Universal infection control precautions

latest 2019

1. UNIVERSAL STANDARD PRECAUTIONS DR. PANKAJ CHAUDHARY RESIDENT G.S.V.M MEDICAL COLLEGE 8/2/2019 1

2. PRESENTATION OUTLINE Total no of Slides: 41 Definition Introduction History Chain of Infection Risk assessment Protection Equipment Barrier Handwashing Selection of protection barrier Safe handling of sharps Safe disposal of sharps Management of spillages Waste disposal Needle stick injuries Post exposure prophylaxis Summary Source: WHO Universal Precautions, OSH INDIA, NCBI, Infection Control Today, Needle stick injuries AIIMS. 8/2/2019 2

3. Definition “ Universal Precautions is the term applied to treating all blood , tissues and some body fluids as potentially infectious .The appropriate level of Precautions necessary is determined according to the extent of possible exposure to blood & body fluid and not because of the speculation of the infectious status of the patient” 8/2/2019 3

4. INTRODUCTION Blood and body fluids may contain blood-borne viruses (e g. Hepatitis B and HIV) or other bacterial and other viral pathogens. These can present a risk to other patients and health care workers. As it is not always possible to know who is infected with these pathogens, emphasis on infection control effort should focus primarily on “Universal Standard Precautions” which prevent the exposure to blood and body fluids which are presumed to be potentially infective. 8/2/2019 4

5. Application for universal standard precautions means that all patients' body fluids should be treated as infectious, since it is not known who is infected and carry a virus. The purpose of these precautions is to prevent the exposure and infection of healthcare workers from blood-borne pathogens. The rationale for applying the precautions is that the health care worker may not know who is and is not infected, thereby making it important to treat all blood and body fluids as infectious. 8/2/2019 5

6. These precaution apply to patients with : HIV Hepatitis B & C N on-A & Non-B Syphilis Malaria B lood-borne viral & B acterial infections 8/2/2019 6

7. HISTORY 1877: INFECTIOUS DISEASE HOSPITAL. 1910 : ANTISEPSIS & DISINFECTIONS. 1985: UNIVERSAL PRECAUTIONS. 1987: BODY SUBSTANCE ISOLATION. 1996: STANDARD PRECAUTIONS. 2007: ISOLATION PRECAUTIONS. 8/2/2019 7

8. CHAIN OF REACTION 8/2/2019 8

9. Agent: Micro-organism which causes infection, i.e bacteria , viruses, fungi and parasites. Reservoir: A place where micro organisms live, such as in humans and animals, in soils, food, plants, air or water. Portal of exit: Where the micro organism leaves the reservoir. Method of transmission: How the micro-organism travels from place to place. Portal of entry: Where the microorganism enters the next host usually the same way as it left the old host. Susceptible host: A person who may become infected. 8/2/2019 9

10. RISK ASSESSMENT F rom sharps and hollow needles. S plashing of conjunctivae and mucous membranes with contaminated blood and body fluids. H eavy contamination of broken skin . H andling of large quantities of blood and body fluids without protective clothing. 8/2/2019 10

11. U se of recycled hollow needles and syringes. C ontaminated blood transfusion. H eavy soiling of the environment. P oor ward facilities and cleaning. 8/2/2019 11

12. Body fluids to be treated under Universal Precautions Blood. Blood-stained body fluids. Semen. Vaginal secretions. Tissues. CSF, A mniotic, Pericardial, Pleural fluids. Feces. Urine. Vomit. Sputum. 8/2/2019 12

13. Universal Precautions do not apply to: Tears. Nasal secretions. Sweat. Saliva. 8/2/2019 13

14. PROTECTION EQUIPMENT BARRIER Gloves: Should be worn for direct contact with blood or body fluids and for direct contact with non-intact skin or mucous membranes. Plastic aprons: These should be worn to protect from body fluids. Eye protection: Goggles or some sort of eye protection (visor) should be worn to avoid conjunctival splash contamination. Spectacles are acceptable. Masks : These are recommended to avoid blood or body fluids splashing into the mouth and nostrils. Broken Skin: Cuts and abrasions on the hands and forearms should be covered with a waterproof dressing. 8/2/2019 14

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18. Handwashing Hand washing is considered the simplest and most important action to prevent infection transmission Microbes on human skin can be classified into two groups : 1. Resident flora 2 . Transient/contaminated flora Resident flora : Not easy to eliminate by scrubbing since they are adapted to living on human hands. Transient /contaminated flora : Easy to eliminate by scrubbing with soap or detergent. This kind of microbe can be frequently found on the skin of health care workers. 8/2/2019 18

