Blood Exposure

A number of factors will be taken into account in the risk assessment, including: Route of exposure - This is classified essentially into 3 categories - percutaneous, mucous membranes which include eyes, mouth , and skin. If indirect, then in what way had the item become contaminated?

Accidental blood exposure: risk and prevention in interventional radiology

Contaminated hollow bore needles eg those used for injection are more likely to transmit than solid needles eg those used in suturing ; Needles that have been present in a blood vessel are more likely to transmit than needles used for intramuscular injection; How soon after the sharps became contaminated did the exposure incident occur? The viability of the BBV will decrease rapidly on drying, so, for instance, transmission is very unlikely from a dried-up needle found lying in a field; Personal protective equipment PPE used - eg, were gloves in use?

There is a wiping effect as a needle pierces a glove, which may reduce the likelihood of transmission. What is known about the source? If the source is known, it may be possible to determine their BBV infection status, or the presence of risk factors for BBV infection, from serological testing with informed consent or from medical notes; and if the incident arose from an unknown source, a risk assessment may still be possible in the light of local knowledge of the prevalence of BBV infections.

Hepatitis B immunisation status of the recipient - has the recipient previously received any doses of HBV vaccine? Early therapy if transmission occurs HIV 0. Resources Control of substances hazardous to health Fifth edition Blood borne viruses in the workplace: Guidance for employers and employees Providing and using work equipment safely: A brief guide More resources. See also HIV post-exposure prophylaxis: As of , there has been an estimated five million new cases of HIV and the virus shows no sign of abating.

What to do

The prevalence of HIV in the general population in the United States is estimated to be less than one percent. Studies at an urban trauma center found that 0. HIV and HBV are found in most body fluids like blood, breast milk, cerebrospinal fluid, semen, vaginal secretions, pleural, pericardial, peritoneal or amniotic fluid and saliva.

Faeces do not contain these viruses unless contaminated with blood. Urine is also not considered to be infective unless the patient has sustained trauma or undergone instrumentation to cause bleeding [ 1 , 9 ]. HIV survives on environmental surfaces at room temperature for a very brief period, but HBV can survive for about seven days.

Three phases of chronic HBV infection are recognized. In Phase 1, the patients are HbeAg positive with high serum levels of virus and minimal hepatitis. In Phase 2, there is intermittent or continuous hepatitis and in Phase three inactive phase , the viral concentrations are at its lowest and there is minimal liver involvement [ 4 ]. The risk of needle stick or other sharps injuries during an interventional radiology procedure is quite low when compared to the risk in surgical procedures. In a prospective study of procedures, Hansen et al. In a national survey done in the United States, the median number of injuries per year was found to be considerably low at 0.

Percutaneous exposure poses a greater risk as compared to mucocutaneous exposure. In IR procedures, cutaneous exposure is more common due to the frequency of glove perforations and splash-type exposures. Studies in the United Kingdom by Davidson et al.

INTRODUCTION

The risk of accidental blood exposure was also found to be greater for procedures requiring more than two catheter exchanges, for thrombolysis and angioplasty as well as for procedures lasting more than 30 min [ 9 ]. The type of instrument is also important in sharps injuries as large bore needles have a greater volume of infected material.

Seroconversion of blood borne pathogens has been reported after percutaneous exposure and contact with mucous membranes and non-intact skin, but not after contact with intact skin [ 9 ]. According to past data, the risk of HIV transmission to health care workers after percutaneous injury is 0. This study concluded that compliance with standard precautions, especially with the use of protective clothes and safety material was poor. It also concluded that the risk of HCV transmission from contact with contaminated blood after percutaneous injury ranged from 0.

This figure was derived simply by multiplying three numbers: She calculated the risk of percutaneous injury to an interventional radiologist using a different set of figures, assuming a worst case scenario. These figures are not to be taken lightly, and are only meant to enlighten us about the real threat of blood borne exposure in interventional radiology.

The Needlestick and Prevention Act P.

• The Englisher (Annie’s People Book #2) (Annies People);
• Nibelungenlied : God or Evil.
• How to deal with an exposure incident?
• Better Health Channel.

The updated standard also requires employers to maintain a log of injuries from contaminated sharps. These guidelines have served as a backbone in the formation of many infectious diseases guidelines globally [ 13 ]. Epic, was established in in the United Kingdom, and its focus was to provide evidence-based guidelines for infection prevention and control in the National Health Service NHS.

Accidental blood exposure: risk and prevention in interventional radiology

There have been various organisations across the world with evidence-based guidelines on infectious diseases and control, and some of them are listed in Table 1 [ 13 ]. We will now look at some of the general guidelines and summarize the important elements to be observed by radiology personnel performing interventional procedures Table 2.

All health care workers should have Hepatitis B vaccination as a prerequisite to employment. For those not vaccinated, the Hepatitis B vaccination should be provided free by the employer [ 14 ]. An infection control plan must be developed by employers of the establishment, in which an IR practice is held. This plan must contain schedules for vaccination, training of personnel, post-exposure treatment and also must detail the measures taken by the employer to minimize exposure to health care personnel.

It is recommended that training in infection control, should be provided within 10 days of an employee being hired and annually thereafter. This training should be documented and records of this should be maintained [ 1 ].

Avoid recapping of needles or resheathing of scalpel blades. Any sharp instrument that is reused should be placed sharp-end down on a sterile pad, plastic container or any other holding device, and placed in a corner of the tray where it will not be readily knocked over. In IR procedures, reassembly of multi-part sharp needles and devices is common and this should be done in the same manner as recapping needles i. Communication of team members is vital during a procedure, especially if there is passing of sharps from one person to another.

Communication with the patient is also important to avoid sudden surprise movements which may lead to injury with sharp objects or instruments. The patient should be informed about the procedure at all times. Designated containers should be available for all sharps after use. These containers should have a wide opening and should be placed at strategic points in the interventional suite. All team members should be aware of the location of sharps disposal containers. Trying to locate a needle tip by palpation should never be done.

Cut the suture and dispose of needle once it is no longer needed. If an injury occurs, the sharp instrument should be discarded immediately [ 9 ]. Universal precautions should be strictly adhered to in IR procedures. Proper hand washing techniques with a germicidal agent before putting on protective gloves, and after removal of gloves should be practiced.

Glove use during procedures is generally accepted and due to the increasing frequency of occult glove perforations, changing of gloves after 90 min is advised. Seniors Online Victorian government portal for older people, with information about government and community services and programs.

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Managing exposures to blood and body fluids or substances

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