Etapas de la intervención comunitaria

SUMMARY BOX

• The potentially infectious nature of all blood and body substances means the implementation of infection control practices in all healthcare setting is essential

• Standard precautions are required in the treatment and care of all patients to prevent transmission of HIV, HBV, HCV, and HAV

• Healthcare workers have a responsibility to protect themselves and their patients from exposure to blood borne viruses within all healthcare settings

• Individuals with a blood borne virus, or living with someone with a blood borne virus, need to be aware of basic measures that will prevent transmission to close contacts / household contacts

All people should be considered to be potentially infected with a blood borne virus, so any contact with blood and bodily fluids is treated in the same way. There are many people who may be infected with a blood borne virus but have never been tested - you can’t tell by looking at someone if they are infected or not. Treating all blood and bodily fluids in the same way for everyone also helps reduce the stigma of blood borne viruses as individuals are not being ‘singled out’ for special care.

It is the responsibility of all healthcare staff to follow infection control guidance.

All healthcare staff should implement standard precautions.

Standard precautions include aseptic technique, barrier protection, safe disposal systems, and the appropriate use of instruments and equipment. They are effective in the prevention of the transmission of blood borne viruses. Additional precautions, transmission-based precautions, are necessary to prevent the transmission of other important pathogens e.g. tuberculosis (airborne route of transmission).

Whether caring for someone in a health centre, hospital, residential centre or patients own home, the principles of Standard Precautions and decontamination procedures are the same. See Lothian Infection Control Manual for local policies available at

http://intranet.lothian.scot.nhs.uk/nhslothian/healthcare/a_z/i/infection_control /infection_control_manual.aspx.

Alternatively, contact the Infection Control Team if you have any questions. See http://intranet.lothian.scot.nhs.uk/nhslothian/healthcare/a_z/i/infection_control 1.aspx

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Preventing Infection

• Hand washing between procedures and patients is an important factor in preventing the spread of infection

• Take care with the disposal of needles and syringes - never re-sheath needles.

Wear gloves when using sharps – they may not prevent injury but they do remove a lot of blood from the sharp, reducing the chance of infection

• Clean all patient equipment thoroughly, never re-use single use equipment

• Wear the appropriate protective clothing for the situation and task

• Cover any cuts or abrasions with a waterproof dressing

• Wash hands after handling all waste or laundry

• Dispose of waste appropriately i.e. sharps containers

See Lothian Infection Control Manual for detailed advice (web link above).

Cleaning up Spillages

• Deal with any blood or body fluid spillage promptly as per Lothian policy (Lothian Infection Control Manual p164). Use disposable nitrile gloves and disposable plastic apron

• Clean area with general purpose neutral detergent, dry area well Skin Care

• Healthy intact skin provides an effective barrier against infection

• Cover all cuts, abrasions and skin lesions with waterproof dressing

• Healthcare Workers with skin conditions (e.g. eczema) should seek the advice of the Occupational Health Department

Needle-stick and other Contamination Injuries

• Risk of HIV infection from needle-stick injury is around 0.3%. No infection has ever been recorded from discarded needles in the community

• There is a medium risk of infection from hepatitis C PCR positive source – reported transmission rates between 3% - 10%

• There is a high risk of infection from hepatitis B carriers who are ‘e’ antigen positive - around 30%. Human bites from carriers should be also regarded as infectious due to presence of infectious HBV in saliva

Procedure following injury

• On broken skin: wash area thoroughly with warm running water and soap, encourage bleeding

• In mouth: do not swallow, wash mouth out

• In eye: wash eye thoroughly with water after removal of contact lenses

• Needle-stick injury - encourage bleeding, wash with water and soap or antiseptic, cover with waterproof plaster

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• Seek medical advice immediately – through Occupational Health Service (OHS) on 0131 537 9369 or 0131 537 6000 outwith normal hours.

There are two important factors in assessing risk of needle-stick injury:

• The injury – The depth? Hollow-bore needle? Gloves worn?

• The source – Known to be positive? If so, viral load for HIV? High risk group?

