Question

When working in a hospital, there are many risks/hazards that you will be confronted with on a daily basis. The following table identifies four (4) infection risks/hazards that may be present in a hospital environment. These hazards always need to be to be reported to a senior staff member or manager, documented correctly and control measures initiated.
Build on this table by identifying the likelihood and severity of harm from each hazard/risk by using the risk ranking matrix below, immediate steps that will need to be taken to manage the situation and possible procedures that will need to be put in place (minimum one point in each section).

Infection/Hazard. Risk rating.    Severity of harm. Likelihood. Immediate actions. Risk Management Procedures

3.1)     Needle stick injury

3.2)     Blood spill on the corridor

3.3)     Exposure to blood/body fluids

3.4)     Contamination of materials, equipment and instruments by aerosols and splatter in an active TB client's hospital room

Answer 1

3.1)     Needle stick injury

There is a measure to avoid needle sticks that is not the opening of a needle, it is particularly important in the cover that behind him, he was used to crossing that original; Recapping and re-coating should be avoided. More importantly, the use of the container, which you can again use the needle stick test. This is important because it is always on hand to avoid the temptation to recap. There is also an important way to protect the use of their own garments, such as gloves, the person's mouth, and it is appropriate in glasses that the observance of endoscopy.

prevention
The most important rule of thumb for designating a needle stick injury is not to cover the back of the needle; Instead, the needle should be based on a specially designed, rigid, puncture-proof container. Make sure the container is always present.

Infection
All hospital employees or healthcare personnel at risk of accidental injury exposed to blood should be vaccinated against HBV. There are available but for HCV, and I will not take preventive vaccines for HIV.

In case of contact with blood
Personal protective equipment and clothing will be excellent. Wear masks, gloves, and gowns. It is more than a double glove. Each additional protective barrier layer (such as one or two gloves) significantly reduces the risk of infection from the needle of a commercially available agent. When absent, the risk of skin needle stick decreased by means of the first research shows that the needleless injection puncture of the art of using mechanics or quality of an article by force of reflection. Crossing the class of people and the advice of the eye of a needle is also important. To needles with safety mechanisms (safety barrel) or blunt point needles to reduce frequent needle stick injuries. Better adherence to safety procedures and sufficient preparation to reduce safe behavior in the operating room can lead to significant fears of injury and infection. Support is entirely up to God, and to save the atmosphere of the operating room, but information about the creator of the atmosphere.

In the disinfection of contaminated material
After contaminated materials are spilled, the area should be cleaned immediately (with gloves!) And disinfected. Lorem equipment and materials, tools and small surfaces and smear with 70% alcohol. It is disinfected with a 1000 ppm chlorine solution in areas such as a large area.

Action immediately after injury
Once accidentally wound care
And not for a moment, just clean the wound with water or saline. A large amount of alcohol to disinfect the wound with soap and water followed by 70%. In the case of contact with the mucosa it is important to rinse thoroughly and immediately using only water or saline solution, not alcohol.

Report the incident
It is important to report workplace incidents immediately. It is this fact that will allow the proper administration of what is behind.

Once the action (or the injured person)

Blood sampling should be done as soon as possible after injury. This year shows at least. For example, if the infection has settled on its own, it becomes necessary to become infected with the virus of the three works. They are the most effective way to idealize, but this is solved. Other blood test patterns, such as HBV, HCV, and HIV, were stored for 1, 3, 6, and 12 months.
Once the action (or chains, the potential source)

and Management

Needle Stick Injury Protocol, Prevention and Management

Needle Stick Injury and Accidental Exposure to Blood

Needlestick Injury : the accidental puncture of the skin by a needle during a medical intervention
Accidental exposure to blood: the unintended contact with blood and or with body fluids mixed with blood during a medical intervention.

Risks
Accidental exposure to blood caused by needle injuries or injuries following, cutting, biting or splashing incidents carries the risk of infection by blood-borne viruses such as the hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

HBV risk= 5 – 40% HCV risk= 3 – 10% HIV risk = 0.2 – 0.5%
HBV prevalence is higher than average in intravenous drug users, homosexual men and in people from developing countries.

