Blood Borne Viruses Refresher Course Occupational Health 2009

Q. Which blood borne viruses are we concerned about in the workplace Hepatitis B, Hepatitis C + HIV Biological hazards under COSHH Hepatitis A & E not blood borne

Hepatitis B 350 Million people worldwide are chronically infected with HBV (WHO) Around 25% of individuals with Chronic HBV infection have progressive liver disease High prevalence regions include: Africa most of Asia and Pacific Islands Intermediate prevalence in: Amazon, Southern parts of Eastern and Central Europe, Middle East and Indian sub-continent In UK approx 800 new infections every year

Hepatitis C 170 million carriers of HCV worldwide Approx 250,000 thought to be infected in UK Injecting drug use is the most common way to acquire HCV infection In the United Kingdom blood donations have been screened for hepatitis C since September However, some people who received blood or blood products before this date could be infected if they received blood from a donor who was carrying the hepatitis C virus

Human Immunodeficiency Virus (HIV) Worldwide epidemic At the end of 2006 an estimated 73,000 persons of all ages were living with HIV in the UK, 21,600 of whom were unaware of their infection. Predominantly an STI main risk groups: Men who have sex with men, Black Africans & black Caribbean populations, Injecting drug users

Q. How are they transmitted Blood to blood i.e. injury from contaminated sharps, used needle Mother to baby Sexually

Contamination incidents In a 25 year career a health care worker might on average expect to receive one needle stick injury

Q. What are the chances of getting HIV/Hep B or C from an injury? (known positive source) Hepatitis B1/3 Hepatitis C1/30 HIV1/300 Mucosal contact less of a risk

Q. What sort of injury is the highest risk Large hollow bore needle that has been in an artery/vein Suture needle Sub-cut needle ie Novopen Scalpel Splash into eyes

Q. What do you need to do if you do have a sharps/splash/scratch injury? It is 11pm - injury with a used needle after taking blood First Aid Ring OH on ext 2421 or (on-call via switchboard for out of hours) ask for sharps advisor on call – risk assessment Tell manager/person in charge Incident form Why do we want to know about this at 11pm? Possible need for Post Exposure Prophylaxis (PEP)

Post Exposure Prophylaxis (PEP) Zidovudine and Lamivudine = Combivir Kaletra Aim to take within 1 hour of injury 4 week course of treatment – Sexual Health / OH Side effects - Loperimide & Domperidone Contra Indications – pregnancy, other medication

How can you minimise the risk of injury? Do not re-sheath needles Take sharps bin with you to patient Dispose of sharps in one go without separating syringes and needles Concentrate

Q. What are the risks of a staff member transmitting a BBV to a patient? Very low HIV very unlikely HCV 15 documented cases HBV highest BBV risk

Q. What would have to happen? Bleed into a patient

Q. Which staff are at risk of doing this? Those that do Exposure Prone Procedures – i.e. where HCWs hands are in or around a body cavity and could cut themselves and bleed into the pt. Surgeons, dentists, midwives A/E, Podiatrists, Paramedics

Q. What do we need to know about these people before they can work/do EPP’s Hepatitis B surface antigen Hepatitis C HIV

Q. What if they think they may be infected? Ethical duty to discuss with someone – Occupational Health

Are you all clear about Hepatitis B vaccine, blood tests and boosters? Course of Vaccine 0,1 & 6 months Accelerated course 0,1 & 2 months or 0, 7 & 21 days – 4 th dose at 12 months HB antibody test 1-4 months later <100mIU/ml – booster and retest >100mIU/ml = immune One single booster after 5 years

Blood Spillages PPE i.e. gloves, apron Blood Spillage pack - read instructions Presept – granules or tablets 10,000ppm, leave 3-4 minutes Not suitable for carpets, soft fabric Check area well ventilated Dispose in yellow bag Refer to Infection Control Manual