19. There are two types of hand washing 1. Social hand washing : • Routinely before and after coming into contact. • When starting work. • W hen going off-duty. • W hen they become visibly dirty . • W hen they are contaminated with body fluids or organic matter . • A fter visiting the toilet. • A fter removing gloves . • A fter a non-sterile procedure. 8/2/2019 19

20. 2. Aseptic hand-washing : This type of hand washing should be used when as aseptic procedure is about to be performed on a patient (e.g. introducing central venous pressure lines, peripheral cannula or urinary catheters). This requires meticulous cleaning of the hands and the use of a sustained action disinfectant. It is usually accompanied by the wearing of gloves. 8/2/2019 20

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22. Selection of Protective Barriers 8/2/2019 22

23. Safe H andling of Sharps Needles must never be re-sheathed or recapped. Must obtain assistance when taking blood or giving injections to uncooperative or confused patients. Never carry sharps by the hand , if transporting always place in an appropriate container. Needles must never be broken or bent prior to disposal. Needles must never be passed from hand to hand. When performing phlebotomy, cannulation or giving injections must wear appropriate disposable gloves. Never reuse a sharp. 8/2/2019 23

24. SCOOP METHOD 8/2/2019 24

25. S afe D isposal of Sharps Do not dispose of sharps with other clinical waste. Sharps containing bins to be kept in location that precludes injury, bins are situated at a suitable height i.e. not placed on the floor or above shoulder height. Always dispose of needles as a complete unit into a sharps container never disassemble prior to disposal. Sharps containers should be ¾ full prior to sealing and disposal. Never force a sharp into a sharps container. 8/2/2019 25

26. Management of Spillage 8/2/2019 26

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28. WASTE DISPOSAL 8/2/2019 28

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34. Needle-Stick Injuries Occupational E xposure to potential blood-borne infections (HIV, HBV and HCV) that occurs during performance of job duties. “Exposure”  which at risk of blood-borne infection is defined as: P ercutaneous injury (e.g. needle-stick or cut with a sharp instrument ). C ontact with the mucous membranes of the eye or mouth. C ontact with non-intact skin (particularly when the exposed skin is chapped, abraded, or afflicted with dermatitis ). C ontact with intact skin when the duration of contact is prolonged (e.g. several minutes or more) with blood or other potentially infectious body fluids . Consider all Needle stick injuries as a serious health hazard 8/2/2019 34

35. Protocol D etermine the status of the exposure and the HIV status of the exposure source . Immediate measures For skin — if the skin is broken after a needle-stick or sharp instrument: Immediately wash the wound and surrounding skin with water and soap, and rinse. Do not scrub. Do not use antiseptics or skin washes (bleach, chlorine, alcohol, betadine). After a splash of blood or body fluids on unbroken skin: Wash the area immediately. Do not use antiseptics. 8/2/2019 35

36. For the eye : Irrigate exposed eye immediately with water or normal saline. Sit in a chair, tilt head back and ask a colleague to gently pour water or normal saline over the eye. If wearing contact lens, leave them in place while irrigating, as they form a barrier over the eye and will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal manner. This will make them safe to wear again Do not use soap or disinfectant on the eye . 8/2/2019 36

37. For mouth: Spit fluid out immediately Rinse the mouth thoroughly, using water or saline and spit again. Repeat this process several times Do not use soap or disinfectant in the mouth Consult the designated physician of the institution for management of the exposure immediately. 8/2/2019 37

38. Post-Exposure Prophylaxis (PEP) Ideally , initiate PEP treatment within 2 hours of exposure   not recommended after 72 hours . • If source patient is HIV negative , discontinue PEP and retest at 6 weeks , 3 months , and 6 months . • If source patient is HIV positive , counsel, support, and refer for continued treatment. 8/2/2019 38

39. Follow approved PEP regimen(suggested ) – Examples ZDV 200 mg 3 times daily for 4 weeks Combivir tablet (300 mg ZDV and 150 mg lamivudine) twice daily Indinavir 800 mg 3 times daily for 4 weeks. 8/2/2019 39

40. Universal Standard Precautions are designed for the care of all persons, patients, health care personnel regardless of whether or not they are infected. Treat all human blood, body fluids and other potentially infectious materials as if they are infectious There are 3 major Blood-borne pathogens: Hepatitis B, Hepatitis C and HIV. The most common mode of transmission of pathogens is the hands. Wear proper Protection Equipment Barrier in exposure situation. Safe handling and disposal of Sharp. Standard Precautions breaks the chain of infection thus minimizing transmission of infection within the Healthcare environment. 8/2/2019 40

41. THANK YOU 8/2/2019 41