Hepatitis b and c prophylaxis

1. HEPATITIS B AND C PROPHYLAXIS NEEDLE STICK INJURY AND PREVENTION PRESENTER: SAPEEDEH AFZAL ROLL # 10 GROUP: A Hep B & C prophylaxis, needle stick injury, FJDC

2. ROA D MAP Hepatitis B and C prophylaxis Pre-exposure prophylaxis Post-exposure prophylaxis. Needle stick injury Prevention Management

3. 3 POTENTIAL ROUTES OF TRANSMISSION OF BLOOD-BORNE PATHOGENS PATIENT DHCP DHCP PATIENT PATIENT PATIENT

4. HEPATITIS B VIRUS Member of hepadnavirus family. 42 nm enveloped virion with partially double-stranded circular DNA. It contains 4 genes which encode 5 proteins. S gene encodes surface antigen. C gene encodes core & e antigen. P gene encodes polymerase. X gene X protein.

5. RISK FOR OCCUPATIONAL TRANSMISSION OF HBV The risk of developing clinical hepatitis if the blood was both hepatitis B surface antigen ( HBsAg )-and HBeAg -positive was 22%–31%. By comparison, the risk of developing clinical hepatitis from a needle contaminated with HBsAg -positive, HBeAg -negative blood was 1%–6%.

6. PRE-EXPOSURE PROPHYLAXIS It is important that dentist and all workers are vaccinated. Pre-exposure prophylaxis consists of administration of a 3 dose series of hepatitis B vaccine given over a 6-month period. Dose # 1 is time zero Dose # 2 given one month after dose #1 Dose # 3 is given 6 months after dose #1 Adolescents aged 11-15 years have the option of a two-dose schedule with the second dose given 4-6 months after the first dose.

7. PRE-EXPOSURE PROPHYLAXIS STANDARD PRECAUTIONS Standard precautions are designed to reduce the risk of transmission of microorganisms from known and unknown sources of infection (blood, body fluids, excretions, secretions etc). These precautions apply to the care of all patients regardless of their diagnosis or presumed infection status. THE PRINCIPLES OF STANDARD PRECAUTIONS INCLUDE: Hand washing. Protective barriers i.e. the use, of personal protective clothing, e.g. gloves, surgical masks, eye protection. Management of healthcare waste. Correct handling and disposal of needles and sharps. Effective cleaning, decontamination and sterilization of equipment, instruments and environment (including blood spillages). Use of appropriate disinfectants at the correct working dilution.

8. ADDITIONAL MEASURES FOR KNOWN HBV POSITIVE PATIENT Patients should be scheduled at the end of the list. Operators & assistants should wear 2 pair of gloves, plastic gown, cap mask, protective eyewear. High volume suction should be used, rubber dam should be applied to minimize the formation of aerosols. All used instruments should be packed in a labeled plastic wrap. After procedure, all equipments & surfaces should be cleaned & decontaminated with disinfectant (0.5% Na hypochlorite).

9. POST-EXPOSURE PROPHYLAXIS Two types of products are available for prophylaxis against HBV infection: Hepatitis B vaccine, which provides long-term protection against HBV infection, is recommended for pre-exposure and post-exposure prophylaxis. HBIG, provides temporary protection (i.e., three to six months) and is only indicated in certain post-exposure settings.

10. POST-EXPOSURE PROPHYLAXIS

11. HEPATITIS C VIRUS Member of flavivirus family. Enveloped virion , genome of single-stranded RNA, no virion polymerase. It has 6 genotypes and multiple sub-genotypes, resulting in a “ hypervariable ” region in envelope glycoprotein. No particular vaccine available.

12. RISK FOR OCCUPATIONAL TRANSMISSION OF HCV HCV is not transmitted efficiently through occupational exposures to blood. The average incidence of anti-HCV seroconversion after accidental percutaneous exposure from an HCV-positive source is 1.8% (range: 0%–7%)

13. PRE-EXPOSURE PROPHYLAXIS No vaccine available. STANDARD PRECAUTIONS TO BE FOLLOWED: Hand washing. Protective barriers i.e. the use, of personal protective clothing, e.g. gloves, surgical masks, eye protection. Management of healthcare waste. Correct handling and disposal of needles and sharps. Effective cleaning, decontamination and sterilization of equipment, instruments and environment (including blood spillages). Use of appropriate disinfectants at the correct working dilution.

