1. Occupational Hazards of Health Care Personnel-I

2. Healthcare workers are exposed to many job hazards: Infections Needle injuries Back injuries Allergy-causing substances Violence  Stress

3. Healthcare workers are exposed to many job hazards: Infections Needle injuries Back injuries Allergy-causing substances Violence Stress

4. Organization for infection control To control nosocomial infection -risk factors for health care–associated infections (HAIs) should be known -so that interventions to prevent HAIs can be implemented.

5. Healthcare workers are exposed to many job hazards: Infections: A-Blood-born B-Respiratory infections....

6. Infection Control Every year, many lives are lost because of the spread of infections in hospitals. Health care workers can take steps to prevent the spread of infectious diseases. These steps are part of infection control: Proper hand washing –hand hygiene is the most effective way to prevent the spread of infections in hospitals. Covering coughs and sneezes Staying up-to-date with immunizations Using gloves, masks and protective clothing Making tissues and hand cleaners available Following hospital guidelines when dealing with blood or contaminated items

7. Blood-born disease

8. http://www.osha.gov/SLTC/etools/hospital /hazards/univprec/univ.html#OPIM OSHA: Occupational safety and health administration regulations

9. http://www.osha.gov/SLTC/etools/hospital/hazards/uni vprec/univ.html#OPIM Employee exposure to bloodborne pathogens from blood and Other Potentially Infectious Materials (OPIM) by Universal Precautions.Other Potentially Infectious Materials Bloodborne pathogens are pathogenic microorganisms that are present in human blood and can cause disease in humans. Some infections that can be transmitted through contact with blood and body fluids include: – HIV, Hepatitis A, B, C, Staph and Strep infections, Gastroenteritis- salmonella, and shigella, Pneumonia, Syphilis, TB, Malaria, Measles, Chicken Pox, Herpes, Urinary tract infections, and Blood infections. The greatest risks are from HIV and Hepatitis B and C. HIVHepatitis ABC

10. OSHA: Occupational safety and health administration regulations The Bloodborne Pathogens Standard allows for hospitals to use acceptable alternatives [OSHA Directive CPL 02-02-069] to universal precautions:CPL 02-02-069 Alternative concepts in infection control are called Body Substance Isolation (BSI) and Standard Precautions. These methods define all body fluids and substances as infectious. These methods incorporate not only the fluids and materials covered by the Bloodborne Pathogens Standard but expands coverage to include all body fluids and substances.

11. The CDC recommends Standard Precautions for the care of all patients, regardless of their diagnosis or presumed infection status. Standard Precautions apply to 1) blood; 2) all body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood; 3) non-intact skin; and 4) mucous membranes. Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals. – Standard precautions includes the use of: hand washing, appropriate personal protective equipment such as gloves, gowns, masks, whenever touching or exposure to patients' body fluids is anticipated.

12. Transmission-Based Precautions (i.e., Airborne Precautions, Droplet Precautions, and Contact Precautions), are recommended to provide additional precautions beyond Standard Precautions to interrupt transmission of pathogens in hospitals. Transmission-based precautions can be used for patients with known or suspected to be infected or colonized with epidemiologically important pathogens that can be transmitted by airborne or droplet transmission or by contact with dry skin or contaminated surfaces. These precautions should be used in addition to standard precautions. – Airborne Precautions used for infections spread in small particles in the air such as chicken pox. – Droplet Precautions used for infections spread in large droplets by coughing, talking, or sneezing such as influenza. – Contact Precautions used for infections spread by skin to skin contact or contact with other surfaces such as herpes simplex virus. Airborne Precautions, Droplet Precautions, and Contact Precautions. May be combined for diseases that have multiple routes of transmission. When used either singularly or in combination, they are to be used in addition to Standard Precautions.

13. Workplace Transmission Professions at risk of exposure: contact with someone bleeding or responsible for the cleanup of blood and other infections materials. physicians and nurses (health center), police officers, athletic trainers, maintenance workers environmental services workers.

14. Bloodborne pathogens may be present in – Blood – Semen – saliva – vaginal secretions – cerebrospinal fluid – synovial fluid – pleural fluid – peritoneal fluid – pericardial fluid – amniotic fluid – any body fluid visibly contaminated with blood – any unidentifiable body fluid.

15. Entrance of these pathogens by an accidental injury with a sharp object contaminated with infectious materials such as – needles, glass, or anything which can pierce, puncture, or cut skin. Transmission may also occur by – transferring the infectious material to the mouth, eyes, nose, or open skin.

16. EXPOSURE CONTROL PLAN A. Purpose The purpose of the Exposure Control Plan is to eliminate workplace exposure to contaminated blood and other infectious body fluids. B. Definitions 1. Engineering Controls are physical or mechanical systems provided to eliminate hazards at their source. providing handwashing facilities, eye stations sharps containers, waste containers, biohazard labels in designated locations. 2. Work Practice Controls Work practice controls are specific procedures to be followed to reduce exposure to bloodborne pathogens or infectious materials.

