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Biological risks in medicine, their
health risks and how to avoid them
Robert Teir
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Table of contents
What are biological hazards?
How do health care workers (HCW) get
contaminated by biological hazards? Biological pathogens
Infection contol guidlines
Infections due to blood exposure to HCWaccidents
Postexposure statistics
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What are biological hazards?
Biological hazards, also known as biohazards,refer to biological substances that pose a threatto the health of living organisms. This can include
medical waste or samples of a microorganism,virus or toxin (from a biological source) that canimpact human health.
The term and its associated symbol is generally
used as a warning, so that those potentiallyexposed to the substances will know to takeprecautions.
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How do HCW get contaminated from
biological hazards?
Through breaks in the skin, cuts, scratches,
scrapes and open sores will all allow
microorganisms easy access to the body. Injection through contaminated sharps.
Animal bites will actively transfer any
microorganisms in the animals mouth into theperson bitten.
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Biological pathogens can be classified
into found different categories.
Hazard Category 1 - Unlikely to cause humandisease
Hazard Category 2-
Can cause human diseaseand may be a hazard to employees
Hazard Category 3 - Can cause severe humandisease and may be a serious hazard to
employees Hazard Category 4 - Causes severe human
disease and is a serious hazard to employees;
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Biological pathogens:
Bacillus subtilis, canine hepatitis, Escherichia coli, varicella,epatitis A, B, and C, influenzaA,Lymedisease, salmonella,mumps, measles, scrapie, dengue fever, and HIV anthrax, West Nile virus, Venezuelan
equine encephalitis, SARS virus, variolavirus (smallpox), tuberculosis, typhus, Rift Valleyfever, Rocky Mountain spotted fever, yellow fever,and malaria. Bolivian and Argentine hemorrhagicfevers, H5N1(bird flu), Dengue hemorrhagic fever, Marburgvirus, Ebola virus, hantaviruses, Lassa fever, Crimean-Congo
hemorrhagic fever, Among parasites Plasmodium falciparum, which
causes Malaria, and Trypanosoma cruzi, whichcauses trypanosomiasis, also come under this level.
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Infection control guidelines:
Staff education:
1. Instructions of dressing and undressing
2. Importance in following the rules andconsequences
3. Training on performing high risk procedures
4. On importance of monitoring and reportingof own health
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Dress and behavioral precautions
1. Airborne precautions using N95
masks/respirators2. Contact precautions
3. Eye protection
4. Hand cleaning5. Hand usage (do not touch ears or nose at work)
6. Care of disposal and excretions
7. No eating or drinking in wards
8. Staff coming into contact with patiends bodyfluids should immediatly take a showe
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A recall phone call has been shown an effectiveand straightforward method to improveimmunization rates
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Testing HCW.
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Some statistics
Around 3 million HCW are exposed to bloodevery year by accident
Gloves get tourn in 1:3 of the procedures
In every 15th surgical operation the skin getspunctured
The average transmission rates are highest forpercutaneous injuries from hepatitis B (22-31%)
Surgeons' shoes had evidence of blood andcontamination, with 63% of all surgeons havingblood-contaminated shoes.
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Collecting data from 60 U.S. hospitals, the center concludedworkers suffer approximately 384,325 sharps and
percutaneous injuries annually. The institute's tally on needlestick injuries per year among
healthcare workers is 800,000, the majority being nursesand physicians. Treating injuries costs between $500 and$3,000 per stick, according to the Occupational Safety and
Health Administration. The use of safety equipment was associated with a 20% to
30% reduction in the risk of injuries or near-miss incidents,respectively. Furthermore, nurses in hospitals with poorstaffing levels and work climate noted a 50% or greaterincreased risk of injuries.
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During 2002-2007, a total of 401 acute
illnesses associated with work-relatedantimicrobial pesticide exposures in health-
care facilities were reported
Occupations with the most cases werejanitors/housekeepers (24%), followed by
nursing/medical assistants (16%) and
technicians (15%).
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Table 3. Occupational death rate for various jobs, United States (in descending order)*
Occupation No. employed ( 103) Total deaths Death rate
Fisherman 39 46 1,179
Construction worker 8251,108 1,198 1,0811,452
Pilot 107129 102 791953
Military (active and reserve) 2,600 94 361
Truck driver 2,5443,365 530 157208Protective service 2,000 219 108
Firefighter 1,100 102 93
US workforce 136,000 5,780 42.5
Healthcare worker 6,2009,100 157353 1757
Sheetmetal worker 172207 8 3946
Bartender 339427 10 2329Lawyer 490920 6 714
Waiter 1,8931,981 9 5
*Numbers represent average of annual deaths during 3-year period, 20002002. Range of number employed reflects 2 different
federal databases (see text). Rates expressed per 1 million workers . [Kent A. Sepkowitz ]
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Postexposure prophylaxis (PEP)
Recommendations for HBV PEP managementinclude initiation of the HB vaccine series toany susceptible, unvaccinated person who
sustains an occupational blood or body fluidexposure. PEP with hepatitis B immuneglobulin (HBIG) and/or HBV series should beconsidered for occupational exposures after
evaluation of the HBsAg status of the sourceand the vaccination and vaccine-responsestatus of the exposed person.
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Postexposure prophylaxis (PEP)
Recommendations for HIV PEP include a basic 4-week regimen of two drugs (zidovudine andlamivudine) for most HIV exposures and anexpanded regimen that includes the addition of athird drug for HIV exposures that pose anincreased risk for transmission. When the sourceperson's virus is known or suspected to beresistant to one or more of the drugs considered
for the PEP regimen, the selection of drugs towhich the source person's virus is unlikely to beresistant is recommended.
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References
(1) http://en.wikipedia.org/wiki/Biological_hazard
(2)Gailiene G, Cenenkiene R.
Department of Infection Control, Hospital of Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, [email protected]
(3)
Updated U.S. Public Health Service Guidelines for the Manage-ment of Occupational Exposures to HBV, HCV,and HIV and Recommendations for Postexposure Prophylaxis, MMWR, June 29, 2001, Vol. 50, RR-11.
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(8) BAS H&S Procedure 10 - Biological Risk Assessment v1. Reviewed - 26 Jan 2005
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