HCV prevalence is higher in people who have had multiple blood
transfusions, in dialysis patients and intravenous drug users.
HIV prevalence is also higher in homosexual men, in intravenous drug users and in people from areas where the condition is endemic.

Accidental contact with blood occurs especially in the following situations:
1. During re-capping
2. During surgery, especially during wound closure
3. During biopsy
4. When an uncapped needle has ended up in bed linen, surgery clothing etc
5. When taking an unsheathed used needle to the waste container
6. During the cleaning up and transporting of waste material
7. When using more complex collection & injection techniques
8. In A&E (Accident and Emergency) departments
9. In high-stress interventions (diagnostic or therapeutic endoscopy in patients with gastrointestinal bleeding)

Although this does not occur very often, there are other blood-borne microorganisms which can be transmitted via blood exposure:
• Other hepatitis viruses
• Cytomegalovirus (CMV)
• Epstein-Barr virus (EBV)
• Parvovirus
• Treponema pallidum (syphilis)
• Yersinia
• Plasmodium
Accidental exposure to blood following a needlestick injury is probably one of the most common occupational health accidents in medical care.

Avoiding needlestick injury and avoiding infection

The single most important measure to prevent needlestick injury is to not put the used needle back in its original cover; re-capping and re-sheathing must be avoided. Instead use a rigid puncture-proof container for used needles. It is important that the container is always close to hand to avoid the temptation of re-capping. It is equally important to use proper protective clothing such as gloves, mouth mask, and goggles which are appropriate during the performance of endoscopy.

Prevention
The most important rule for preventing needlestick injury is not to put the needle back in its cover, instead, the needle should be put in a specially designed, rigid, puncture-proof needle container. Make sure the container is always at hand.

Vaccination
Every hospital employee or any healthcare personnel at risk from accidental exposure to blood should be vaccinated against HBV. There are no preventive vaccines available yet for HCV and HIV.

Prevention of accidental blood contact
Personal protective equipment and clothing is very important. Use mouthmasks, gloves and gowns. Double gloving is safer than single gloving. Each additional layer of protective barrier (such as one or two gloves) significantly reduces the threat of any infectious agent present on the outside of the needle. Research shows a decreased or absent needlestick injury risk when using prior skin puncture techniques, or when using a needle-free delivery mechanism such as jet-injection devices. Needle type and design is also important. For example needles with safeguard mechanisms (safety barrel) or blunt tipped needles, can reduce the frequency of needlestick injury. Adequate training in safety procedures and improved compliance with safe operating room behavior can significantly reduce injury and infection risks. The maintenance of a safe operating room atmosphere is totally dependent on the atmosphere set by the operator.

Disinfection of contaminated material
After spilling possibly contaminated materials the affected area should be cleaned immediately (wearing gloves!) and then disinfected. Nursing equipment and materials , tools and small surfaces are cleaned with 70% alcohol. Large surfaces such as floors are disinfected with a chlorine solution 1000 ppm.

Immediate action after injury
Taking care of the wound immediately after the accident
Let the wound bleed for a moment and then cleanse thoroughly with water or a saline solution. Disinfect the wound using an ample amount of soap and water followed by 70% alcohol. In case of contact with mucous membranes it is important to rinse immediately and thoroughly, using water or a saline solution only, not alcohol.

Reporting the incident
It is important to report the incident immediately to the department dealing with occupational accidents. This will allow proper registration and subsequent management of the event.

Immediate action (injured person)

A blood sample should be taken as soon as possible after the injury. This sample should be kept for at least one year. It can act as a baseline value in case infection takes place and it becomes necessary to determine whether infection by one of the three viruses occurred at work. The kept sample may only be analysed for this particular purpose. Further blood samples to test for HBV, HCV and HIV are collected after 1, 3, 6 and 12 months.
Immediate action (dealing with the potential source)
If the source of the blood is known the patient must be asked for permission to sample blood for a HCV and HIV test. If the patient refuses then it must be assumed the patient is a carrier of the virus. If the origin of the blood is unknown then any blood present on the needle can be used for a serological examination.

