2.  INFECTION CONTROL refers to policies and procedures used to minimize the risk of spreading infections, especially in hospitals and health care facilities.  INFECTION CONTROL is a multi- disciplinary responsibility.

3. I)Personal protective barriers Definition: “ specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) Goal: Improve personnel safety in the healthcare environment through appropriate use of PPE.

6.  Sequence of donning PPE: 1. Gown first 2. Mask or respirator. 3. Google or face shield. 4. Gloves  How to safely remove PPE: 1. Gloves. 2. Google or face shield. 3. Gown. 4. Mask or respirator.

7. Contaminated – outside front Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside Clean – inside, outside back, ties on head and back Areas of PPE that are not likely to have been in contact with the infectious organism

8. At doorway, before leaving patient room or in anteroom. Remove respirator outside room, after door has been closed. Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

9. REMOVE GLOVES WASH HANDS Min 15-20 seconds OR Rub with alcohol for about 30 seconds f37539-CDC Guidelines 2007

10. Sharps: any article can puncture or cut and used in patient care. e.g.; needles, syringes, scalpel blades, razors, forceps, broken tubes and glasses

11. Passing or transferring equipments.

13. Colliding with coworkers. Decontaminating used equipments. Sharps left in unusual places( laundry, mattresses, tables, trays and other surface)

14.  Be prepared  Be aware  Dispose with care

15. should be avoided when it is reasonable to do so. If recapping is necessary based on specific circumstances, a one- handed technique should be used.

16. With one hand, hold the syringe with attached needle and scoop or slide the cap, which is lying on a horizontal surface, onto the needles sharp end. Once the point of the needle is covered, you can tighten the cap; I. By pushing against an object, or II- By pulling the base of the needle cap onto the hub of the needle

18. Proper & safe disposal of infected needles, sharp instruments & infectious materials During Cleanup o Be accountable for sharps you use o Look for sharps/equipment left behind

19.  Inspect container  Keep hands behind sharps  Never put hands or fingers into sharps container

20. o Visually inspect sharps container for overfilling  Replace containers before they become overfilled  Keep filled containers for disposal in a secure area

21. Preventing Sharps Injuries IS Your Role And Responsibility

26.  Healthcare-associated pathogens are most often transmitted from patient to patient on the hands of healthcare workers  Cleaning your hands before and after patient contact is one of the most important measures for preventing the spread of microorganisms in healthcare settings

27. Heavy workloads (too busy)  The busier healthcare workers are, the less likely they are to wash their hands when recommended  Nursing shortages have caused nurses to be busier than ever before

28.  Sinks used for handwashing are often installed in inconvenient locations  Personnel may fail to wash their hands when indicated because it is too much trouble to get to the sinks provided

29.  Frequent hand washing with soap and water often causes skin irritation and dryness  In winter months, the skin on the hands of some personnel may become so dry and cracked that bleeding occurs

30.  hands don’t look dirty  hand washing takes too long

31.  pulling patients up in bed  taking a blood pressure or pulse  touching a patient’s hand  rolling patients over in bed  touching the patient’s gown or bed sheets  touching equipment like bedside rails, over bed tables, IV pumps

33. Culture plate showing growth of germs 24 hours after a nurse placed her hand on the plate

34.  soap and water  alcohol-based hand rub

35. › inconvenient › time-consuming › often causes skin irritation and dryness

36. When compared to soap and water hand washing, alcohol-based hand rubs have the following advantages:  take less time to use  can be made more accessible than sinks  Cause less skin irritation and dryness  are more effective in reducing the number of bacteria on hands  making alcohol-based hand rubs readily available to personnel has led to improved hand hygiene practices

37. Wash your hands with plain soap and water, or with antimicrobial soap and water if:  your hands are visibly soiled and contaminated  before eating  after using the restroom  before And after any direct patient contact  before And after removing gloves

39. Palm to palm. 1 Right palm over left dorsum and left palm over right dorsum. 2 Palm to palm fingers interlaced. 3 Backs of fingers to opposing palms with fingers interlocked. 4 Rotational rubbing of right thumb clasped in left palm and vice versa. 5 Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa. 6

40. What is the most biohazards agent in healthcare settings?

42. What is the hazards of exposure to blood?

43. 1- Transmission of Blood borne infections: › Viral e.g. HBV, HCV, HIV & Cytomegalovirus (CMV). › Bacterial : Syphilis. › Protozoal : Malaria. 2- Pyrogens in the transfused blood may lead to fever 3- Blood incompatibility a) ABO incompatibility b) Rh incompatibility 4- Allergic reactions.

45.  Safe blood : Blood free from blood borne pathogens.  Effective blood : Properly handled and stored blood and blood components in order to preserve their natural properties & therapeutic benefits.

46.  Donor screening  Blood screening  Proper processing

47. Potential donors must be :  Healthy from 18 – 60 years.  Body weight above 50Kg.  Hemoglobin level above 13gm/dl in male and 12gm/dl in female.  They answer questions about their health and risk factors.

48. Temporarily  Allergy, fever, common cold, or sore throat on the day of donation.  Minor surgery (for 6ms)  Major surgery or blood transfusion (for one year)  Pregnant, lactating or menstruating women.  Blood donation within 3ms for males & 4 ms for females

49. permanently  HIV infection.  Multi partners & homosexuality  Intravenous drug abuse.  History of viral hepatitis.  Under weight (<50Kg)  Chronic diseases

50. Blood screening  Every donation is tested for infectious diseases hepatitis B surface antigen (HBsAg) hepatitis C antibodies HIV antibodies Syphilis antibodies.  Blood grouping ABO Rh.

