# Presentation: 281734

## Safety and Supportive Care in the Work Environment

- M O D U L E   8

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## Module 8: Objectives

- Describe strategies for preventing HIV transmission in the healthcare setting.
- Define Universal Precautions (UP) in the context of the prevention of mother-to-child transmission (PMTCT) of HIV.
- Identify key steps and principles involved in the decontamination of equipment and materials.

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## Module 8: Objectives 

- Assess occupational risk and identify risk-reduction strategies in maternal and child (MCH) settings.
- Describe the management of occupational exposure to HIV.
- Identify measures to minimise stress and support healthcare workers and caregivers.

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## Safety and Supportive Care in the Work Environment

**Sess****ion 1**
**Universal Precautions and Creating a Safe Work Environment**

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## Basic Concepts of HIV Transmission

- Primary source of HIV infection in the healthcare setting
- Blood or body fluids in direct contact with an open wound, or by needle or sharp stick
- High-risk MCH settings
- Obstetric procedures
- Labour and delivery
- Immediate care of the infant

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## Universal Precautions Definition

- A simple set of effective practices designed to protect health workers and patients from infection with a range of pathogens including bloodborne viruses. These practices are used when caring for all patients regardless of diagnosis.

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## Bloodborne Pathogens

- In addition to HIV, bloodborne pathogens include:
- Hepatitis B and C virus
- Syphilis
- Brucellosis

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## Prevention of HIV Transmission

- Apply universal precautions.* *
- Healthcare worker to patient
- Patient to healthcare worker
- Prevent patient-to-patient transmission .
- Sterilise contaminated equipment and devices.

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## Infection Control Measures

- Universal precautions
- Management of the work environment
- Ongoing education of employees in all aspects of infection prevention

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## Universal Precautions

- Applied in caring for all patients
- Handwashing
- Decontaminate equipment and devices
- Use and dispose of needles and sharps safely (avoid recapping, especially two-handed)
- Wear protective items
- Promptly clean up blood and body fluid spills
- Use safe disposal systems for waste collection and disposal

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## Promoting a Safe Work Environment

- Implement, monitor and evaluate use of universal precautions.
- Develop procedures for reporting and treating occupational exposure to HIV infection.
- Attain and maintain appropriate staffing levels.
- Provide protective equipment and materials.

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## Education in Infection Prevention

- Make all staff aware of established infection control policies.
- Provide ongoing training to build skills in safe handling of equipment and materials.
- Supervise and evaluate practices to remedy deficiencies.

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## Safety and Supportive Care in the Work Environment

**Session 2**
**Handling and Decontamination of Equipment and Materials**

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## Handling of Equipment and Materials

- Risk reduction strategies
- Assess condition of protective equipment.
- Safely dispose of waste materials.
- Make available appropriate cleaning and disinfecting agents.
- Decontaminate instruments and equipment.
- Monitor skin integrity.

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## Instrument Processing

**High-Level Disinfect**
**Boil**
**Steam**
**Chemical **

**Instrument Processing**

**Sterilise**
**Chemical **
**High pressure steam**
**Dry heat**

**Dry/Cool and Store**

**Decontaminate**

**Clean**

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**Notes:**
After use, instruments and other items should be decontaminated by soaking them in a 0.5% bleach solution for 10 minutes. Decontamination will help protect the person who is cleaning the instruments. 

Then, physically wash the items until they are visibly clean. 

Finally, either sterilize or high-level disinfect the instruments. For a step-by-step description of this process, see the document “Instrument Processing” on the Resources page.

## Use syringe or needle once only.
Avoid recapping, bending, or breaking needles.
Use puncture-proof container for disposal.
Clearly label container—“SHARPS”.
Never overfill or reuse sharps containers.
Dispose of sharps according to local protocol.

- Avoid recapping, bending, or breaking needles.
- Use puncture-proof container for disposal.
- Clearly label container—“SHARPS”.
- Never overfill or reuse sharps containers.
- Dispose of sharps according to local protocol.