Treatment approaches

General Prophylaxis
Management is based on finding out whether there is a risk of HBV, HCV or HIV . Depending on the serological analysis of the sample, steps must be taken to limit infection risks from the identified virus.

If the blood source is known to be a patient and permission for HCV is requested, a blood test for HIV is performed. And if the patient refuses to be assumed as a carrier of a patient. Therefore, if some blood is now of unknown origin, a blood needle can be used for serological examination.

Immediate action after Needlestick Injury
After a review of the accident with the doctor responsible for occupational health and safety a recommendation is given whether or not to prescribe Post Exposure Prophylaxis (PEP). If in doubt it is best to contact an AIDS expert. If PEP is advisable then it is important to discuss :
1. the advantages and disadvantages of PEP
2. the necessary follow-up examinations (of liver and kidneys) after 2 weeks, 1, 3 and 6 months)
3. follow up examination for HIV infection (after 1, 3 and 6 months)
4. the importance of avoiding transmission to sexual partner(s) (use of condoms)

Start PEP as soon as possible after this. Post Exposure Prophylaxis (PEP)

3.2)     Blood spill on the corridor:

Safety management systems and services have substantially the body and blood to deal with spills. The protocols should be included in the procedures manual or permanently emphasized in the training program.

The blood and basic fluids in the body / handling of substance spills are:

Use standard precautions, including the use of personal protective equipment (PPE), which belongs to
Cleaning in the area will be cleaned up before spills (adding moisture to clean up spills will increase pain and prevent size)
The generation of aerosols requires development that should be avoided.
After starting the championship flexible enough to cope with the management championship, various circumstances, following the factors

the nature (type) they become (for example, saliva, vomit, feces, urine, blood, and laboratory cultures)
the less likely it is that a man has devoted himself to most of all these different types of ball pathogens - for example, when entering copies they have it, such as viruses, bacteria or protozoal pathogens, such as Mycobacterium tuberculosis with sputum, which are processed;
spill size: for example, one spot (few drops), small (<10 cm), '' or '' large ''> 10 cm)
what kind of surface, for example, by, or waterproof carpet floor,
is involved, that is, if the spill occurs in a confined space (such as a milk lab), or in a public health or clinical area of ​​the service or in a public place within city facilities
if there is any possibility of bare skin contact with the horrified (contaminated) surfaces.
Cleanup Spills - Equipment
Standard equipment cleaning, including brooms, buckets, and cleaning agents is clean, may not be available for management, and discreetly. He also founded the field of music. This places great importance on it, especially in the clinic.

To help manage spills, areas where cleaning materials may not be readily available to the kit cannot be released quickly, such as a large (10 50) LONGINA reusable plastic container or pail, or a bucket with a lid, in which the following elements:

should be result-proof bags for containers and waste material from inside
Sturdy skillet fixed and a scraper spills out (like 'pooper scoop')
sachets of granules of which five formulas: 10,000 ppm available chlorine or equivalent (the file contains a self sufficient 10 cm diameter granules for the spill)
CLEANING BOOK with rubber gloves (handling 400 blood gloves is not recommended)
eye protection (disposable and not reusable)
a plastic apron
Respiratory protection to protect the powder or granules of disinfectant aerosols (which are generated in the championship of high risk process developers).
destroyed by incineration
sodium and potassium, soak for 1 hour in the pan for 18 minutes and washed with pure water and sterilized on weekends.
The kit must be replaced after each use. One affects the use of spillage items from the kit.

Since all handling protocols spill, it is essential that the area is left clean and dry.

Sodium hydroxide (caustic soda), deep packaging in hazardous areas should be available for increased risk of Creutzfeldt-Jakob disease (CJD) spills, such as in morgue and laboratory neurosurgery

Spill Cleanup - System
In clinical areas, blood and body fluids / substance are shed as soon as possible. In the operating room, and in what medical procedures the discreet way cannot be attended as soon as it is safe to do so.

