Universal precautions

2021 medical and surgical precautions

1. UNIVERSAL PRECAUTIONS DR SAPAN KUMAR 3 RD YEAR PG GENERAL SURGERY MKCG MCH

2. CONTENTS Introduction History Why universal precautions Key elements of universal precaution Universal precautions in covid 19 Universal precautions in surgical practice 2

3. Introduction It refers to the practice in medicine, of avoiding contact with patient’s bodily fluids, by means of wearing nonporous articles such as medical gloves, goggles, face shield Blood and certain bodily fluids are assumed to be possibly infected and precautions are taken universally in all exposure situation These precautions are written in accordance with guidelines established by CDC (centre for disease control and prevention) 20XX Presentation title 3

4. History Universal precautions were first introduced in US by CDC in the wake of the AIDS epidemic between 1985 and 1988. universal precautions do not apply to sputum, feces , sweat, vomitus, tear, urine, nasal secretions unless contaminated with visible blood, because there transmission of HIV/ HepB is extremely low In 1987 , the practice of universal precautions were adjusted by a set of rules known as body substance isolation. These guideline advocate avoiding direct physical contact with all moist and potentially infectious body substances In 1996, practices were replaced by latest approach known as Standard precaution . These guidelines also introduced 3 transmission based precautions- airborne, droplet, contact 4

5. Why universal precaution Universal precautions were designed for health care professionals , who come into contact with patient and their bodily fluids. Bodily fluids- blood, semen, vaginal secretions, synovial fluids, amniotic fluids, pleural fluids, peritoneal fluids Body fluids ( unless contamination with blood) which do not require precautions are- nasal secretions, vomitus, sputum, saliva, feces , urine, sweats 20XX Presentation title 5

6. Standard precautions The CDC recommends standard precautions for the care of all patients, regardless of their diagnosis or presumed infection status It is designed for care of all patients and aim to reduce risk of transmission of infection Standard precautions apply to – blood all body fluids, secretions, excretions except sweat non intact skin mucous membrane 20XX Presentation title 6

7. Key elements of standard precautions Hand hygiene Respiratory hygiene Prevention of needle stick injury and sharp instruments Waste disposal PPE 20XX Presentation title 7

8. HAND WASHING Most effective method of preventing disease transmission Alcohol based hand wash Under clear running water

9. 20XX Presentation title 9

10. Steps of Hand Washing 20XX 10

11. Steps of surgical hand wash 20XX 11

12. Hand washing procedure 12

13. Respiratory Hygiene and cough etiquette Preventive measures are designed to limit the transmission of respiratory pathogens spread via droplets or airborne routes Covering mouth and nose when coughing and sneezing Hand hygiene after contact with respiratory secretions Eg , oral cavity examination, ryle’s tube insertion 20XX Presentation title 13

14. Sharp instruments precautions All used needle and sharps to be discarded into the thick walled puncture proff container All the disposable needle and sharp should be discarded into hypochloride solution at work station before final disposal Shredding continues to be important method of dealing with used needle Never reuse a sharp Never carry sharps by hand, always use a appropriate container 14

15. Dealing with needle stick injuries All events of needle stick injuries to be reported to the supervisory staff Wash the injured area with soap and running water Encourage bleeding if any Prophylaxis for prevention of HIV/ HepB is top priority Prophylaxis should be started early if injury from the high risk group 20XX 15

16. Sterilisation & Disinfection Sterilization- process that kills all forms of microbial life, including endospores Disinfection- destroys pathogenic organisms, but not necessarily all microorganisms, endospores Decontamination- removal of pathogenic microorganisms so items are safe to handle Endoscope- 2% glutaraldehyde solution Surgical instruments- autoclave 20XX 16

17. BIOMEDICAL WASTE MANAGEMENT Biomedical waste is defined as waste generated during diagnosis, treatment or immunization of human beings or animals, or in research activities Biomedical waste management is refer to proper collection, segregation and disposal of waste Biomedical waste management rules, 2016 Ministry of environment and forest, govt of india 20XX 17

18. 20XX Presentation title 18

19. Personal protective equipments Last line of defence against infection It includes Gown Gloves Mask Face shield Foot wear Assess the risk of exposure to body substances before any health care activity. Select PPE based on the assessment of risk 20XX 19

20. Mask and face shields- protect against splashes or droplets through mucous membranes of eye, mouth,nose Gowns- disposable paper gowns Gloves- made of latex, vinyl 20XX Presentation title 20

21. PPE Donning 20XX 21

22. PPE Doffing 20XX 22

23. Examination Gloves Exam gloves of latex, vinyl or other non-allergic materials must be worn Gloves must be removed and discarded after each use Peel them down without touching outside. Then wash hand 20XX 23