In most cases the risk is low, however:

• Seek medical help immediately

• Report injury to manager

• Follow Lothian Infection Control guidelines for dealing with contamination

• Test the source (with informed consent) if possible

• See Lothian Standard Operating Procedure for Incidents Involving Potential Exposure to Blood Borne Viruses (Wilks 2007, at the end of this section) for guidance

POST EXPOSURE PROPHYLAXIS (PEP) - see Lothian policy for details

http://intranet.lothian.scot.nhs.uk/nhslothian/healthcare/a_z/i/infection_control /infection_control_manual.aspx

Post exposure prophylaxis can be given to reduce the likelihood of an individual developing an infection after they have been exposed to the virus in question.

HIV

• No vaccine currently available

• If exposure risk is significant then a combination of antiretroviral drugs can be given as a prophylaxis to reduce the risk of infection (see Wilks 2007, appendix 4 for details)

• Ideally, should be commenced within two hours of injury. It is never too late to commence PEP but individuals presenting more than 48 hours after exposure should be discussed with the on-call RIDU consultant (see the Services section for contact details)

Hepatitis C

• No vaccine currently available.

• No specific PEP treatment currently recommended

• Blood test and follow-up blood samples advised

• Counselling is available

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Hepatitis B

• Most healthcare workers have been immunised against HBV. Healthcare workers who have not received a Hepatitis B booster dose in the past 5 years should be considered for one following a significant injury - see the Prevention section for further details on immunisation

• PEP for hepatitis B consists of administering an accelerated course of HBV immunisation or administering both HBIG (immunoglobulin) and a course of immunisation depending on the risk and response to immunisation

• PEP for HBV should be commenced within 24 hours, outwith this timescale discuss with the on-call RIDU consultant

• Counselling and follow up bloods advised

Hepatitis A

• PEP for hepatitis A includes giving HAV Immunoglobulin (IgG) and an immunisation course

• Counselling and follow up bloods advised Clearance for Healthcare Workers

• The General Medical Council (GMC), Nursing and Midwifery Council (NMC) and General Dental Council (GDC) offer guidance on professional accountability of doctors, nurses and dentists respectively

• Department of Health (2007) published new guidance on health clearance for serious communicable diseases (HIV, hepatitis B, hepatitis C and TB).

It recommends: pre-appointment/pre-admission health checks for serious communicable diseases for ALL new entrants to the NHS, including healthcare students. This includes checks for TB disease/immunity and hepatitis B immunity (with immunisation if needed), and the offer of testing for hepatitis C and HIV

• Health clearance for blood-borne viruses (i.e. proof that not infectious for hepatitis B and C, and HIV negative) is required for posts or careers involving exposure-prone procedures (EPPs)

• Currently all healthcare workers who are involved in Exposure-Prone Procedures (EPP) must be up to date with Hepatitis B immunisation and must show an adequate immunity status, or be non-infectious with HBV.

Further guidance on infected healthcare workers can be found at:

http://www.hps.scot.nhs.uk/bbvsti/guidelines.aspx

Social contact/household transmission (HIV, HBV, HCV)

Infection is not acquired through everyday social contact, for example from a cup or by touching an infected person. However, if a person is infected with a blood borne virus they should use their own personal items such as nailbrush, scissors or razor and be meticulous about cleaning up any blood from cuts or scratches.

Undiluted household bleach should be used to clean up blood from floors and work

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surfaces. Scratches, cuts and wounds should be carefully cleaned and covered with a waterproof dressing or plaster. Sanitary products should be safely disposed of. Members of a household where one person is infected with a blood borne virus should be aware to take basic precautions with blood and body fluids.

Immunisation against HBV can be sought by household / sexual contacts of an individual with active hepatitis B.

HAV transmission in social / household situations can be avoided by good hygiene.

Immunisation can be sought by at risk individuals – see the Prevention section.

Foster Carers

Some children requiring fostering may have been at increased risk of acquiring a blood borne virus. Emergency placements may be made within a few hours. Foster carers who accept children as emergency placements should be made aware of the risks of undiagnosed infection and how they can minimise the risks of transmission of all blood-borne virus infections. All short-term foster carers who receive emergency placements, and their families, should be offered immunisation against hepatitis B. Permanent foster carers (and their families) who accept a child known to be at high risk of hepatitis B should also be offered immunisation (Salisbury et al 2006).

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