UNIVERSAL
PRECAUTION
DR
.R .GANESH
Prof
and Head, Dept of STD,
GRH,
Madurai
AIM
TO PREVENT ACCIDENTAL
INFECTION OF HCWs WITH
1) HIV
2) HBV
3) HCV
AND OTHER POSSIBLE BLOOD BORNE INFECTIONS A PATIENT MAY BE
CARRYING
Risk
factors
1)
Injury while re-sheathing needle
2) Direct transfer
of sharps between people
3) Contact of
mucous surfaces with patients
body fluids
4) Soiling of
hands/feet with patients
body fluids
STEPS
IN
OP AND WARD
ALL
PATIENTS/ALWAYS
1) WEAR
GLOVES WHILE HANDLING ULCERS, MUCOUS MEMBRANES
OR BODY FLUIDS
2) DO NOT
RESHEATH NEEDLES WITH TWO HANDS
3) USE
SAFETY PIPPETTES
IN
THEATRES
DOUBLE GLOVES
SAFETY GOGGLES
DO NOT PASS
SHARPS DIRECTLY
USE ROUND BODY
NEEDLES WHERE POSSIBLE
MOPPING ONLY
BY FORCEPS
WARN ASST
WHERE TO EXPECT NEEDLE
REMOVE
OVERSHOES WITH GLOVED HANDS
GENERAL
WASH HANDS WITH SOAP/ANTISEPTICS
BOTH BEFORE
AND AFTER
HANDLING PATIENTS
AVOID DISTRACTION DURING
INJECTIONS/SURGERY etc
COVER ANY WOUND WITH WATER PROOF
DRESSING
BEWARE
OF GLASS WITH BLOOD
COVER
SPILLED BLOOD WITH
TISSUE PAPER / CLOTH AND
POUR DISINFECTANT OVER IT
SEGREGATION
OF WASTE
NEEDLE
STICK INJURY
DO NOT STOP BLOOD FLOW
WASH UNDER RUNNING WATER
APPLY ANTISEPTICS[SAVLON]
WATER PROOF DRESSINGS
REPORT TO PEP
AUTHORITY
POST
EXPOSURE PROPHYLAXIS
AIMS TO PREVENT HIV
INFECTION IN HCWs, IN THE EVENT
OF
EXPOSURE IN CLINICAL SETTINGS.
NOT FOR PREVENTION OF
SEXUAL TRANSMISSION
UNDER CONSIDERATION FOR
RAPE/TRANSFUSION VICTIMS
RISK
ASSESSMENT
General
HIGH RISK:
PENETRATIVE INJURY WITH PATIENTS BODY FLUIDS [BLOOD,CSF,PLEURAL FLUID etc]
MEDIUM RISK:
NON PENETRATIVE SPLASHING OF PATIENTS BODY FLUID ON MUCOUS MEMBRANES.
LOW RISK:
EXPOSURE OF INTACT SKIN TO PATIENTS BODY FLUIDS.
URINE,FAECES,SWEAT AND TEARS ARE NOT CONSIDERED AS DANGEROUS.
Degree
of Exposure
(Exposure code I,II, III)
Ec I -
few drops of blood of
short duration of
contact
Ec II - large amount of blood
of longer duration of contact, splash over
mucous membrane,solid needle prick, scratch
in the epidermis
Ec III
hollow needle
prick, cut with sharp instruments
HIV
Status of the source
( Status code I & II)
Sc I - asymptomatic patient with
normal CD4 count
Sc II Symptomatic
patient with low CD4 count & high viral load
PEP
Recommendations
| EC |
Sc |
PEP |
| I |
I |
No |
| I |
II |
Basic
Regimen |
| II |
I |
Basic
Regimen |
| II |
II |
Expa
nded Regi |
| III |
I or II |
Expa
nded Regi |
| II or III |
unknown |
Basic regi. if Epidemiologic risk
|
STEPS
1) ASSESS RISK PROFILE OF HCW
2) ASSESS PATIENT CONCERNED
[SEROSTATUS,CLINICAL
STAGE,RISKY BEHAVIOUR etc]
3) BASE LINE ELISA FOR HCW. IF +VE HCW HAS ALREADY BEEN
INFECTED
[HENCE NO PROPHYLAXIS]
4) DEPENDING ON RISK PROFILE START PEP WITHIN 6 HOURS OF
EXPOSURE
5) PEP FOR 4 WEEKS ONLY.
PEP
BASIC REGIMEN
For
Non penetrative/short exposure
AZT
300mgs +LAMIVUDIN 150mgs
TWICE a day for 4 WEEKS
PEP
EXPANDED REGIMEN
For
Penetrative/Prolonged exposure
BASIC REGIMEN
+
INDINAVIR
800mgs x 3 times a day
for
4 weeks
CAUTIONS
FOR HCW DURING PEP
-
NO
UNPROTECTED SEX UNTILL PROVED NOT INFECTED.
-
AVOID
PARTICIPATION IN SURGICAL OR OTHER INVASIVE PROCEDURES UNTIL PROVED NOT
INFECTED.
-
AVOID
PREGNANCY IF U R FEMALE
-
AVOID
BREAST FEEDING UNTILL PROVED NOT INFE
CTED.
PREGNANCY
& PEP
I Trimister
- Not well studied.
So counseling & MTP
II & III Trimister - No side effect reported.
ASSESSMENT
OF PEP EFFICACY
ELISA
Base line
- at the time
of Exposure
I Repeat
- 6 weeks
after Exposure
II Repeat
- 12 weeks
after Exposure
III repeat
- 6 months
after Exposure
DNA/PCR IF AFFORDABLE
At
4 weeks [on completion of PEP]
PEP
RESPONSIBILITY
AT LEAST TWO DOCTORS MADE RESPONSIBLE IN EACH
INSTITUTION
PEP DRUGS MADE AVAILABLE IN CASUALTY/DUTY ROOM
NAMES OF AFFECTED HCWs KEPT CONFIDENTIAL
FACILITIES FOR COUNSELLING FOR AFFECTED HCW