Care should be taken to thoroughly clean and let dry, bare soil from passages where there is no possibility of contact with the surface of the skin (for example, in bed, on examination).

The PPE must be cleaning in every way, either by desire sent for cleaning after use. Hands should be washed and dried after cleaning.

For where there is pain occurs on the carpet, or shampoo as soon as possible. Make disinfectant. The steam of the professionals to be a place to sleep.

Cleaning wash your hands completely free.

Your cleaning or small championship
Drops of blood and other places (up to 10 cm) cleaning the floor with hard paper towels and detergent in warm water, then rinsing and drying the area. The dry area, wet areas to attract pollutants.

The consumer area can use a hospital grade disinfectant.

Large spill cleanup
Where there are large spills (more than 10 cm) and it is damp, space in the bathroom or on the bathroom floor and the consumer should carefully wash the sewer system with plenty of water and rinse the area with warm water and detergent.

For large blood spills in "dry" areas (such as clinical areas) that contain aerosols, age to prevent such development.

The granules and formulations that are available for the production of high concentrations of chlorine may include the poured material and will be less capable aerosols. A strigili, the pan should be to remove all the material. The pieces are then turned into a mop bucket with warm water for cleaning and detergent. From a bucket, a mop, dry well, and to buy and clean to use and put away after it is put away.

It is essential that for the most part sodium spillage is administered: But it is impossible that you could be out of luck. It is known, however, as others believe, that the risk of contagion from the cares of workers and members of the public is softer, so write it, if it applies to sodium. Health workers and members of the public should be aware that it is good for the government from the perspective that they are nowhere in the infection.

3.3)     Exposure to blood/body fluids:

All health services must develop their own protocols for the control of communicable disease infections. This includes appropriate action to clarify written instructions in the event of exposure to blood and bodily fluids / substances, such as needle stick injuries to other bodily fluids or blood, or incidents involving patients or healthcare workers. If the protocol includes:

that the physician or medical officer who qualifies a qualified professional contacts
of the laboratory, that there is something that ideals are dismayed by
the pharmacy with the drug that is prophylactic
reasons for investigating the incident and taking steps to prevent luck from happening again (this includes changes in work practices, change of equipment and / or training)
your willingness, to waive, in particular, to judgment, advice and treatment of the rules to follow, of the dangers of occupational exposure to blood-borne viruses.

Exhibitions: immediate action
Treatment protocols include removing contaminated clothing and thoroughly washing the injured area with soap and water. The sensation of being the wild mucous membranes with the water. He should gently be like the eyes of the haughty ones to submit to.

That person must be exposed to immediately report any occupational exposure.

The exposed person must undergo a medical trial, including information on underlying medical conditions and medications, they may even be lucky. Post-exposure prophylaxis (PEP), non-occupational post-prophylaxis (PEP-N) and counseling, and is offered as appropriate money. Treatment should be based on all available work hours and hours after the call (eg, that infectious disease doctor, a call).

Or patients exposed to blood or other bodily fluids / substances to be informed about the act or in any profession, maintaining the confidentiality of the source of the blood. As long as the IV to patient ratio is only the most basic plan, not what has become of him outside the military. Labor, labor-N long-term follow-up to give to the priests and to one's own, where appropriate. The patient refuses admission and the spring carrots must be stored for serum analysis.

Document the incident and include::

give the appearance of exposure
How is it done
The name of the individual font (if known).
You cannot carry out surveys in the health service, you must be registered in the art emergency medical department or in the nearest hospital.

Post-exposure to single source management
Human body and blood fluids are the source of an occupational / non-occupational injury or zero with HIV infection should be evaluated for HBV and HCV. Either the record or the information available from the source of the doctors suggest that a man has with him to rule out virus infection. Whether the source is known to be infectious for HIV infection and the types of information on the stage, and current and previous antiretroviral therapy to decide the most appropriate collected and organized NAP.

