Universal precautions

to prevent
Disease transmission
(with focus on HIV)
to health care workers
Forman Erwin Siagian
Email: formanerwin@yahoo.com
KP Blok XVIII HIV/AIDS
Senin, 21/01/2015

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

QUIZ

1. Topik kuliah ini mengenai

a. HIV

b. Universal precautions

c. infeksi oportunistik

d. pengobatan e. jamur

2. 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

3. 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:

a. 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:
a. Masker
b. Sarung tangan c. Mencuci tangan
b. d. Gaun/apron e. Branded Hand sanitizer

Objectives
In this lecture you will learn:
General epidemiology of HIV/AIDS, hospital acquired accidental
infection
Characteristics of universal and or standard precautions
Routes 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

background
Health 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, 200

Roth& Worthington,

Risk of transmission is closely related to

work practices habits best practice
Deuffic-Burbana, 2011
http://www.lmaco.com/catalogue_item.php?catID

Universal precaution adherence among health care

providers sustaining occupational exposure
Aggarwal et al, Ind J Comm med. 2013; 37(1): 45-49

Fact about needlestick

injury:

greatly underreported
Overall, crudely estimate that a third of at-risk employees have
a needlestick injury annually and that only one-third of the cases
reported
the hospital workers at greatest risk are nurses,
housekeeping staff, laboratory workers, surgical support
workers and physicians, all of whom constitute about twothirds 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 nonpuncture-resistant containers)
Stock et al, 1990
Universal precautions to prevent HIV transmission to health care workers

www.mynursedegree.com

Needlestick injuries
Healthcare workers incur 2 million
needlestick injuries (NSIs) per year that
result in infections with hepatitis B and C
and HIV
Wilburn & Eijkemans. 2004

drugline.org

www.meded.umn.ed

Hoy & Richmond. Standard

precautions and
infection 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

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

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 hollowbore needles for vascular access, i.e.
blood-drawing and intravenous
/arterial catheters

Deuffic-Burbana, 2011

gloves

Hand washing

must 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
substances

Must be done immediately:

Before and after each clinical
contact with a patient
Before and after eating
After using the toilet
Before and after using gloves
After contact with used
equipment
Immediately following
contact with body substances

Other personal protective

equipment
Protective eyewear and face shields

must be worn during procedures where

there is potential for splashing, splattering
or spraying of blood or other body
substances
Impermeable gowns and plastic
aprons should be worn to protect clothing
and skin from contamination with blood
and body substances
Footwear should be enclosed to protect
against injury or contact with sharp objects

Health care worker

Vaccination: HBV
Testing/screening: HIV, HBV, HCV
Occupational exposure
Post-exposure prophylaxis (PEP)

Hoy & Richmond. Standard precautions and infection

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 open
If mouth has been exposed, thoroughly rinse the mouth with water and
spit out
Seek 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
sought

Hoy & Richmond

Stock et al. Can Med Assoc J 1990; 142

Statistics of HIV,
worldwide...

Co-infection with other disease (e.g

TB, HBV, HCV, helminth infection)

Baca tulisan prof. Retno tentang

infeksi
Oportunistik pada HIV di Majalah
kedokteran UKI (masuk

Sekian dan terimakasih....

1.
2.
3.
4.
5.

6.
7.

8.

referensi

Bouwari 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.146-51
WHO. Infection control standard precautions in health care. In Epidemic and
pandemic alert and response. 2006
Virginia Roth, Jim Worthington. Implementing a Policy for Practitioners
Infected with Blood-Borne Pathogens. Health care Quarterly . 2005; 8: 45-8
Stock 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): 937-46
Wilburn SQ, Eijkemans G. Preventing needle stick injuries among healthcare
workers: a WHO-ICN collaboration. Int J Occup Environ health. 2004; 10:451-6
Deuffic-Burban S, Delarocque-Astagneau E, Abitebould D, Bouvet E,
Yazdanpanah Y. Blood-borne viruses in health care workers: Prevention and
management. J Clin Virol .2011
Naveed 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:
1.Tetap tenang, jangan panik, JANGAN RIBUT !!!!!!
2.Ambil selembar kertas (tidak usah terlalu besar)
3.Tuliskan nama, nim serta POST
4.Baca soal dengan seksama
5.tuliskan pilihan jawaban nya saja (mis. 1. G)
6.Kerjakan sendiri-sendiri, lembar jawaban quiz
sebagai bukti tanda kehadiran mahasiswa (untuk
dosen)

QUIZ

1. Topik kuliah ini mengenai

a. HIV

b. Universal precautions

c. infeksi oportunistik

d. pengobatan e. jamur

2. 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

3. 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:

a. 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:
a. Masker b. Sarung tangan c. Mencuci tangan
b. d. Gaun/apron e. Branded Hand sanitizer