eliminate unnecessary
injections
2: Infection Control Overview - HIV

Dispose of sharps
immediately after use to
minimise handling that
increases risk of
needlesticks

Substitute safer devices or
tools whenever possible

Report needlesticks
Slide 5
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
2: Infection Control Overview - HIV
Slide 6
HIV: 3 Infections per 1,000 Sticks with a
HIV+ Needle

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2: Infection Control Overview - HIV
Slide 7
Hepatitis C: 18 Persons per 1,000
Needle-sticks
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2: Infection Control Overview - HIV
Slide 8
Hepatitis B is Most Infectious
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2: Infection Control Overview - HIV
Slide 9
Why is Hep B Virus More Infectious than HIV?

Viral concentration per mL

Virulence factor

Incubation period
2: Infection Control Overview - HIV
Slide 10
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?
2: Infection Control Overview - HIV
Slide 11
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?
2: Infection Control Overview - HIV
Slide 12
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
2: Infection Control Overview - HIV
Slide 13
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?
2: Infection Control Overview - HIV
Slide 14
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
2: Infection Control Overview - HIV
Slide 15
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
2: Infection Control Overview - HIV
Slide 16
Substitute Metal or Plastic for Glass
when Possible

Staff are discussing
using metal tubes for
pulmonary drainage
rather than glass to
help prevent
accidents
2: Infection Control Overview - HIV
Slide 17
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
2: Infection Control Overview - HIV
Slide 18
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
2: Infection Control Overview - HIV
Slide 19
Disposal of Sharps: The Ideal

Immediately after use,
put sharps in a leakproof and punctureproof container

The container should
be within arm’s length
2: Infection Control Overview - HIV
Slide 20
Sharps Disposal at GHTM

Needle destroyer

Disposal of sharps in
blue bins

What are some
potential problems
with the current sharps
disposal system?
2: Infection Control Overview - HIV
Slide 21
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
2: Infection Control Overview - HIV
Slide 22
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
2: Infection Control Overview - HIV
Slide 23
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
2: Infection Control Overview - HIV
Slide 24
NACO PEP Guidelines
Determination of Exposure Code
2: Infection Control Overview - HIV
Slide 26
Determination of HIV Status Code
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Slide 27
Determination of PEP Recommendation
EC
HIV SC
PEP Recommendation
1
1
Pep may not be warranted
1
2
Consider basic regimen
Exposure type poses a negligible risk for HIV transmission
2
1
Recommend basic regimen
Most 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 regimen
Exposure type represents an increased HIV transmission risk
3
1 or 2
Recommend expanded regimen
Exposure 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
2: Infection Control Overview - HIV
Slide 28
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
2: Infection Control Overview - HIV
Slide 29
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
2: Infection Control Overview - HIV
Slide 30
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)
2: Infection Control Overview - HIV
Slide 31
Group Discussion: Help the Infection
Control 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?
2: Infection Control Overview - HIV
Slide 32
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
2: Infection Control Overview - HIV
Slide 33
Discussion: Personal Protective Equipment

When do you need to wear gloves?
2: Infection Control Overview - HIV
Slide 34
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
2: Infection Control Overview - HIV
Slide 35
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
2: Infection Control Overview - HIV
Slide 36
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
2: Infection Control Overview - HIV
Slide 37
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
2: Infection Control Overview - HIV
Slide 38
Hospital Infection Control Committee (HICC)
2: Infection Control Overview - HIV
Slide 39
BREAK