Theater protocol in high risk infectious patients

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Theater protocol in high risk infectious patients

Dr. Arshad Abdullah Khan, Karachi

Blood borne pathogens are microorganism, virus and bacterial camed in blood and can cause disease in people. There are a number of different pathogens such as these causing malaria syphles and brucellosis but hepatitis B, C and HIV are the most deadly. Since there is no known core for any of the three infections, the patient will have to suffer life long disabilities or death.

While this module focuses primarily on HBV, HCV and HIV, it is important to know that during our professional work, especially surgery we are exposed to all blood borne pathogens.

RISK OF TRANSMISSION

Pathogens in the blood such as HBV, HCV and HIV can be transmitted through contact with infected human blood and other potentially infections body fluid such as semen, vaginal secretions, CSF, synavial fluids, Pleural fluid, Peritoneal  fluid, amnoratic fluid saliva in dental procedure and any fluid that is visibly contaminated with blood.

It is important to know that the ways exposure of transmission are most likely to occur in particular situation, by providing first and to a student in a classroom, handling blood sample in the laboratory or cleaning of blood from a pathway.

HBV and HIV are most commonly transmitted through sexual contact, sharing of hypodermic needles, from mother to their babies at before birth, accidental puncture from contaminated needles, broken glass or other sharp contact between broken or damaged skin, contact between broken or sharp, contact between mucous membrane and infected body fluids contact with contaminated waste especially in use of hepatitis B which can last in dried body fluid for as long as 7 days.

Accidental puncture from contaminated needles and other sharp object can result in transmission of blood borne pathogens.

In most work or laboratory situations transmission is more likely to occur because of accidental puncture from contaminated needles, broken glass or other sharp object contact between broken skin and infected body fluid or contact between mucous membrane and infected body fluid for example if someone infected with HBV at their finger on a piece of glass and then you cut yourself on the now infected piece of glass it is possible that you could contract the disease.

Many time there is blood to blood contact with infected blood or body fluid there is a slight potential for transmission.
Unbroken skin forms an impervious barrier against blood borne pathogens. However, infected blood can enter your system through open spore, cuts abrasion once or any sort of damaged or broken skin such as sunburn or blusters.

Blood borne pathogens may also be transmitted through the mucous membranes of eye, nose and mouth. For example, a splash of contaminated blood to your eye, nose or mouth could result in transmission.

SERO-CONVERSION FOLLOWING EXPOSE

Sero-Conversion means after being exposed body fluids from a paired infected source. The percentage of HCVs develops the infection.

Sero-Conversion rate HIV 0.3 %. HBV 30%, HCV 10%. Potential risk factors for Sero-Conversion following percutaneous  injury.

  1.  Internal between needle use and exposure
  2.  Quantity of blood infected
  3.  Needle bore
  4.  Source patient
  5.  Clinical status
  6.  Titre of circulating virus
  7.  Use of anti-viral agent
  8.  Healthcare worker
  9.  Use of barriers
  10. Post-exposure management
  11. Depth or severity of exposure

PREVENTION & PRECAUTION

General Measures

  1.  Education of staff so that they are aware that there is full vaccination program for hepatitis B.
  2.  The availability of advice for staff in event of injury.
  3.  Take practical care with handling of sharps which should always be left in receivers.
  4.  Hypechante 1% solution may be applied to blood spitted on the floor.
  5.  Swab should be counted but not to left exposed on the spike rack, they should then be placed on deep swab pockets on the plastic racks.
  6.  Disposable equipment should be placed in yellow bags at earliest possible time then sealed and double bagged with hazard label attached.
  7.  Soiled linen should be placed in the special alginate bags, clearly marked and sent to laundry. At the end of operation all surface should be cleaned with detergent and domestic officer be informed.

PRACTICAL MEASURES

  1.  
    • Identify high risk patients on operating list and reduce the number of staff in theatre to cover essential role only.
    • Remove all extraneous equipment from theatre.
    • Prevent staff from coming into contact with contaminated body fluid especially blood and for this should be excluded from theaters and if contaminated does occur, rapid washing should be undertaken.

Gloves should be made of latex nitril rubber or other water impervious materials. If glove material is thin or flimsy, double gloving can provide an additional layer of protection. Also if you know you have cuts or sores on yours hand, you should cover these with bandage.

You should always inspect your gloves for tears, puncture before putting them on. If a glove is damage, don’t use it. When taking contaminated gloves with any bare skin and be sure to dispose of them in proper container so that no one else will come in contact with them either.

Anytime there is a risk of splashing or evaporation of contaminated fluid, goggles or others eye protection should be used.

Again blood borne pathogens can be transmitted through the thin membrane of the eye so it is important to protect them. Splashing could occur while cleaning up a spill, during laboratory procedures or while providing first aid medical assistance.

Face Shield may be worn in addition to goggles to provide additional face protection. A face shield will protect against splashes to the nose and mouth. They may be used during labour (delivery) related procedures.

Apron may be worn to protect your clothing and to keep blood or other contaminated fluid from soaking through your skin, ensure that staff wear non permeable gowns and use absorbent disposable contaminated which blood should be removed as soon as possible because fluid can seep through the cloth to come into contact with skin.

Contaminated laundry should be handle as possible and it should be placed in an appropriately labeled bag or container until it is decontaminated and disposed. Footwear that cover your feet completely can be worn in places like trauma ward, operation theatre, mortuary etc.

Specimen at high risk of infectivity should be identified and treated according to policy. Formalyn splashing in container must be avoided. The record book must be signed with full description of specimen and the time that it left theatre.

Disposable such as drains should be secured to patient and checked for potency  those disposable to be discarded such as soiled linen and other waste should be disposed of appropriately and maternal of high infectivity need to be sealed and marked accordingly.

The record block should be kept in each theatre. If surgical procedure is different from the one that was planned, it is the responsibility of the surgeon to inform both the patient and relative subsequently.

2017-04-26T12:35:42+00:00