Forman Erwin SiagianEmail: formanerwin@yahoo.comKP Blok XVIII HIV/AIDSSenin, 21/01/2015Universal precautions to preventDisease transmission (with focus on HIV)to health care workers

Quiz.Petunjuk:Tetap tenang, jangan panik, JANGAN RIBUT !!!!!!Ambil selembar kertas (tidak usah terlalu besar)Tuliskan nama, nim serta PREBaca soal dengan seksamatuliskan pilihan jawaban nya saja (mis. 1. G)Kerjakan sendiri-sendiri, lembar jawaban quiz sebagai bukti tanda kehadiran mahasiswa (untuk dosen)

QUIZTopik kuliah ini mengenai a. HIV b. Universal precautions c. infeksi oportunistik d. pengobatan e. jamur

Jenis penyakit yang bisa dicegah berdasarkan topik diatas adalah sebagai berikut kecuali a. HIV b. hep. B c. hep. C d. blood borne disease e. vector borne disease

Yang paling kecil resiko terinfeksi a. Perawat b. Staf admin c. Dokter d. Petugas lab e. Petugas kebersihan

4. Dalam konteks kuliah ini, cara infeksi nya terbanyak krn:Needlestick injury b. Seks bebas c. Narkoba suntik d. Transfusi e. Ibu ke anak

5. Yang termasuk dalam upaya pencegahan (berdasarkan konteks kuliah ini) adalah sebagai berikut kecuali:Masker b. Sarung tangan c. Mencuci tangan d. Gaun/apron e. Branded Hand sanitizer

ObjectivesIn this lecture you will learn:General epidemiology of HIV/AIDS, hospital acquired accidental infection Characteristics of universal and or standard precautionsRoutes of transmission of hospital acqured infection (HAI), in this case HIV/AIDS, through health care workers (occupational risk of infections)Exposure control methods to prevent exposure to infectious materials Management of blood and body substance exposures and incidents

backgroundHealth care workers, such as medical doctors, nurses, lab staff and aides who work in the hospitals, clinics and other health care settings are frequently exposed to infectious disease (acquiring infection from patients at the workplace)Bouwari, 2012

World Health Organization, 2006

Roth& Worthington, 2005

http://www.lmaco.com/catalogue_item.php?catID Risk of transmission is closely related to work practices habits best practiceDeuffic-Burbana, 2011

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40

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occupational based infection of health workers

occupational based infection of health workers

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occupational based infection of health workers

HIV (4%)4

HBV+HCV (40%)40

not infected (56%)56

To resize chart data range, drag lower right corner of range.

Aggarwal et al, Ind J Comm med. 2013; 37(1): 45-49 Universal precaution adherence among health care providers sustaining occupational exposure

Fact about needlestick injury:greatly underreportedOverall, crudely estimate that a third of at-risk employees have a needlestick injury annually and that only one-third of the cases reportedthe hospital workers at greatest risk are nurses, housekeeping staff, laboratory workers, surgical support workers and physicians, all of whom constitute about two-thirds of hospital employees.30% to 40% of the injuries occurred during recapping of a needle or were associated with disposal problems (needles left in linen, trash cans or surgical trays or sticking out of non-puncture-resistant containers)Stock et al, 1990Universal precautions to prevent HIV transmission to health care workers

Needlestick injurieswww.mynursedegree.comwww.meded.umn.edudrugline.orgHealthcare workers incur 2 million needlestick injuries (NSIs) per year that result in infections with hepatitis B and C and HIVWilburn & Eijkemans. 2004

Hoy & Richmond. Standard precautions andinfection control

Health care workers who have direct patient contact, or who handle medical equipment and tissue specimens, are required to follow certain guidelines to prevent the spread of infectious diseases. These guidelines are referred to as "standard precautions," "universal precautions," or "body substance isolation.Universal precautions are defined as work practices that help prevent contact with blood and a number of other body fluids visibly contaminated with blood. These precautions take the guesswork out of self-protection by extending the practices to all people and all bloodborne pathogens.Although the objective is the same, standard precautions widen the spectrum of potentially dangerous body substances. They combine the major components of universal precautions and body substance isolation (reduces the chances of transmitting pathogens from moist body substances)

Probably the biggest difference between universal precautions and standard precautions lies in the addition of body fluids regardless of visible blood. Standard precautions include work practices to avoid contamination by blood, body fluids, secretions, excretions (with the exception of sweat), nonintact skin, mucous membranes, dried blood, and other body substances, including saliva.

