safety measures and importance in all health care workers

1. Safety Measures of Health Care
Providers in Trauma
Dr. Soma Sekhara Reddy
Emergency medicine

2. Objectives
• Introduction
• Types of injuries / exposures
• Health hazards behind needle prick
• Safety precautions and prophylaxis
• Impending threat
• Conclusion

3. Introduction
• H C Ps , especially E.D. personnel , surgeons
are more vulnerable for infection when
carrying out their jobs.
• E.D. staff – 2 fold risk
“Bloodborne Infections in Emergency Medicine” revised in October 2000;
April 2004; and April 2011

4. • Fortunately we have
- safety precautions
- prophylactic measures
- treatment options

5. Types of injuries
• Needle stick injuries
• Contact of blood and OPIMs
• Human bite injuries

6. Needle stick injuries
• Most common occupational health accident
• E.D – high risk
• Hollow > solid needle
• Interns and resident doctors are at higher risk for
HIV infection

7. Incidence in different H C Ps
Nurse
43%
Technician
15%
Student
4%
Dental
1%
Housekeeping/
Maintenance
3%
Clerical /
Admin
1%
Other
5%
Physician
28%

8. Incidence in different jobs
During Sharps
Disposal
13%
During Clean Up
9%
In Transit to
Disposal
4%
Handle/Pass
Equipment
6%
Improper
Disposal
9%
Access IV Line
5%
Transfer/Process
Specimens
5%
Recap Needle
6%
Collision
W/Worker or
Sharp
10%
Manipulate
Needle in Patient
28%
Other
5%

9. STATISITICS – Tertiary hospital
YEAR 2010 2011 2012
(UPTO JUNE )
Total no. of NSI 47 56 26
Doctors 6 7 2
E.D 10 10 1

12. Health hazards behind NSI
 Most common
• HBV
• HCV
• HIV
 Other possible
• CMV , EBV , PARVO VIRUS
• Treponema
• Yersinia
• Plasmodium
• Other hepatic viruses

13. VIRUS HBV HCV HIV
Risk 5 – 40 % 3 – 10 % 0.2 – 0.5 %
Vaccination Available no no
P E P Vaccine + Ig no 2/ 3 drug
regimen
Prevention very good - good

14. HCV
• HCV + HIV
(studies by BERGER , Institute of medical virology)
• As there is no vaccination and PEP for HCV only option
available is follow up and treatment .
• Chronic carrier state , liver cirrhosis and cancer is more than
HBV

15. Contact of blood and body fluids
• Always possible and also preventable.
• More risk if abraded skin or wounds get exposed
• Mucous membrane > skin
• Immediately wash with soap and water or
plenty of plain water in case of mucus
membranes

16. Bite injuries
• Rare but possible
• Potentially serious infection caused by rapid
growth of bacteria in broken skin
• Bacteria – Streptococci
Staphylococci
Eikenella corrodens
Anaerobes

17. Bite injuries - continued
• 15 to 30 percent cases – infected
• Infections that begin < 24 hours –Necrotising fascitis
• Wash immediately with soap and water
• If hands are involved – I.V. antibiotics are necessary

18. Universal Safety Precautions
• Personal protective equipment
– Gloves: always wear whenever using the needle
– Gowns : Especially non permeable if available
– Mask, protective eyewear ,face shield,foot wear:
wear when splashes or droplets are likely .

19. vaccination
• Most important precautionary measure
• Prior HBV vaccination
• Know the immune status
• Unfortunately not available for HCV and HIV

20. Safety measures to avoid NSI
• Avoid needle whenever safe alternative
available
• Avoid needle recapping

22. • Plan for safe handling
and disposal before
beginning of any
procedure

24. • Report all NSIs and prompt others to do the
same
• Educate your subordinates / colleagues /
employers about risk of NSIs.

25. What to do..
• Hold the affected limb down and get it to bleed
• Don’t squeeze
• Wash immediately with soap and water / sterilite
• Report immediately to infection control board
• Check the viral status of the source

26. Impending threat – under reporting
• Acc. To WHO study
Avg no. of injuries – 0.2 to 4.7 injuries /1 hcw /1 yr
In India > 3 injuries / 1 hcw / 1 year
• But injuries reported is far less than actual incidence

27. • Developed countries – nearly 40 %
• India - > 70 %
• More from physicians rather than nursing staff
• Many are junior residents , internees and nursing
students
Original article from community medicine -safdarjung hospital , New delhi, INDIA

30. • MIMS Statistics : -
- 129 injuries were reported / 30 months
- 21 doctors got injured
• Is this statistics actual incidence / incidents reported ?
• Whether actual incidence is low / under reporting is
high?

31. What happens if same trend
continues…?

32. conclusion
• Every HCP should follow existing regulations and
guidelines
• When exposed immediately get evaluated and
PEP to be taken if indicated
• All HCPs should receive HBV vaccine and should
be tested for immunity after vaccination

33. • All contacts with blood and OPIM should be
considered as potential HIV exposures.
• NSIs are omnipresent.
• Every incidence of injury should be notified to
assure the follow up and further care.

34. Additional information
• University of Virginia’s International Health
Care Workers Safety Center and its EPINet
needle stick injury data collection system:
www.med.virginia.edu/~epinet
• www.cdc.gov/niosh
• OSHA Web page: www.osha.gov;for needle
stick information, www.osha-
slc.gov/SLTC/needlestick/index.html

35. References
• Original article from community medicine -
safdarjung hospital , New delhi, INDIA.
• HealthLink BC File #97, April 2011 , England
• ACEP Board of Directors titled, “HIV and
Bloodborne Infections in Emergency Medicine”
, U.S.
• Occupational Safety and Health Administration (OSHA)

36. • Centers for Disease Control and Prevention
• National Institute for Occupational Safety and
Health – NIOSH , U.S.
• ITLS text book

37. Thank you