Safety Measures of Health Care Providers in Trauma Dr. Soma Sekhara Reddy Emergency medicine
Jun 12, 2015
Safety Measures of Health Care Providers in Trauma
Dr. Soma Sekhara ReddyEmergency medicine
Objectives• Introduction
• Types of injuries / exposures
• Health hazards behind needle prick
• Safety precautions and prophylaxis
• Impending threat
• Conclusion
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
• Fortunately we have
- safety precautions
- prophylactic measures
- treatment options
Types of injuries
• Needle stick injuries
• Contact of blood and OPIMs
• Human bite injuries
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
Incidence in different H C Ps
Nurse43%
Technician15%
Student4%
Dental1%
Housekeeping/Maintenance
3%
Clerical / Admin
1%
Other5%
Physician28%
Incidence in different jobs
During Sharps Disposal
13%
During Clean Up9%
In Transit to Disposal
4%
Handle/Pass Equipment
6%
Improper Disposal
9%
Access IV Line5%
Transfer/Process Specimens
5%
Recap Needle6%
Collision W/Worker or
Sharp10%
Manipulate Needle in Patient
28%
Other5%
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
Health hazards behind NSI Most common• HBV
• HCV
• HIV
Other possible
• CMV , EBV , PARVO VIRUS
• Treponema
• Yersinia
• Plasmodium
• Other hepatic viruses
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
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
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
Bite injuries• Rare but possible
• Potentially serious infection caused by rapid growth of bacteria in broken skin
• Bacteria – Streptococci Staphylococci Eikenella corrodens Anaerobes
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
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 .
vaccination
• Most important precautionary measure
• Prior HBV vaccination
• Know the immune status
• Unfortunately not available for HCV and HIV
Safety measures to avoid NSI
• Avoid needle whenever safe alternative available
• Avoid needle recapping
• Plan for safe handling and disposal before beginning of any procedure
• Report all NSIs and prompt others to do the same
• Educate your subordinates / colleagues / employers about risk of NSIs.
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
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
• 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
• 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?
What happens if same trend continues…?
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
• 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.
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
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)
• Centers for Disease Control and Prevention
• National Institute for Occupational Safety and Health – NIOSH , U.S.
• ITLS text book
Thank you