- Handling and Disposalof Sharps

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## Handling Needles and Sharps 

- Use a puncture-proof container for storage and/or disposal.
- Do **not** recap a needle before disposal unless using one-hand technique.

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**Notes:**
Because needle stick accidents continue to be a problem in the clinic and the hospital, immediately after using a needle and syringe, place it into a puncture-proof container for disposal. 

If there is a possibility that someone else may come into contact with used needles and syringes, decontaminate them by flushing three times with a disinfectant before disposal (bleach is cheap). 

Do not bend, break or recap a needle before disposal. If, in some instances, it is absolutely necessary, recap the needle using the one-hand technique. 

## Hand Hygiene 

- Recommended practice
- Soap and water handwashing using friction under running water for at least 15 seconds
- Using alcohol-based hand rubs (or antimicrobial soap) and water for routine decontamination

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## Personal Protective Equipment

- Basic personal protective equipment
- Gloves—correct size
- Aprons—as a waterproof barrier
- Eyewear—to avoid accidental splash
- Footwear—rubber boots or clean leather shoes

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## Safe Work Practices

- To reduce occupational risks
- Assess high-risk situations and areas.
- Develop safety standards and protocols.
- Institute measures to reduce occupational stress.
- Orient new staff to protocols.
- Provide ongoing staff education and supervision.
- Develop protocols for post-exposure prophylaxis (PEP).

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## Risk Reduction in the Obstetric Setting

- Minimise high risk of exposure to HIV-infected blood and body fluids in obstetric unit.
- Cover broken skin with watertight dressing.
- Wear proper protective clothing.
- Dispose of solid waste according to local protocols.

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## Session 3 

Managing Occupational Exposure to HIV

**Managing Occupational Exposure to HIV**

- Safety and Supportive Care
- in the Work Environment

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## Post-Exposure Prophylaxis(PEP)

- Immediate steps post-exposure
- Wash exposed wound or skin with soap and water.
- For needle or sharp injury, allow to bleed for a few seconds before washing.
- Inform supervisor of type of exposure and the actions taken.
- Assure confidentiality and support and referral for treatment.
- Short-course of ARV drugs is recommended to reduce the likelihood of infection.

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## Guidelines for PEP

- Ideally, initiate PEP treatment within 2 hours of exposure.
- If patient is not infected with HIV, discontinue PEP and retest at 6 weeks, 3 months, and 6 months.
- If patient is infected with HIV, counsel, support, and refer healthcare worker for continued treatment.

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## Guidelines for PEP  

- Currently there is no single approved PEP regimen.
- Dual or triple drug therapy is recommended and believed to be more effective than a single agent.
- Follow approved PEP regimen.

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## Session 4

Supportive Care for the Caregiver

** **
**Supportive Care for the Caregiver**

- Safety and Supportive Care
- in the Work Environment

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## Compassion Fatigue and Burnout

- Characteristics of burnout syndrome
- Emotional exhaustion
- Loss of interest
- Decreased productivity

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## Tips to Prevent Burnout

- Find a support group of peers.
- Search out a mentor.
- Become educated on methods of coping.
- Take a new course or update skills.
- Exercise, eat right, and get enough rest.
- Make time for yourself and your family.

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## Module 8: Key Points

- Universal precautions apply to all patients, regardless of diagnosis.
- Key components include:
- Handwashing
- Safe handling and disposal of sharps
- Use of personal protective equipment
- Decontamination of equipment
- Safe disposal of infectious waste materials
- Safe environmental practises

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## Module 8: Key Points 

- Needle-stick injuries from patients who are infected with HIV are the most common source of HIV transmission in the workplace.
- Cleaning, disinfection, and sterilisation of all instruments used in invasive procedures reduces risk of patient-to-patient transmission of infection.
- During labour and delivery, safe care reduces risk of occupational exposure.

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## Module 8: Key Points

- Short-course ARV treatment reduces the risk of HIV infection after occupational exposure.
- Burnout syndrome is related to intense, prolonged job stress but can be managed and the effects minimised by individual and organisational supports.

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