CARING FOR HEALTH OF HEALTH CARE WORKERS

Dr. Rashid, a diligent student who’s life revolved around his studies. His hard work bore fruit when he became a Cardiovascular surgeon and got a high profile job in a prestigious hospital. His journey from a studious medical student to a distinguished cardiovascular surgeon was a testament to his unwavering dedication.

However, fate had a cruel twist in store for him. His beloved son Zafar fell ill and was diagnosed with Hepatitis B infection. As he delved deeper into the cause of Zafar’s illness, a haunting truth emerged. Actually Dr. Rashid had contracted Hepatitis B infection from a needle stick injury (NSI) during his internship, a moment of oversight in his hectic schedule. It was a busy day at the hospital, with patients lined up in need of urgent care. In a haste of moment while attending a patient in need of an IV line, a sudden slip had resulted in a NSI. Despite of the potential risks, he hadn’t received proper vaccination or post exposure prophylaxis. This oversight had inadvertently passed the infection to his wife and son.

The shock of diagnosis reverberated through every aspect of his life. His carrier shattered, he was barred from performing surgeries due to the risk of transmission of the viral disease to the patients as his viral load was very high. The burden of guilt weighed heavily on Dr. Rashid, realizing that his family’s sufferings could have been prevented if he had taken vaccine for Hepatitis B and other preventive measures earlier.

‘Prevention is better than cure especially when there is no cure’

NEEDLE STICK INJURIES

Needle stick injuries pose a serious threat to the wellbeing of health care workers. CDC estimates approximately 385000 sharp injuries annually among hospital-based health care workers (HCW) (greater than 1000 injuries per day). These accidental punctures or cuts usually from syringes, suture needles, intravenous catheter stylets, scalpels etc. expose HCWs to the risk of transmission of blood borne viruses (BBVs). The risk of seroconversion due to sharp injury from a known positive source is 6-30% for Hepatitis B virus (in HCW not vaccinated for Hepatitis B), 2% for Hepatitis C and 0.3% for HIV infection. Addressing this issue demands a comprehensive approach involving prevention strategies and prompt post exposure prophylaxis.

Strategies to prevent NSIs include:

1. Following standard precautions
2. Regular disinfection of work surfaces.
3. Proper management of spillages of blood and other body fluids.
4. Not recapping needles and if required should be done by single hand scoop technique.
5. Proper disposal of used sharps/needles.
6. Using devices with safety measures.
7. Hepatitis B vaccination of HCWs.

Post exposure prophylaxis (PEP)

In the event of NSI, timely intervention is of paramount importance. The protocol typically includes:

1. Fist aid: Earlier the first aid, lesser is the chance of transmission of BBVs

The site should be thoroughly irrigated with water for atleast 5minutes.

Don’ts:

Most of HCWs do what should not be done. The don'ts include:

• Don't panic
• Don't place pricked finger into the mouth reflexively.
• Don't squeeze blood from wound
• Don't use antiseptics and detergents

2. Prompt reporting: Any NSI should be reported immediately to the designated authority within the healthcare facility.
3. Medical interventions: Based on the assessment, the health care professional might require proper treatment in the form of antiretroviral drugs, Hepatitis B immunoglobulins, Hepatitis B vaccination etc. Testing for BBVs of both source and HCWs should also be done immediately. Testing of HCW and counseling regarding the precautions to be adopted during follow up period are important.

Crucial role of Hepatitis B vaccination

The risk of transmission of Hepatitis B virus is 100 times than HIV and 10 times than HCV. Hepatitis B virus can spread to the family of HCW. Hepatitis B virus can cause fulminant hepatitis, Hepatocellular carcinoma and end stage liver disease.

HCWs fully vaccinated and with known protective antibody tired are safe. They do not require any PEP even if they get NSI from a positive source. The vaccine has 95% efficacy and provide HCWs with best protection against this occupational risk.

BY Dr. Abiroo Jan

Dr. Abiroo Jan is a Associate Professor and Head, Department of Microbiology, GMC Anantnag