UNIVERSAL/STANDARD

PRECAUTIONS

BLOODBORNE

PATHOGENS

Dr.T.V.Rao MD

What are Universal Precautions

Dr.T.V.Rao

Universal precaution are control guidelines designed to protect

workers

from exposure to Diseases spread by Blood and other Body

fluids.

CDC

Universal precautions means

Observing “Universal Precautions”

means you consider all human

blood and certain human fluids

infectious for all blood borne

pathogens.

Why Universal Health

Precautions.

Dr.T.V.Rao

The concept of Universal Health

Precautions emphasizes that all our

patients should be treated as though

they have potential blood born

infections, and can infect the caring

health care workers. ( CDC )

The blood borne pathogens that pose the

most serious health risks

Hepatitis B virus

(HBV)

Hepatitis C virus

(HCV)

Human

Immunodeficiency

Virus (HIV)

Human Materials/Tissues considered

Highly Infectious

1 Blood

2 Semen

3 Vaginal secretions

4 C S F

5 Synovial fluids

6 Amniotic fluid

7 All other body

fluids

Dr.T.V.Rao

Exposure occurs through contact with

infected body fluids

Our Role to protect follow

Universal Precautions

Perform all tasks

using safe work

practices

Use appropriate

personal protective

equipment.

Use engineering

controls

Who is at risk for sharps injury?

Workers performing finger sticks

Lab workers

Housekeepers/janitorial staff

Medical waste contractor

Not Infectious unless contaminated

with Blood or Body fluids.

Dr.T.V.Rao

Feces,

Nasal secretions,

Sputum,

Sweat,

Tears,

Urine / Vomitus,

Saliva unless blood stained.

These Body Fluids Include:

Blood

Vomit

Saliva

Stool (feces)

Urine

Drainage from nose

or sinuses

Drainage from cuts,

scrapes, wounds or

sores

Secretions from mucous

membranes

Sputum (mucus from

lungs)

Vaginal secretions

Semen

Protect Yourself…

Universally, treat

every child’s body

fluid as if it were

infected.

Precaution – Use

foresight and plan

ahead to avoid

exposure

Work practices that increase the

risk of a sharps injury

Recapping needles

Transferring a body fluid between containers

Opening blood tubes

Failing to dispose of used sharps properly in a puncture-proof sharps container

Universal Precaution Steps

Gloves (Personal

Protective

Equipment)

Decontamination

Hand Washing

Waste Disposal

Use of Gloves

Use of a pair of

disposable plastic

gloves can protect

if chances of

contact with Blood

or Body fluid is

anticipated /

inevitable.

Dr.T.V.Rao

Step 1: Gloves...

Always wear gloves when …

Direct contact with body fluids is anticipated (nosebleeds, bleeding abrasions, etc.)

Handling clothes soiled by urine, feces, vomit or blood

Diapering children

Step 2:

Handwashing The MOST IMPORTANT STEP in Preventing the

spread of disease!

Use liquid soap and warm water.

Wash vigorously for 10 – 15 seconds.

Rinse under warm running water.

Turn off faucet with paper towel.

Why HAND WASHING ?

There is no Health precaution

like Hand washing.

Washing with simple toilet soap

- reduces the rate of

transmission of common

infections including the HIV.

Dr.T.V.Rao

How to Wash our hands

Dr.T.V.Rao

Indications for Hand Washing

Dr.T.V.Rao

In prolonged contact with patient.

Before taking care of Immune supressed,New born

infants, patients in ICU / ICCU, Dialysis Units, Burn’s

Units.

Before and after touching wounds.

When Microbial contamination of Hands, likely to

occur when in contact with mucous membranes, body

fluids, and other secretions contaminated with Blood,

and serous fluids.

What to be used for hand

washing

Dr.T.V.Rao

In most circumstances Non medicated soaps and detergents are effective in removing most transient contaminants.

In demanding circumstances, in handling potentially harmful infections, use Ethyl or Isopropyl alcohol.

