The presentation is solely meant for Academic purpose
Knowledge about blood and body fluid exposure
Personal protective equipment
Periodic immunization
Safe equipment
Reporting of exposure
PEP
Isolation precaution – MRSA, TB, H1N1, chicken pox
Sharp injuries
Blood and body fluid exposure
Deficiency in PEP
Deficiency in PPE
Care of HCWs dealing with patients under isolation
Radiation safety
Infrastructural safety
Globally a serious problem
6 to 8 L in US, 6 L in Germany
Indian data ?
3 HCW/ 10,000
3.5 million HCWs
115 L estimated injuries
Fortis Jan 2010 5
Job categories injured
Doctors
10%
Nurses
55%
Housekeeper
19%
Others
16%
Data A Data B Total data
Yes 83 (49.1) 254 (51) 337 (55)
No 66 (39) 182 (48) 248 (41)
Unknown 14 (8.2) 0 14 (2.3)
N-A 6 (3.5) 0 6 (1)
Accountability towards nurses and technicians
Budgeting expenses - HIPAC
Change attitude of ‘super’ HCWs ◦ Waste disposal
◦ Appropriate handing over of sharps
◦ Sharp disposal units
◦ Personal protection equipment
◦ Educate and re educate
Education of nurses, doctors and technicians
Providing sharp disposal in the bedside
Cheaper sharp disposals
Surveillance of waste disposal
Interventions
Use of safety device
Making sharp injury reporting more friendly
What’s that?
80%
20%
correct segregation wrong segregation
0
10
20
30
40
50
60
70
80
90
100
surgeon anesthetist technician nurse House keeping staff
24.09
42.3
78.66
97.48
63.26
Perc
en
tag
e o
f co
mp
lian
ce
Profession
33%
15% 26%
7%
19%
Surgeon Anesthetist
Technician Nurse
Housekeeping staff
Data A Data B Total data
Safety Design (SEMD)
34 (20.1) 19 (3.9) 53 (8)
Not a Safety Design
114 (67.5) 467 (95.3) 581 (88.2)
Unknown
11(6.5) 4 (0.8) 15 (2.3)
N-A
10 (5.9) 0 10 (1.5)
Only from hospital A and B
Prevalence of Hep B among the general population ranges from 2 to 8%,
Among healthcare workers seroprevalence is two to four times higher than that of the general population.
NY compensation board “compensable occupational hazard.”
1% HCWs HBsAg – positive
In the US, 57 HIV sero conversion in 2001 alone
2000/ yr infected Hep C
400 contract hepatitis B.
More than 20 infections
Exposure to HIV, HBV or HCV also has implications on personal relationships, future employment, and even insurance coverage.
Hep B vaccination
• Nursing 98%
• Doctors: 75%
• Technicians: 98%
• Housekeeping- 60%
A1 A2 B1 B2 C1 C2 D1 D2 E1 E2
Yes, partially, 1 or 2 doses 48 24 3 27 5 17 2 16 5 28
No 62 31 12 17 1 7 0 5 3 7
N-A 0 1 0 0 0 0
Total234 118 48 146 14 63 2 53 24 109 234
• Masks, caps, gowns, gloves – available mostly
• N95 masks, disposable gowns, goggles – not common
• Even if provided,
compliance to use low
Uncommon
Reprimanded and location of work changed
Asked to quit
Looked down upon
Avoiding PEP
Approx 15k per HCW
26
Rs. 750 HCV(antibody testing)
Rs. 750 HBSAg (antibody testing)
Rs. 2000 PCR test
Rs. 500 HCV(Elisa)
Rs. 450 HBV(Elisa)
Rs. 2000 HIV(Western Blot)
Rs.300 x 5 = 1500
HIV(Elisa) Immediately after injury,6 weeks,3 months,6 months & 12 months later
Costs Laboratory testing
Miserable
No statutory requirement
Unknown in many un-accredited hospitals
Under reporting – prevalent
Encouraged by administration
No insurance cover for these shots
Even decent facilities shun away when it comes to interferons
Farrell GA, Shafiei T, Chan SP. Patient and visitor assault on nurses and midwives: An exploratory study of employer 'protective' factors. Int J Ment Health Nurs. 2012 Dec 20.
Nurses are most compliant!
Housekeeping staff are next
Doctors are very poor icons
They think they know, but neither they think nor they know.
Too proud to attend sessions run by nurses
Healthcare worker safety is in jeopardy
Every healthcare worker to prioritize issues regarding safety
Set targets
Strive working ambience safe
Fortis Jan 2010 31