17. Personal Protective Equipment Equipment that protects from contact with potentially infectious materials will be provided at no cost to the employee. The type of protective equipment depends on the degree of exposure and could include gloves, mask, eye shield, gown, shoe covers, cap, and CPR microshield

18. How can occupational exposures be prevented? Many needlesticks and other cuts can be prevented by using safer techniques – for example, not recapping needles by hand, – disposing of used needles in appropriate sharps disposal containers Using appropriate barriers – such as gloves, – eye and face protection, – gowns when contact with blood Can prevent many exposures to the eyes, nose, mouth, or skin. Always check your gloves for damage before using them Labels should display this universal biohazard symbol.

19. IF AN EXPOSURE OCCURS Immediately following an exposure to blood: – Wash needlesticks and cuts with soap and water – Flush splashes to the nose, mouth, or skin with water – Irrigate eyes with clean water, saline, or sterile irrigants – No scientific evidence shows that using antiseptics or squeezing the wound will reduce the risk of transmission of a bloodborne pathogen. – Using a caustic agent such as bleach is not recommended.

20. . Safety & Health Bloodborne Pathogens Accident Report Report the exposure to the department (e.g., occupational health, infection control) responsible for managing exposures. Prompt reporting is essential – in some cases, postexposure treatment may be recommended and it should be started as soon as possible. – Discuss the possible risks of acquiring HBV, HCV, and HIV and the need for postexposure treatment with the provider managing your exposure. – You should have already received hepatitis B vaccine, which is extremely safe and effective in preventing HBV infection. A. Name:_________________________________________________ __ Last Name First Name Middle Name Social Security Number / / Race Sex M Q Age Date of Birth / / F Q Address: __________________________________________________ ________________ Home Phone #: Work Phone #: B. Name of person whose blood contacted: Last Name First Name Middle Name Social Security Number / / Race Sex M Q Age Date of Birth / / F Q Address: Home Phone #: Work Phone #: C. Incident: Location of Incident: Remarks:

21. POST-EXPOSURE EVALUATION AND FOLLOW-UP: a confidential medical evaluation documenting the circumstances of exposure, identifying and testing the source individual testing the exposed employee's blood if he/she consents, post-exposure prophylaxis, counseling evaluation of reported illnesses. If not vaccinated: hepatitis B vaccination following the exposure. – 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 Refer infected worker to specialist for medical evaluation and management

22. Bloodborne Diseases are caused by Bloodborne pathogens are microorganisms such as viruses or bacteria are carried in blood and can cause disease Types of pathogens – malaria, syphilis, and brucellosis – Hepatitis B (HBV),HCV and the Human Immunodeficiency Virus (HIV) are the 3 diseases specifically addressed by the OSHA Bloodborne Pathogen Standard OSHA: Occupational safety and health administration regulations

23. Healthcare personnel who have received hepatitis B vaccine and developed immunity to the virus are at virtually no risk for infection. For a susceptible person: – the risk from a single needlestick or cut exposure to HBV-infected blood ranges from 6-30% – depends on the hepatitis B e antigen (HBeAg) status of the source individual. – Hepatitis B surface antigen (HBsAg)-positive individuals who are HBeAg positive have more virus in their blood and are more likely to transmit HBV than those who are HBeAg negative.

24. HDV Is composed of a RNA genome, surrounded by an envelope of HBsAg. is now known to require a helper function of HBV for its transmission. HDV is coated with HBsAg which is needed for release from the host hepatocyte and for entry in the next round of infection. In the first, a susceptible individual is co- infected with HBV and HDV, – a more severe form of acute hepatitis is seen – Vaccination against HBV also prevents co- infection. In the second, an individual chronically infected with HBV becomes superinfected with HDV. – a second episode of clinical hepatitis and accelerate the course of the chronic liver disease, – cause overt disease in asymptomatic HBsAg carriers

25. Protection against HDV HBV-HDV Coinfection – Pre or postexposure prophylaxis to prevent HBV infection HBV-HDV Superinfection – Education to reduce risk behaviors among persons with chronic HBV infection

26. AIDS (acquired immune deficiency syndrome) is caused by a virus called the human immunodeficiency virus, or HIV. – is very fragile and will not survive very long outside of the human body – It is primarily of concern to employees providing first aid or medical care in situations involving fresh blood or other potentially infectious materials. It is estimated that the chances of contracting HIV in a workplace environment are only 0.4%. Once a person has been infected with HIV, it may be many years before AIDS actually develops. HIV attacks the body's immune system.

27. The risk The average risk of HIV infection after a needlestick or cut – about 1 in 300 The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000). The risk after exposure of non-intact skin to HlV- infected blood is estimated to be less than 0.1%.

28. HCV The average risk for infection after a needlestick or cut exposure to HCV infected blood is approximately 1.8%. The risk following a blood exposure to the eye, nose or mouth is unknown, but is believed to be very small; – HCV infection from blood splash to the eye has been reported. There also has been a report of HCV transmission that may have resulted from exposure to nonintact skin, but no known risk from exposure to intact skin. When infected chronic carrier state: approx 80%

29. Accidental puncture from contaminated needles and other sharps can result in transmission of bloodborne pathogens. HBV and HIV are most commonly transmitted through: Sexual Contact Sharing of hypodermic needles From mothers to their babies at/before birth Accidental puncture from contaminated needles, broken glass, or other sharps Contact between broken or damaged skin and infected body fluids Contact between mucous membranes and infected body fluids

30. Unbroken skin forms an impervious barrier against bloodborne pathogens Infected blood can enter your system through: Open sores Cuts Abrasions Acne Any sort of damaged or broken skin such as sunburn or blisters Bloodborne pathogens may also be transmitted through the mucous membranes of the Eyes Nose Mouth For example, a splash of contaminated blood to your eye, nose, or mouth could result in transmission.