Detergent formulations containing Chlorhexidine Povidone,or Hexachlorophene are effective in prevention of spread of infections.

Words of Wisdom on Hand

Washing

Soap, water and

Common sense are still

be Best Antiseptics

William Osler

Dr.T.V.Rao

Use of Mask, Cap, Eye Wear

Will certainly protect

us from splashes of

Blood or Body fluids.

Don't underestimate

the importance of

Use of Cap and

Mask.

It equally protects our

patients. Dr.T.V.Rao

Uses of Cap and Mask

Stringent use of

Mask and Cap

can save several

Lives in the

Hospital

Dr.T.V.Rao

Use of Foot wear

Dr.T.V.Rao

Wearing foot wear covering

entire sole protects the entry of

Microbes from the

contaminated floors with Blood

and Body fluids.

Remember many of us have

cracks on our feet.

Use of Impervious Gown

A simple thin Plastic

apron underneath

the linen is of great

help in preventing

the soaking our inner

clothes and

exposure to harmful

microbes.

Dr.T.V.Rao

Disposal of Needles and Sharps

Dr.T.V.Rao

All used needles and sharps should be deposited in thick walled puncture resistant containers.

Bending, Reshaping, should be prohibited.

Do not recap the needles to avoid needle stick injures,

All used Disposable syringes and needles should be discarded into Bleach solution at the work station before final disposal.

Dealing with Used Needle

Shredding continues to

be Important Method

Of dealing with used

Needle

Dr.T.V.Rao

Dealing with Needle stick

Injuries

Dr.T.V.Rao

Consider all Needle stick injuries as a serious health hazard in the era of AIDS

All events of Needle stick injuries to be reported to the supervisory staff.

Wash the injured areas with soap and water.

Encourage bleeding if any.

Prophylaxis for prevention of HIV/HBV is top priority.

Anti retroviral prophylaxis, if necessary should started within 2 hours, ( if injury is from HIV positive or high risk group).

Avoid Needle Stick Injuries

Dr.T.V.Rao

Protect Yourself (continued)

Promptly dispose of used sharps in appropriate sharps disposal containers

Report all occupational exposures promptly to ensure that you receive appropriate follow-up care

Tell your employer about real or potential hazards you observe

Participate in training related to infection prevention

Get a Hepatitis B vaccination

Accidental Exposure

Alert your supervisor.

Complete employee injury report.

Follow-up with District’s Worker’s Comp medical provider for confidential evaluation.

Handling Occupational Exposures

Employee should

immediately report

the expose to a

supervisor

Immediately wash

skin with soap and

water

Apply first aid to the

wound

Hazards of Needle stick

Injuries

Dr.T.V.Rao

HIV , HBV and HCV viral infections

can spread by Needle stick Injuries

Nursing staff are at greater risk

Several Injuries are preventable

Decontamination of Hospital

Linen

Dr.T.V.Rao

All the linen contaminated with

Blood or Body fluids should be

soaked in 1: 100 bleach solution

for 30 minutes.

Advised Autoclaving, as the most

ideal procedure for

decontaminating Linen

Spillage of Blood/Body fluids

Dr.T.V.Rao

A common health hazard in the working environment.

Never wipe the spillage with working wet mop.

Always cover the spills with paper and pour 1 % Hypochlorite or Bleaching powder to decontaminate the spills

with HIV/HBV virus.

Care of Endoscopes

Dr.T.V.Rao

Endoscopes are delicate/precious instruments.

Follow the instruction of Manufacturers.

It is commonly cleaned with 2 % Glutaraldehyde solution.

Specified time schedules to be followed to decontaminate for HIV.

Mycobacterium needs even > 2 hours for decontmination.

Decontamination of Metal

Instruments

Dr.T.V.Rao

Hold all contaminated instruments with Gloved hands.

Subject all metal instruments to washing with soap and water.

Treat all contaminated instruments with 2% Glutaraldehyde. For at least 30 minutes.

Many consider sterilizing in Hot air oven if not sharp instruments.