14. ADDITIONAL MEASURES FOR KNOWN HCV POSITIVE PATIENT Patients should be scheduled at the end of the list. Operators & assistants should wear 2 pair of gloves, plastic gown, cap mask, protective eyewear. High volume suction should be used, rubber dam should be applied to minimize the formation of aerosols. All used instruments should be packed in a labeled plastic wrap. After procedure, all equipments & surfaces should be cleaned & decontaminated with disinfectant (0.5% Na hypochlorite).

15. POST-EXPOSURE PROPHYLAXIS No protective antibody response has been identified following HCV infection. (Experimental studies in chimpanzees with IG containing anti-HCV failed to prevent transmission of infection after exposure.) In the absence of PEP for HCV, recommendations for postexposure management are intended to achieve early identification of chronic disease and, if present, referral for evaluation of treatment options.

16. NEEDLE STICK INJURY THE ACCIDENTAL PUNCTURE OF THE SKIN BY A NEEDLE DURING A MEDICAL INTERVENTION Accidental contact with blood occurs especially in the following situations: During re-capping During surgery, especially during wound closure During biopsy When an uncapped needle has ended up in bed linen, surgery clothing etc When taking an unsheathed used needle to the waste container During the cleaning up and transporting of waste material When using more complex collection & injection techniques In A&E (Accident and Emergency) departments In high-stress interventions (diagnostic or therapeutic endoscopy in patients with gastrointestinal bleeding)

17. CDC ESTIMATES ~385,000 SHARPS INJURIES ANNUALLY AMONG HOSPITAL-BASED HEALTHCARE PERSONNEL (>1,000 INJURIES/DAY)

18. INFECTIONS TRANSMITTED The major blood-borne pathogens of concern associated with needle stick injury are: hepatitis B virus (HBV) 6-30% hepatitis C virus (HCV) ≈ 2% human immunodeficiency virus (HIV). 0.3% However, other infectious agents also have the potential for transmission through needle stick injury. These include: hepatitis D virus (HDV or delta agent, which is activated in the presence of HBV) hepatitis G virus (GB virus or GBV-C) cytomegalovirus (CMV) Epstein Barr Virus (EBV) West Nile Virus (WNV) malarial parasites

19. PREVENTION Employee training. Use devices with safety features to isolate sharps. Safe recapping system. Do not recap needles or scalpels & dispose them through effective disposal system. Plan for safe handling and disposal of sharps before using them.

20. EXAMPLES OF SAFER NEEDLE DEVICES Self-sheathing system Retractable technology. Add on safety features

21. MANAGEMENT Report the incident immediately. Wash the area immediately under running water or use an eye-washing bottle as appropriate. Make the wound bleed for three to four minutes whilst continuing to wash the area. Dry area with paper towel. Cover the wound with a water-impermeable sticking plaster and consider double gloving any hand injury if continuing to work. The source patient should be identified and arrangements made for a blood sample to be obtained, with informed consent. This should be tested for the presence of the blood borne viruses hepatitis B, hepatitis C and HIV.

22. MANAGEMENT (continue….) Arrangements should be made for blood samples to be taken from the staff member (victim) with informed consent. One sample is marked “for storage” and is retained in the relevant laboratory. The other is analyzed to determine the staff members hepatitis B antibody level. Further assessment, treatment and follow up of the staff member are performed in accordance with current best practice. Arrangements should be in place for speedy assessment and treatment. Counseling, reassurance and information may be required and arrangements for accessing this should be in place as appropriate. Appropriate records must be kept.

23. REFERENCES: http://depts.washington.edu/hepstudy/hepB/prevention/pep_oe/discussion.html ADA guidelines for infection control (second edition) WGO practice guideline: needle stick injury and accidental exposure to blood Cdc: http :// www.Cdc.Gov /hepatitis/HBV/ PEP.Htm , NC hepatitis B public health program manual/post-exposure prophylaxis February 2012 Recommendations for prevention and control of hepatitis c virus ( hcv ) infection and hcv -related chronic disease U.S. Department of health and human services centers for disease control and prevention ( cdc ) Atlanta, Georgia

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