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