Universal precautions
Definition
Universal precautions are a set of procedures and precautions adopted to
minimize the risk of transmission of bloodborne pathogens by health care and
public safety workers
Necessity for Universal
Precautions
These precautions are necessary because
- Some patients do not disclose their infectious status,
- Many are unaware that they are infected since there may be asymptomatic or subclinical disease.
- Antibodies or other markers of infection may be undetectable during the “window period” immediately after infection. This is particularly relevant in HIV infections because the levels of circulating virus (viral load) and the maximum infectivity for HIV are highest during the “window period”.
Risk of infection
- An estimated 800,000 needleprick injuries occur each year. Nursing staffs are most frequently injured.
- The estimated risk for HIV transmission needle prick injury and after mucous membrane exposure are 0.3% and 0.09% respectively
- The risk associated with a single parenteral exposure to HBV infected blood ranges from 6% in HBV "e" antigen negative patients to 40% in "e" antigen positive.
- In addition, unsafe practices in hemodialysis and plasmapheresis centres have been associated with HIV transmission.
The risk of healthcare workers
acquiring a blood borne pathogen after an occupational exposure
depends on multiple factors
- Prevalence of infection in the specific population.
- Frequency of activities capable of transmitting the infectious agent.
- Nature and efficacy of exposure: percutaneous injury has increased risk of transmission compared with exposure to mucous membrane or skin.
- Virus present in the contaminated fluid and the viral load.
- Availability and
efficacy of pre-exposure and post-exposure prophylaxis: proper
guidelines still do not exist in developing countries including
What is an Exposure?
- A percutaneous injury (for
example, a needlestick or cut with a sharp object).
- Contact of infected material with non-intact skin or skin lesion (skin chapped, abraded or dermatitis or acne).
- Contact of infected material with mucous membrane of eye, mouth, nose.
Measures taken in universal precautions
Pre exposure precautions: All medical
staff should be given immunization for Hepatitis B. Chemoprophylaxis is not
practical due to the severity of side effects and cost.
All human blood and body fluids should be treated as if they
are infectious
Safe work place practices: Do not recap
used needles by hand; do not remove used needles from disposable syringes by
hand; and do not bend, break, or otherwise manipulate used needles by hand.
Sharp objects should not be passed hand-to-hand; they should be placed on a
table and picked up.
Personnel protective equipment: protective
barriers include gloves, gowns, masks, and protective eyewear. Gloves should
reduce the incidence of contamination of hands, but they cannot prevent
penetrating injuries due to needles or other sharp instruments. Masks and
protective eyewear or face shields should reduce the incidence of contamination
of mucous membranes of the mouth, nose, and eyes.
Specimen management: All microbiological
and pathological specimens should be transported in a secondary container, and
after testing it should be incinerated.
Waste management: Place used disposable
syringes and needles, scalpel blades, and other sharp items in
puncture-resistant containers for disposal. Locate the puncture-resistant containers
as close to the use area as is practical. Different type of wastes should be
indicated by different colours or markers and should be disposed accordingly.
Regular screening of staff: Regular
screening should be conducted on medical and housekeeping staff for early
detection of any disease.
Post exposure measures
A. Treatment to the
exposed site
- Wounds and skin sites that have been in contact with blood or body fluids should be washed with soap and water; mucous membranes like eye or mouth should be flushed with water.
- The use of antiseptics is encouraged.
- However there is no evidence that the use of antiseptics for wound care or expressing fluid by further squeezing the wound reduces the risk for HIV transmission.
- The application of caustic agents or instillation of antiseptics or disinfectants into the wound is not recommended.
B. Documentation of
the data
Trained medical personnel should document the data in the medical record about
· The type and the infective status of the source,
· Date and time of exposure; Nature of exposure,
· Previous testing and immune status of the exposed healthcare worker.
C. Testing of the source
Testing of the source for HIV, HBsAg, and HCV should be done as early as possible after by rapid testing, if infective status is not known already.
D. Treatment
HIV
Basic (28 days): Zidovudine 300 mg BD + lamivudine 150 mg BD or
Stavudine 30–40 mg BD + lamivudine 150 mg
BD
Expanded (28 days): above + Indinavir 800 mg TD or
Nelfinavir 750 mg TD or
Efavirenz 600 mg OD
HBV
If vaccinated: Check the anti-HBs levels
> 10 m IU/ ml : Hepatitis B vaccine single dose
< 10 m IU/ ml : Hepatitis B Ig, Hepatitis B vaccine single dose
If not vaccinated: Check for the HBe Ag status of the source
HBe Ag +ve :
Hepatitis B Ig, Hepatitis B vaccine 0,1,6
HBe
Ag –ve : Hepatitis B vaccine 0,1,6
Presented by
Laxminarayan Bhandari P.
Roll No: 020201265