1. بسم الله الرحمن الرحيم PROTECTING THE HEALTHCARE WORKER FROM BLOODBORNE INFECTIONS Prof. Khalifa Sifaw Ghenghesh Dept. of Medical Microbiology Faculty of Medicine, Tripoli University, Tripoli, Libya

2. General Information  Infection Control Techniques: –Cleanliness, Disinfection and Sterilization. –Not Costly and are of great value.  Due to amount of protection provided –Strongly supported by organizations such as  WHO, CDC and other health agencies and professional associations.

3. Bloodborne Disease Transmission  Important Bloodborne Diseases: –HBV, HCV and HIV –All have been transmitted in occupational settings –Blood is the single most important source –Protective measures:  Preventing exposure to blood  Receiving HBV vaccination

4.  Risk of HBV infection following a parenteral (i.e. needlestick or cut) exposure: –HBV transmission is greater than for HCV or HIV –Directly proportional to probability of:  blood containing HBsAg  Immunity status of recipient  Efficiency of transmission

5. Probability of the Source of Blood Being Positive for HBV  In General population in Libya: 2.5-8%  In High Risk Groups: 5-15% –Individuals from high endemicity areas:  China, Southeast Asia, sub-Sahara Africa. –Clients in institutions for mentally retarded. –IV drug users and homosexual active males. –Household contacts of HBV carriers.

6. Risk of Infection Following One Needlestick Exposure to Blood  From HBV infected patient: –6-30% (in individuals with no prior HB vaccination or postexposure prophylaxis).  From HCV infected patient: –~ 3-10%  From HIV infected patient: –< 0.3%

7. Barrier Precautions Healthcare workers must:  Wear gloves when touching mucous membranes, wounds, blood and other body fluids or objects contaminated with them or when carrying any invasive procedure.  Wash their hands and reglove them before performing procedures on another patient.  Never reuse a single pair of gloves or wash them between patients.

8.  Wear surgical masks and protective eyewear when splashing or spattering of blood, saliva or other body fluids is likely.  Wear reusable or disposable gowns, laboratory coats, or uniforms when clothing is likely to be soiled with blood, or other body fluids.  Gowns should by changed at least daily or when visibly soiled with blood.  Reusable gowns should be washed using normal laundry cycle.

9. Types of Gloves  Disposable examination gloves: –Made of vinyl or latex. –For procedures involving contact with mucous membranes.  Sterile disposable gloves: –Used when sterility is necessary > during surgical procedures.  General purpose utility gloves: –Used when cleaning instruments, equipment, and contaminated surfaces. –Rubber household gloves are suitable, and can be decontaminated

10. IMPORTANT  NEVER reuse surgical or examination gloves.  Utility gloves may be reused if they are not punctured or torn. They should be properly decontaminated before reuse.  If your gloves are torn, cut or punctured, remove them immediat- ely and dispose of them properly. Then wash hands thoroughly with soap and water and put a new pair of gloves.

11. IMPORTANT  Regardless of gloves type, make sure your gloves are intact before using them.  It is not necessary to double- glove, as long as the glove is intact.

12. EYEWEAR  You should wear mask or protective glasses or goggles, or chin-length face shield to protect your self from spatter.  Wear facial protection whenever blood or other body fluids may be spattered > during patient treatment, while cleaning instruments or disposing of contaminated fluids.  Use new surgical mask for every patient. If mask becomes wet during treatment, the mask should be replaced.  Wash reusable facial protective equipment with detergent and water between patients and disinfect with proper disinfectant.

13. NEEDLESTICK PRECAUTIONS  Healthcare workers should take precautions to prevent injuries caused by needles and other sharp instruments. 1. A disposable syringe with a disposable needle: –Single use only –Should not separate the disposable needle from its disposable syringe. –Once used, SOULD be disposed of immediately and properly. –NEVER recap.

14. 2. A non-disposable aspirating syringe with a disposable needle: –One exception to the rule against recapping –Recap them using a one-handed technique > the cap stabilized by forceps or appropriate device. –OR by the “scoop” technique.

15. Disposal of Sharp Instruments and Infectious Waste  Syringes and Needles: - Disposable syringes and needles and other disposable sharp items should be placed in puncture-resistant containers for disposal. - The puncture-resistant container should be located as close as practical to the use area.

16.  Solid or Liquid Waste: - Solid waste such as blood contaminated gauze, cotton rolls, disposable gowns and masks should placed and secured in leakproof plastic bag. - Do not contaminate the outside of the bag. - Soiled linen should be washed with hot or cold water with detergent and, if possible, chlorine bleach. Normal washing and drying cycles are used.

17. - Handle soiled linen as little as possible. - Wash your hands after handling soiled linen.

18. Management of Exposure  Occupational exposure is defined as: –Contact with blood, tissues or other body fluids to which universal precautions apply, including laboratory specimens that contain HIV, HBV or HCV with: –1. An injury to the skin *e.g. needlestick or cut with sharp object). –2. Mucous membranes, or –3. Skin (especially when exposed skin is chapped, abraded, or afflicted with dermatitis, or the contact is prolonged or involves an extensive area). –The source patient should be informed and tested for serological evidence for HIV infectios, HBsAg and HCV antibodies after consent is obtained.

19. Postexposure Management: Wound Care  Clean wounds with soap and water  Flush mucous membranes with water  No evidence of benefit for: –application of antiseptics or disinfectants –squeezing (“milking”) puncture sites  Avoid use of bleach and other agents caustic to skin

20. Postexposure Management: The Exposure Report  Date and time of exposure  Procedure details…what, where, how, with what device  Exposure details...route, body substance involved, volume/duration of contact  Information about source person and exposed person  Exposure management details

21. Recommended Postexposure Management: PEP for Exposure to HBV Treatment when source is not tested or status unknown –HBIG x 1 and initiate hepatitis B vaccine series –No treatment –If known high-risk source treat as if source were HBsAg positive –Test exposed person for anti-HBs 1. If adequate, no treatment 2. If inadequate, vaccine booster and recheck titer in 1-2 mos Vaccination and antibody status of exposed person  Unvaccinated  Previously vaccinated –Known responder –Known nonresponder –Antibody response unknown

22. Postexposure Management for HCV  IG, antivirals not recommended for prophylaxis  Follow-up after needlesticks, sharps, or mucosal exposures to HCV-positive blood –Test source for anti-HCV –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 –Confirm all anti-HCV results with RIBA  Refer infected worker to specialist for medical evaluation and management