Routine Practices and BBF Exposure

1
Routine Practices and BBF Exposure

• Bruce Gamage, RN CIC
• Infection Control Consultant
• BCCDC

2
Outline

• Routine Practices
• Hand Washing
• Gloves
• Gowns
• Facial Protection
• Bloodborne Pathogens
• Exposure Control
• Exposure Follow-up

3
Routine practices apply to

• Blood,
• All body fluids, secretions, and excretions
  except sweat, regardless of whether they contain
  visible blood,
• Non-intact skin, and mucous membranes

4
Routine Practices

• Routine Practices are the essential and primary
  infection control measures to be used for the
  care of ALL clients, at ALL times, regardless of
  their presumed infection status.

5
Hands must be washed

• After any direct contact with a client, before
  contact with the next client
• After contact with blood, body fluids
• After contact with contaminated items
• After removing gloves
• Before preparing, handling, serving or eating
  food
• Before smoking

6
Hands must be washed

• After personal use of toilet or wiping nose.
• Clients and family members should be instructed
  in proper hand washing
• Client's hands should be washed before eating,
  after toileting
• Plain soap may be used for routine hand washing.

7
Waterless antiseptic hand rinses

• Antiseptic hand rinses are superior to soap and
  water in reducing hand contamination.
• An alternative to hand washing.
• Antiseptic hand rinses are especially useful when
  time for hand washing or access to sinks is
  limited.

8
Gloves

• Gloves are not as a substitute for hand washing.
• Gloves are not required for routine client care.
• Clean, non-sterile gloves should be worn
• for contact with blood, body fluids, mucous
  membranes, draining wounds or non-intact skin
• for handling items visibly soiled with blood,
  body fluids
• when the health care worker has open skin lesions
  on the hands.

9
Mask and Eye Protection

• Masks and eye protection should be worn to
  protect the mucous membranes of the eyes, nose
  and mouth during client care activities likely to
  generate splashes of body fluids.

10
Gowns

• The routine use of gowns is not recommended.
• Gowns should be used to protect uncovered skin
  and clothing during client care activities likely
  to generate splashes of body fluids.

11
Bloodborne Pathogens

• Bloodborne pathogens are present in blood and
  body fluids of infected individuals
• May be transmitted to HCW via certain types of
  exposure
• HIV
• HBV
• HCV

12
Risk of Transmission

• High-risk
• Needlestick with hollow-bore needle or cut from
  contaminated sharp
• Mucous-membrane (eyes, nose, mouth)
• Non-intact skin (cut gt three days old)
• Low-risk
• Exposure to intact skin
• Exposure to non-infectious body fluids

13
Body Fluids and BBP
14
Risk of Exposure

• HBV - 1 to 6 of susceptible exposed HCW
  (19-40 if HBeAg present)
• 100 preventable through vaccination
• HIV 0.3 following needle stick from HIV
  infected patient.
• There has only ever been one case of HCW
  seroconversion in Canada
• There has never been a case of HIV transmission
  from skin or mucous membrane exposure
• HCV 1.8 seroconversion in HCW following
  needlestick

15
Exposure Control

• Handle sharps/equipment safely
• Sharp items should be placed immediately in
  puncture-resistant containers located in the area
  where the items were used.
• Mouthpieces and resuscitation bags
  should be available for staff
  performing CPR.

16
Exposure Follow-up

• Skin wash with warm water and soap
• Mucous membrane flush with water or NS
• Go to local emergency for assessment
• Notify triage nurse is BBF exposure
• Needlestick (sharps injury) - wash with warm
  water and soap.
• Do not squeeze or soak in bleach
• Go to local emergency for assessment
• Notify triage nurse is BBF exposure
• Fill out and submit WCB forms (should not delay
  referral for assessment)
• HIV Centre for Excellence (1-800-665-7677)
• If treatment is needed it should be started
  within 2 hours

17
Summary

• Use Routine Practices
• Handle Sharps Safely
• Follow-up exposures to BBF
• Dont Panic

18
More information...

• Routine Practices and Additional Precautions for
  Preventing the Transmission of Infection in
  Health Care
• www.hc-sc.gc.ca/pphb-dgspsp/dpg_e.html
• Communicable Disease Control Manual Blood and
  Body Fluid Exposure Management May 2005
• www.bccdc.org/content.php?item83