If the source person's HIV, HBV, or HCV status is known to be an informed source about the incident and the agreement sought to test for the virus, pre-test and post-test counseling should be provided. Have your consent for your information to be used to register the requested patient. If an agreement cannot be obtained, for example if the patient is unconscious or does not wish to consent, the laws and procedures established for Victory are followed.

In fact, what has been proven in one source of every detail, as follows, at the time of injury:

vidhim disease;
HSV surface antigen (HBsAg)
Antibody against HCV.
If the antibody test is positive for HCV, therefore, they must be for HCV encephalitis (CRP) to be tested for HCV RNA. It is much less likely to occur in mid-spring, which is PCR negative. And you can know from that moment the status of the origin of each of the incidents. The motion described below as the person to be dealt with, "immediate management. If a man knows, the cause of which should be dealt with in the book" Management of the exposed person. "

Unknown single source
Reasonable efforts must be made to identify the source. If the source remains unknown, it must be determined based on the individual's tracking;

there is no figure
the probability of being the source of blood positive for the pathogen
the multitude that HIV, HCV and HBV is the instrument of the eye of a needle, most likely, from the province of which we have passed at the source.

A person exposed to management
Immediately and without taking care of the place,
Remove contaminated clothing and the injured area should be washed with soap and water (called antiseptic one). If the mucous membrane like to be the feelings of a large supply of water, he reddened with victory. If the eyes are contaminated, you have to wash them with water or normal saline and gently do not open them completely.

The trial was supposedly crazy
It should be clear that the person should be examined to establish the nature of the exposure and the possibility of disease transmission from the blood transmission plan.

And that the test of the exposed human trial
Let us, then, that a man should have the opinion of the doctors, to the knowledge of one of those medicines, not of luck, but of an underlying medical condition. And also the whole town should decide to decree the risk of tetanus.

Depending on the exposure circumstances, the following should be considered:

Tetanus immunoglobulin
Diphtheria and tetanus vaccine adsorbed mainstream vaccine (PS)
Td is running.
In the current edition of the book in Australia, immunization should be consulted for more details.

Of course, a man is typically tested for antibodies against HIV, Homo sapiens against HCV, and HBsAg at the time of injury, and to establish his so-called insanity serostatus. It follows that it should be offered since the expert advice is to appropriate the thing for the job How can you for a long time?

Or you want the option of being that they cannot suffer, that they did not offer to do the investigation in the Health staff is for a time of their naked person, so that the blood is collected and stored, but not done. In other words, the 12-month blood, you've already taken by contract, and it's stored so that this is a very small part.

If the source is a species of HIV, HBV and HCV are negative, what is nothing to follow is that an essential condition of those exposed, unless a man is a good reason to suspect that the source of the virus, or of those at higher risk, it manifested itself at the time of blood seroconversion of the viral infection. If the source of the virus is positively one of the For's of this type, for women, of childbearing age, the pregnancy test and being prepared was, in the words of the given, who they are, and whose state of pregnancy is unknown.

Postexposure counselling

A specialist with knowledge of bloodborne infections should do the follow-up. If it is demonstrated that a person has been exposed to a bloodborne pathogen, they should not donate blood, semen, organs or tissue for 6 months, and should not share implements that may be contaminated with even a small amount of blood (for example, razors or toothbrushes).

For HIV and HBV, the exposed person should be informed of the risk of transmission to sexual and injecting partners for a 6-month period, and be counselled about issues of safe sex and safe injecting.

If PEP is indicated, or if there is a risk of acute infection with HIV, HCV or HBV, advice should be offered on pregnancy and breastfeeding based on an individual risk assessment. In the case of HIV, patients should be advised of the remote risk of seroconversion up to 12 months post-exposure, particularly if specific PEP was undertaken.

Follow-up for the exposed person

If the source person is seronegative for HIV, HBsAg and HCV, baseline testing or further follow-up of the healthcare worker is normally not necessary. If the source person has recently engaged in behaviours that are associated with a risk for transmission of these viruses, baseline and follow-up HIV-antibody testing of the healthcare worker should be considered.