51. Handling of blood. Separation of blood into components. Storage of blood & blood components.

52. Occupational exposure  CDC estimates ~385,000 sharps injuries annually among hospital-based healthcare personnel (>1,000 injuries/day) › Many more in other healthcare settings (e.g., emergency services, home care, nursing homes)  Increased risk for blood borne virus transmission  Costly to personnel and healthcare system

53. - Needle stick & other sharps injuries. - Direct inoculation of virus into cutaneous scratches, skin lesions, abrasions or burns. - Direct inoculation of virus into mucosal surfaces.

54. Potential Risk of transmission Hepatitis BHepatitis CHIV Source patient is HBeAg positive 30% Source patient is HBeAg negative Less than 6% 3% 0.3%

55. A) Prevention of occupational exposure to blood I) Personal protective barriers. II) Work techniques & safety devices. III) Sterilization & Disinfection. B) Vaccination against HBV infection C) Proper management of exposure vaccination Response testing Exposure reporting Emergency Management Post exposure management

56.  All spills of blood should be promptly cleaned by a person wearing gloves.  Visible material should first be removed with disposable towels  Area should be decontaminated with an appropriate disinfectant

57. o Pre-employment vaccination : Three intramuscular doses of hepatitis B vaccine.  Post vaccination testing : Should be done 1 to 2 months after vaccination. Persons who do not respond to the primary vaccine series should complete a second three-dose vaccine series and be evaluated to determine if they are responders N.B. * A responder : defined as a person with adequate levels of anti-HBs in serum ( anti-HBs is 10 mIU/ml).

58. Exposure reporting : Report the exposure exposure must recorded in person’s medical record. Emergency Management and Exposure Assessment : Puncture wounds and other cutaneous injuries should be washed with soap & water. Exposed oral and nasal mucous membranes should be vigorously flushed with water. Eyes should be irrigated with clean water, saline or sterile irrigants. Person whose blood or body fluid is the source of an occupational exposure should be evaluated for HBV, HCV & HIV.

60. Post exposure Prophylaxis (PEP) for HBV :  * If the exposed person is unvaccinated - HB immunoglobulin (IG) (0.06 ml/kg IM). - HB vaccine series.  * If the exposed person is previously vaccinated -Measure the level of antibodies to HBs Ag. Post exposure Prophylaxis for HCV : Perform baseline testing and follow up testing (e.g. at 4-6ms) for anti HCV and liver enzymes. Confirm all anti-HCV testing results reported +ve by RIBA. Post exposure Prophylaxis for HIV: The use of PEP with antiviral drugs as soon as possible should be considered.

61. Training Exercises

62. Ahmed is 25 years old, he is a laboratory technician in the national blood bank.while taking a sample,he had a needle stick injury. After testing the source.it found that he was HBV positive. 1)what are measures done for AHMED ?

63.  HBIG and vaccination depending on vaccination status. This risk can be decreased by 80% with two injections of HBIG; one immediately after exposure.  Follow up every 3 months

64.  The risk of contracting Hepatitis B is: › o.3% › 3-6% › 6-30% › Non of the above  HBV highest incidence in : › Asia and Africa › Europe › Northern America

65. If you are the director of the blood bank, what are the precautions you will put for safety of all health workers ?

66.  Good selection of blood donors,.  Exclusion of carriers and those who have past history of Hepatitis infection and addicts.  Blood donors should be free from HBsAg.  Healthcare professionals are required to stick to standard universal hygienic precautions to avoid the transmission of viral infections as wearing gloves, goggles to avoid blood splashes.  Healthcare workers are advised to take HB vaccine.

67. Fatma is 30 years old, she is a nurse in Hepatology department in Mansoura university hospital.after giving a patient the vial she had a stick injury on recapping the syringe. 1) In your opinion,what should be done for Fatma ?

68. Exposure reporting: Report the exposure to the department responsible for managing exposure. - The circumstances & post exposure management of the exposed should be recorded in person’s medical record. Emergency management and exposure assessment: - Puncture wounds and other coetaneous injuries should be washed with soap & water. - Person whose blood or body fluid is the source of an occupational exposure should be evaluated for HBV, HCV & HIV.

69. If the source is free, nothing will be done. If the source is HBV +ve: Post exposure management: Post exposure prophylaxis (PEP) for HBV : If the exposed person is unvaccinated: -  HB immunoglobulin (IG) is indicated as soon as possible <24hr (0.06 ml/kg IM).  Also, HB vaccine series should be started as soon as possible.

70. * If the exposed person is previously vaccinated:  Measure the level of antibodies to HBs Ag If sufficient (>10 mIU/ml) i.e. responder do not require post exposure prophylaxis.  HB immunoglobulin and initiate revaccination.

71. If the source is HCV +ve Post exposure prophylaxis for HCV : Perform baseline testing for anti HCV and liver enzymes. Perform follow up testing (e.g. at 4-6ms) for anti HCV and liver enzymes. Confirm all anti-HCV testing results reported +ve by RIBA. If the source is HIV +ve Post exposure prophylaxis for HIV: The use of PEP with antiviral drugs as soon as possible should be considered. Then follow up HIV serology 6 weeks, 3 months&12 months.

72. The most common form of occupational exposure to Blood born infections among health care workers is : › Operative Room. › Dentist clinic. › Dialysis unit. › Needle recapping. The risk of occupational transmission of hepatitis B if HBe Ag negative is: › Less than 6%. › More than 30%. › Exactly 3%. › Less than 0.3%.

73. The recommended sequences for safe removal of PPE:  Gloves-Goggles-Gown-Mask  Mask-Gown-Goggle-Gloves  Goggle-Gown-Mask-Gloves

74. Thanks a lot