31. TREATMENT FOR THE EXPOSURE All healthcare personnel who have a reasonable chance ofexposure to blood or body fl uids should receive hepatitis B vaccine. Vaccination ideally should occur during the healthcare worker’s training period. – should be tested 1-2 months after the vaccination is complete to make sure that vaccination has provided immunity to HBV infection. Hepatitis B immune globulin (HBIG) alone or in combination with vaccine (if not previously vaccinated) is effective in preventing HBV infection after an exposure. The decision to begin treatment is based on several factors – Whether the source individual is positive for hepatitis B surface antigen – Whether you have been vaccinated – Whether the vaccine provided you immunity

32. HCV no vaccine against hepatitis C no treatment after an exposure that will prevent infection. Neither immune globulin nor antiviral therapy is recommended after exposure. For these reasons, following recommended infection control practices to prevent percutaneous injuries is imperative. Postexposure treatment: There is no postexposure treatment that will prevent HCV infection. should be tested for HCV antibody and liver enzyme levels (alanine aminotransferase or ALT) as soon as possible after the exposure (baseline) and at 4-6 months after the exposure. To check for infection earlier, exposed worker can be tested for the virus (HCV RNA) 4-6 weeks after the exposure. Report any symptoms suggesting hepatitis

33. HIV There is no vaccine against HIV. However, results from a small number of studies suggest that the use of some antiretroviral drugs after certain occupational exposures may reduce the chance of HIV transmission. Postexposure prophylaxis (PEP) is recommended for certain occupational exposures that pose a risk of transmission. However, for those exposures without risk of HIV infection, PEP is not recommended because the drugs used to prevent infection may have serious side effects. You should discuss the risks and side effects with your healthcare provider before starting PEP for HIV.

34. How are exposures to blood from an individual whose infection status is unknown handled? HBV–HCV–HIV If the source individual cannot be identified or tested, decisions regarding follow-up should be based on the exposure risk and whether the source is likely to be infected with a bloodborne pathogen. Follow-up testing should be available to all personnel who are concerned about possible infection through occupational exposure.

35. How soon after exposure to a bloodborne pathogen should treatment start? HBV Postexposure treatment should begin as soon as possible after exposure – within 24 hours, and no later than 7 days. HIV Treatment should be started as soon as possible – within hours as opposed to days, after the exposure Starting treatment after a longer period (e.g., 1 week) may be considered for exposures that represent an increased risk of transmission.

36. Can pregnant healthcare personnel take the drugs recommended for postexposure treatment? HBV Yes. Women who are pregnant or breast-feeding can receive the hepatitis B vaccine and/or HBIG. HIV Pregnancy should not rule out the use of postexposure treatment when it is warranted. – Preganant person should understand what is known and not known regarding the potential benefi ts and risks associated with the use of antiviral drugs in order to make an informed decision about treatment.

37. What precautions should be taken during the follow- up period? HBV If you are exposed to HBV and receive postexposure treatment, it is unlikely that you will become infected and pass the infection on to others. No precautions are recommended. HCV Because the risk of becoming infected and passing the infection on to others after an exposure to HCV is low, no precautions are recommended. HIV During the follow-up period, especially the first 6-12 weeks when most infected persons are expected to show signs of infection, you should follow recommendations for preventing transmission of HIV. These include – not donating blood,semen, or organs and not having sexual intercourse. – If you choose to have sexual intercourse, using a condom consistently and correctly. In addition, – women should consider not breast-feeding infants during the follow-up period.

38. Exposure to HBV risk HBV Source is known to be HBsAg(+) or unknown Injured person Anti HbsAg (+) Anti- HbsAg (-) > 10 No follow-up< 10 HBV vaccine is started The same day to the other arm HBIG Finish the HBV vaccination program

39. Exposure to HIV risk HIV Source is known to be HIV(+) or unknown Confirmed HIV seropositivity Antiretroviralprophylaxis On the day of exposure for evaluation Anti-HIV 6 weeks later Anti-HIV 3 months later Anti-HIV 6 months later Anti-HIV

40. Exposure to HCV risk HCV On the same day anti-HCV and ALT 6 weeks later ALT* 2 months later ALT* 3 months later anti HCV VE ALT* 4 months later anti HCV VE ALT* 6 months later anti-HCV *In case of ALT positivity :HCV RNA by PCR

41. Risk of Infection Following a Single HIV, HBV, or HCV-Contaminated Needlestick or Sharp Instrument Injury (revised 5/09/01) HIV 0.25% - 0.4% HBV 6% - 30% HCV 0.4% - 1.8%