24. Wearing of surgical gloves 20XX Presentation title 24

25. Covid 19 20XX Presentation title 25

26. Precautions in COVID 19 20XX Presentation title 26

27. Universal precautions in surgical practice Operation theatre and examination site should be organised to minimise the risk of exposure 20XX Presentation title 27

28. Bloodborne pathogens Hepatitis B- extremely contagious, effective vaccine Hepatitis c- no vaccine HIV- no vaccine, no cure 20XX Presentation title 28

29. Hepatitis Both hepatitis B and C carry risk in surgery as they are blood-borne pathogens that can be transmitted both from surgeon to patient and vice versa Usual mode of transmission is blood to blood contact through needle stick injury or a cut Most of the time hepatitis B is asymptomatic, and surgeon may carry virus without being aware of it There is a effective vaccine against Hepatitis B. surgeon should know immune status against hepB and should get vaccinated 20XX 29

30. Hepatitis Hepatitis C infection often become chronic with risk of significant liver damage It is potentially curable with interferon alfa and ribavirin Surgeons exposed to infection should seek medical advice and antibody measurement 20XX Presentation title 30

31. HIV Transmitted by body fluids, particularly blood Increased prevalence through sexual transmission, iv drug abuse, infected blood products Risk of transmission is more through needlestick injury during operations After exposure virus binds to the CD4 receptors with subsequent loss of CD4 cells, T helper cells In early weeks after HIV infection, there may be flu like symptoms, during the phase of seroconversion, great risk of HIV transmission During the early phase, HAART (highly active antiretroviral therapy) , inhibit reverse transcriptase and protease synthesis. Thus suppress the virus but do not clear it completely. Treated patients can still transmit virus to other Within 2 years, untreated HIV can progress to AIDS in 25-35% of patients 31

32. Bodily fluids require universal precautions Blood Wound secretions 20XX Presentation title 32

33. Surgeons with HIV or Hepatitis patients Patients (with HIV or Hepatitis) may present to surgeons for operative treatment if they have surgical disease. Universal precautions have been drawn up by CDC and adopted by NHS (National Health Service) In summary Use of full face mask, protective spectacles Use of fully waterproof, disposable gowns and drapes, particularly during seroconversion Boots to be worn, not clogs, to avoid injury from dropped sharps 20XX Presentation title 33

34. Double gloving (large size on inside is comfortable) Allow only essential personnel in OT Avoid unnecessary movement in OT Respect is required with sharps, with passage in a kidney dish Slow meticulous operative technique is needed with minimized bleeding 20XX 34

35. After Contamination Needle stick injuries are commonest after surgical procedure Hollow needle injury carries greater risk of viral transmission The injury part should be washed under running water, incident should be reported Local policies dictate wheather post exposure antiretroviral treatment should be given Occupational health advice is required after high risk exposure 20XX Presentation title 35

36. Post exposure prophylaxis Hepatitis B Hepatitis B immunoglobulin (HBIG)- as soon as possible , ideally within 6 hours , not later than 48 hours Recommended dose is 0.05 to 0.07 mg/kg, two doses at 30 days apart At the time victims blood should be drawn for HbsAg testing If positive- full vaccination needed as per schedule If negative- no action need Simultaneous administration of HBIG and HepB vaccine is more efficacious than HBIG alone If possible HepB vaccine 1ml to be taken within 7 days of exposure, next 1month and 6month 36

37. Post exposure prophylaxis HIV Risk of transmission by hollow needle is 0.3% Risk from broken skin, mucous membrane is 0.1% Post exposure prophylaxis reduces the risk of seroconversion by 80%, if started within one hour of exposure Should be started within 2 hours not later than 72 hours PEP is continued for 4 weeks As per NACO, recommended regimen is Tenofovir (300mg) + Lamivudine (300mg) + Efavirenz (600mg) once daily for 28 days 37

38. Ethical Issue HIV and Hepatitis patients have same right to equal health care and treatment as normal patients Much stigma has been attached , because of taboo behaviours and fear of infection Consequences have included discrimination and reluctant to test and to disclose the status 20XX Presentation title 38

39. Confidentiality of patient Confidentiality is right of every individual under medical care Permission should be sought from patient, before information is passed to any other person who does not need to know, including relative and health workers 20XX 39

40. Transmission based precautions Transmission based precautions are recommended to provide additional precautions beyond standard precautions to interrupt transmission Airborne precautions- spread of small particles in air. Eg chicken pox Droplet precautions- spread of large droplets by coughing, talking, sneezing. Eg , influenza Contact precautions- spread by skin to skin contact. Eg , herpes simplex 20XX 40

41. 20XX Presentation title 41