1. INOCULATION INJURIES A Training Pack for Health Care Professionals Sponsored by Daniels Healthcare © 1999 Daniels Healthcare Ltd. All rights of copyright in connection with this work and all parts of it are reserved to Daniels Healthcare Ltd. This work may be reproduced by the customer only for the purpose of utilising the same for training purposes within the customer’s own organisation and no copies may be made for use by third parties without the specific written consent of Daniels Healthcare Ltd. No consent for such further reproduction of the material herein is deemed to have been given. Unauthorised use of the material may lead to legal proceedings including a civil claim for damages. Daniels Healthcare Ltd will not accept any responsibility for any amendments to or alterations to the material in this pack other than those produced and authorised by Daniels Healthcare Limited. Issue 1 October 1999

2. INOCULATION INJURIES Minimizing the risk Prevention Strategies Treatment Protocols Paul HateleyRona McMillan Lead NurseClinical Nurse Specialist Infection ControlInfection Control St. Bartholomew’s HospitalSt. Bartholomew’s Hospital LondonLondon

3. MINIMISING THE RISK

4. Every employee has a legal responsibility under the Health and Safety at Work Act (1974), to take care of both their own and others Health and Safety. All health care workers have a legal requirement to identify the hazards and assess the risks relevant to Health and Safety. Identified risks must be reduced as far as is reasonably practical by introducing suitable safety measures. Health and Safety at Work Act,(1974)

5. THE RISKS Contaminated blood / body stained fluid Through skin Onto broken skin Onto mucous membranes

6. Body fluids that may contain HIV and/or Hepatitis B and/or C Blood Blood stained body fluids Semen Vaginal secretions Tissues CSF, amniotic, pericardial, pleural fluids Body fluids that are unlikely to contain pathogenic organisms: Tears Nasal secretions Sweat Saliva

7. What is risk assessment? Assessment of the risk to the health and safety of employees to which they are exposed while at work

8. For risk assessments to be effective they need to be: Systematic An ongoing process monitoring, reviewing and modifying

9. Assess body fluid risk of task to be undertaken No risk of splashingNo protective clothing Blood/blood stainedDisposable gloves & aprons body fluid but low risk of splashing Blood/blood stainedGloves, waterproof gown & eye body fluid and highprotection risk of splashing (Adapted from EAGA 1998)

10. When undertaking risk assessment: Identify hazards / risks Acts / regulations that must be complied with will help identify hazards Evaluate extent hazards / risks Take into account existing control measures Assess the population of staff affected and consequence of the risks Risk assessment must be recorded

11. Occupational transmission of infection to health care workers Through skin Onto broken skin Onto mucous membranes Direct contact with infective material By droplet spread Risk of health care workers acquiring HIV and HBV occupationally HIV0.37% HBV20 - 40% following exposure to contaminated blood (Alder, 1997)

12. HIV Transmission: Global summary, June 1996 Type of exposure% of global total Blood transfusion3-5 Perinatal5-10 Sexual intercourse70-80 vaginal60-70 anal5-10 Injecting drug use (sharing works etc)5-10 Heath care (inoculation injury etc)<0.01 (Friedman Kien AE, Cockerell CJ 1997)

13. Prevention Strategies

14. Sharps safety Prevention of inoculation injury Never re-sheath used needles Take a sharps container with you and dispose of sharps at the point of use Never fill a sharps bin to more than 75% of its capacity Ensure you take responsibility for your own sharps

15. Body substance isolation (BSI) Devised by Lynch and Jackson in 1984 Purpose of BSI Reduce risk of cross-infection to patients Protect health care workers from acquiring infections occupationally Simplify infection control procedures reduce cost of the prevention of hospital acquired infections (Jackson & Lynch, 1992)

16. Basic elements of BSI Gloves are worn for anticipated contact with body substances (blood, urine, faeces, wound drainage etc). To be put on just before contact with body substances Protect clothing if soiling with body substances is anticipated Eye and face protection as appropriate handwashing Careful use and disposal of sharps Waste contaminated with body substances segregated as clinical waste In addition All specimens categorised the same way All linen is treated the same way

17. Conclusion BSI effective infection control strategy Senior management support required for successful implementation Multidisciplinary agreement Ongoing education Compliance studies / audits

18. Treatment Protocols

19. Inoculation injury Prevention is better than cure Should an injury occur: Encourage bleeding / irrigation OHD / Virologist Hepatitis B status vaccine immunoglobin No Hepatitis C vaccine Serum storage (Hep B, C and HIV) Staff? Test later Patient - if known - ? Test with ‘informed’ consent Report incident / documentation

20. Prophylactic therapy Dual / triple High risk - double Known HIV - triple Pregnancy - mono only Drug regimens AZT - zidovudine 3TC - Lamivudine Indinavir AZT - pregnancy second and third trimester - no foetal damage

21. Drug therapies Triple therapy suppresses the viral load, thus increases the CD4 count. Lamivudine is not recommended for monotherapy

22. Side effects Rare in short courses Dose related Nausea / vomiting Fever Myalgia Fatigue Anaemia Leucopenia Parasthesia Insomnia Rashes

23. Understand the options and decide beforehand!