Anesthetic Tubing's and other

Equipment's

Dr.T.V.Rao

Since they are in intimate contact with Human secretion need utmost attention in decontamination.

Treat all Non disposable as highly hazardous, if used without safe practices can infect the next patient undergoing procedures.

Soaking in 2 % Glutaraldehyde is common practice in Developing world.

Pregnant Health Care Workers

Dr.T.V.Rao

Not at more risk than other, Health care workers.

Should adopt Universal Health Precautions with more dedication,

If neglected the Unborn is at grave risk of attaining congenital infections.

The Laboratory supervisors should monitor/ guide the HCW’s for adherence to scientific practices.

Safe Work Habits (continued)

Place all contaminated waste in an appropriately labeled container and transport in a leak proof, puncture-proof outer container

Disinfect all work surfaces and items before and after testing with 10% bleach solution or EPA approved disinfect

Operating on HIV/High risk groups

Dr.T.V.Rao

It is a concern all should be cared equally.

HIV infected carries the risk of being neglected at the time of crisis.

Law many not change for equality but motivated health workers should bring in change of attitude.

Adherence of Universal Health precaution bring in safety to all HCW.

Follow the precautions even in Non HIV patients as some of our patients are in window period and more dangerous than truly positive with Serotesting.

Caution on Operating HIV

Sero Negative Patients

Dr.T.V.Rao

Universal precaution apply to all our patients irrespective of Blood tests we undertake.

We handle so many patients in emergency situation with out any details.

Education on Universal precautions participation of you and educating your subordinates/Juniors will make a lot of Difference in the work Environment.

Precaution for Invasive Procedures

Dr.T.V.Rao

All HCW’s who participate in invasive procedures must routinely use appropriate barrier precautions.

All Health care workers who perform/assist vaginal, and cesarean deliveries should wear gloves and gowns when handling, the placenta, and the new born, till blood and amniotic fluid has been removed from infants.

Amniotic fluid is rich in HIV/HBV virus, in infected mothers.

Handling Dentistry Patients

Blood,Saliva,Gingival

fluid from all Dental

patients should be

considered infective,

Dental, workers should

wear surgical mask,

gloves and eye wear

Dr.T.V.Rao

Caring Bleeding Patients

Dr.T.V.Rao

Primary health care workers who handle the patients in Emergencies, and Accidents to be trained in basic principles of Universal Health care precautions.

Mouth to Mouth resuscitation is life saving in the Critically injured accident victims. May be neglected because of fear of HIV infection.

If the situation warrants, Bleeding from mouth can be wiped out with clean cloth, or Handkerchief, and still one can do resuscitation.

Importance of Vaccination in Hepatitis B

Infection.

Dr.T.V.Rao

We have > 400 Million carriers with

Hepatitis B infections.

Every HCW is at risk of Contacting

infection.

Vaccination is safe -Genetically

Engineered vaccination remains the

great hope for prevention, apart from

Major component of Universal

precautions.

Vaccination for HBV infection

Dr.T.V.Rao

All HCW’s must take at least three doses of Vaccine,

At 0 – 1 – 6 months. without discontinuationof the schedule.

All Health care workers many not attain equal response.

High risk HCW’s should undergo estimation of anti HB s ( antibodies ) to know whether they were well protected.

Problem of HBV vaccines in the

Developing world

Dr.T.V.Rao

Who pays for the Vaccine.

Many who work in unorganized sector, do

not get Institutional support of Vaccine.

Life, at risk if Infected with HBV

More Awareness to be brought in by

Managers of the Hospitals, to promote to

vaccinate their Employees.

Waste Disposal

Bag and tie after segregation as per codes

Place in second bag and tie again (double bag technique)

Place all sharps (used needles) in sharps container.

Wash hands after removing

gloves.

Never forget to take Hepatitis B

Vaccine if You are a HCW

Dr.T.V.Rao

Created for benefit of Medical and Paramedical

Health care workers in the

Developing world

Dr.T.V.Rao, MD

E mail : doctortvrao@gmail.com

Dr.T.V.Rao