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INOCULATION INJURIES
A Training Pack for Health Care Professionals
Sponsored by Daniels Healthcare
© 1999 Daniels Healthcare Ltd . All rights of copyright in connection with this work and all parts of it are reserved to Daniels Healthcare Ltd. This work may be reproduced by the customer only for the purpose of utilising the same for training purposes within the customer’s own organisation and no copies may be made for use by third parties without the specific written consent of Daniels Healthcare Ltd. No consent for such further reproduction of the material herein is deemed to have been given. Unauthorised use of the material may lead to legal proceedings including a civil claim for damages. Daniels Healthcare Ltd will not accept any responsibility for any amendments to or alterations to the material in this pack other than those produced and authorised by Daniels Healthcare Limited.
Issue 1 October 1999
INOCULATION INJURIES
•Minimizing the risk
•Prevention Strategies•Treatment Protocols
Paul Hateley Rona McMillanLead Nurse Clinical Nurse SpecialistInfection Control Infection ControlSt. Bartholomew’s Hospital St. Bartholomew’s HospitalLondon London
MINIMISINGTHERISK
Every employee has a legal responsibility under the Health and Safety at Work Act (1974), to take care of both their own and others Health and Safety.
All health care workers have a legal requirement to identify the hazards and assess the risks relevant to Health and Safety.
Identified risks must be reduced as far as is reasonably practical by introducing suitable safety measures.
Health and Safety at Work Act,(1974)
THE RISKSContaminated blood / body
stained fluid
• Through skin
• Onto broken skin
• Onto mucous membranes
Body fluids that may containHIV and/or Hepatitis B and/or C
• Blood
• Blood stained body fluids
• Semen
• Vaginal secretions
• TissuesCSF, amniotic, pericardial, pleural fluids
Body fluids that are unlikely to contain pathogenic organisms:
• Tears
• Nasal secretions
• Sweat
• Saliva
What is risk assessment?
Assessment of the risk to the health and safety of employees
to which they are exposed while at work
For risk assessments to be effective they need to be:
• Systematic
• An ongoing process monitoring, reviewing and modifying
Assess body fluid risk of task to be undertaken
No risk of splashing No protective clothing
Blood/blood stained Disposable gloves & aprons
body fluid but low
risk of splashing
Blood/blood stained Gloves, waterproof gown & eye
body fluid and high protection
risk of splashing
(Adapted from EAGA 1998)
When undertaking risk assessment:
• Identify hazards / risksActs / regulations that must be complied with will help identify hazards
• Evaluate extent hazards / risksTake into account existing control measures
• Assess the population of staff affected and consequence of the risks
• Risk assessment must be recorded
Occupational transmission of infection to health care workers
• Through skin
• Onto broken skin
• Onto mucous membranes
• Direct contact with infective material
• By droplet spread
Risk of health care workers acquiring HIV and HBV occupationally
• HIV 0.37%
• HBV 20 - 40%following exposure to contaminated blood
(Alder, 1997)
HIV Transmission: Global summary, June 1996
Type of exposure % of global total
Blood transfusion 3-5
Perinatal 5-10
Sexual intercourse 70-80
vaginal 60-70
anal 5-10
Injecting drug use (sharing works etc) 5-10
Heath care (inoculation injury etc) <0.01
(Friedman Kien AE, Cockerell CJ 1997)
Prevention Strategies
Sharps safetyPrevention of inoculation injury
• Never re-sheath used needles
• Take a sharps container with you and dispose of sharps at the point of use
• Never fill a sharps bin to more than 75% of its capacity
• Ensure you take responsibility for your own sharps
Body substance isolation(BSI)
Devised by Lynch and Jackson in 1984
Purpose of BSI
• Reduce risk of cross-infection to patients
• Protect health care workers from acquiring infections occupationally
• Simplify infection control procedures
• reduce cost of the prevention of hospital acquired infections
(Jackson & Lynch, 1992)
Basic elements of BSI• Gloves are worn for anticipated contact with body substances (blood,
urine, faeces, wound drainage etc). To be put on just before contact with body substances
• Protect clothing if soiling with body substances is anticipated
• Eye and face protection as appropriate
• handwashing
• Careful use and disposal of sharps
• Waste contaminated with body substances segregated as clinical waste
In addition
• All specimens categorised the same way
• All linen is treated the same way
Conclusion
• BSI effective infection control strategy
• Senior management support required for successful implementation
• Multidisciplinary agreement
• Ongoing education
• Compliance studies / audits
TreatmentProtocols
Inoculation injuryPrevention is better than cure
Should an injury occur:
• Encourage bleeding / irrigation
• OHD / Virologist
• Hepatitis B status• vaccine
• immunoglobin
• No Hepatitis C vaccine
• Serum storage (Hep B, C and HIV)
• Staff? Test later
• Patient - if known - ? Test with ‘informed’ consent
• Report incident / documentation
Prophylactic therapyDual / triple
• High risk - double
• Known HIV - triple
• Pregnancy - mono only
Drug regimens• AZT - zidovudine
• 3TC - Lamivudine
• Indinavir
• AZT - pregnancy second and third trimester - no foetal damage
Drug therapies
Triple therapy suppresses the viral load, thus increases the CD4 count.
Lamivudine is not recommended for monotherapy
Side effects
• Rare in short courses
• Dose related
• Nausea / vomiting
• Fever
• Myalgia
• Fatigue
• Anaemia
• Leucopenia
• Parasthesia
• Insomnia
• Rashes
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