Protective barriers (PPE)the highest proportion of transmission occurs through Percutaneous Injury with hollow-bore needles for vascular access, i.e. blood-drawing and intravenous /arterial cathetersDeuffic-Burbana, 2011

glovesmust be used when: Handling blood and/or body substances Performing venepuncture Touching mucous membranes Touching non-intact skin Handling contaminated sharps Performing invasive procedures Cleaning body substances spills or any equipment (instruments) or materials (linen) or surface that may have been contaminated by body substancesHand washingMust be done immediately:Before and after each clinical contact with a patientBefore and after eatingAfter using the toiletBefore and after using glovesAfter contact with used equipmentImmediately following contact with body substances

Other personal protective equipmentProtective eyewear and face shields must be worn during procedures where there is potential for splashing, splattering or spraying of blood or other body substancesImpermeable gowns and plastic aprons should be worn to protect clothing and skin from contamination with blood and body substancesFootwear should be enclosed to protect against injury or contact with sharp objects

Health care workerVaccination: HBVTesting/screening: HIV, HBV, HCVOccupational exposurePost-exposure prophylaxis (PEP)

Hoy & Richmond. Standard precautions and infection control

Occupational exposure...In general, if an injury or incident occurs where blood or body substances come into contact with non-intact skin or membranes, the following action should be taken:Wash exposed membrane or injury with soap and water (an antiseptic could also be used on the skin)If eyes have been exposed, thoroughly rinse the eyes with tap water or saline while openIf mouth has been exposed, thoroughly rinse the mouth with water and spit outSeek medical advice immediately for assessment of nature of the exposure, the risk of transmission of blood-borne viruses and the need for HIV or HBV post-exposure prophylaxis (PEP)If the exposure is significant and the source patient is known, their consent for HIV antibody, HCV antibody and HBsAg testing should be soughtHoy & Richmond

Stock et al. Can Med Assoc J 1990; 142 (9):937-46

Statistics of HIV, worldwide...

Co-infection with other disease (e.g TB, HBV, HCV, helminth infection)

Baca tulisan prof. Retno tentang infeksiOportunistik pada HIV di Majalah kedokteran UKI (masuk www.academia.edu atau situs UKI)

Sekian dan terimakasih....

referensiBouwari OY. Universal precautions: a review. Nigerian Health journal. 2012; 12(3): 68-74 Hoy J, Richmond. Standard precautions and infection control. In HIV, viral hepatitis and STIs: a guide for primary care.146-51WHO. Infection control standard precautions in health care. In Epidemic and pandemic alert and response. 2006Virginia Roth, Jim Worthington. Implementing a Policy for Practitioners Infected with Blood-Borne Pathogens. Health care Quarterly . 2005; 8: 45-8Stock SR, Gafni A, Bloch RF. Universal precautions to prevent HIV transmission to health care workers: an economic analysis. Can Med Assoc J. 1990; 142 (9): 937-46Wilburn SQ, Eijkemans G. Preventing needle stick injuries among healthcare workers: a WHO-ICN collaboration. Int J Occup Environ health. 2004; 10:451-6Deuffic-Burban S, Delarocque-Astagneau E, Abitebould D, Bouvet E, Yazdanpanah Y. Blood-borne viruses in health care workers: Prevention and management. J Clin Virol .2011Naveed Z Janjua, Mahreen Razaq, Subhash Chandir, Shafquat Rozi, Bushra Mahmood4Poor knowledge predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan. BMC Infectious Diseases 2007, 7:81

Quiz.Petunjuk:Tetap tenang, jangan panik, JANGAN RIBUT !!!!!!Ambil selembar kertas (tidak usah terlalu besar)Tuliskan nama, nim serta POSTBaca soal dengan seksamatuliskan pilihan jawaban nya saja (mis. 1. G)Kerjakan sendiri-sendiri, lembar jawaban quiz sebagai bukti tanda kehadiran mahasiswa (untuk dosen)

QUIZTopik kuliah ini mengenai a. HIV b. Universal precautions c. infeksi oportunistik d. pengobatan e. jamur

Jenis penyakit yang bisa dicegah berdasarkan topik diatas adalah sebagai berikut kecuali a. HIV b. hep. B c. hep. C d. blood borne disease e. vector borne disease

Yang paling kecil resiko terinfeksi a. Perawat b. Staf admin c. Dokter d. Petugas lab e. Petugas kebersihan

4. Dalam konteks kuliah ini, cara infeksi nya terbanyak krn:Needlestick injury b. Seks bebas c. Narkoba suntik d. Transfusi e. Ibu ke anak

5. Yang termasuk dalam upaya pencegahan (berdasarkan konteks kuliah ini) adalah sebagai berikut kecuali:Masker b. Sarung tangan c. Mencuci tangan d. Gaun/apron e. Branded Hand sanitizer

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