Biological risks in medicine, their health risks and

how to avoid them

Robert Teir
 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 HCW
accidents
• Postexposure statistics
 What are biological hazards?
• Biological hazards, also known as biohazards, refer
to biological substances that pose a threat to the
health of living organisms. This can include medical
waste or samples of a microorganism, virus or toxin
(from a biological source) that can impact human
health.
• The term and its associated symbol is generally used
as a warning, so that those potentially exposed to
the substances will know to take precautions.
 How do health care workers (HCW) get
contaminated by biological hazards?

• Inhalation of dusts or aerosols that may be

contaminated by the organism.
• Ingestion of contaminated material. This may
be food, drink, or saliva that has been
contaminated through inhaling the organisms
or contact with contaminated fingers,
cigarettes etc.
 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 the
person bitten.
 Biological pathogens can be classified into
found different categories.
• Hazard Category 1 - Unlikely to cause human
disease
• Hazard Category 2- Can cause human disease and
may be a hazard to employees
• Hazard Category 3 - Can cause severe human
disease and may be a serious hazard to employees
• Hazard Category 4 - Causes severe human disease
and is a serious hazard to employees;
 Biological pathogens:
•  Bacillus subtilis, canine hepatitis, Escherichia coli, varicella,
epatitis A, B, and C, influenza
A,Lymedisease, salmonella,mumps, measles, scrapie, dengue fever,
and HIV  anthrax, West Nile virus, Venezuelan equine
encephalitis, SARS virus, variola
virus (smallpox), tuberculosis, typhus, Rift Valley fever, Rocky
Mountain spotted fever, yellow fever, and malaria.
Bolivian and Argentine hemorrhagic fevers, H5N1(bird flu), Dengue
hemorrhagic fever, Marburg virus, Ebola virus, hantaviruses, Lassa
fever, Crimean-Congo hemorrhagic fever,
• Among parasites Plasmodium falciparum, which causes Malaria,
and Trypanosoma cruzi, which causes trypanosomiasis, also come
under this level.  
 Infection control guidelines:
• Staff education:
1. Instructions of dressing and undressing
2. Importance in following the rules and
consequences
3. Training on performing high risk procedures
4. On importance of monitoring and reporting
of own health
• Dress and behavioral precautions
1. Airborne precautions using N95
masks/respirators
2. Contact precautions
3. Eye protection
4. Hand cleaning
5. 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 body
fluids should immediatly take a showe
• A recall phone call has been shown an effective and
straightforward method to improve immunization rates
Testing HCW.
 Some statistics

• Around 3 million HCW are exposed to blood every year

by accident
• Gloves get tourn in 1:3 of the procedures
• In every 15th surgical operation the skin gets
punctured
• The average transmission rates are highest for
percutaneous injuries from hepatitis B (22-31%)
• Surgeons' shoes had evidence of blood and
contamination, with 63% of all surgeons having blood-
contaminated shoes.
• Collecting data from 60 U.S. hospitals, the center concluded
workers 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 nurses and
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 poor staffing levels and work
climate noted a 50% or greater increased risk of injuries.
• During 2002-2007, a total of 401 acute
illnesses associated with work-related
antimicrobial pesticide exposures in health-
care facilities were reported
• Occupations with the most cases were
janitors/housekeepers (24%), followed by
nursing/medical assistants (16%) and
technicians (15%).
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 825–1,108 1,198 1,081–1,452
Pilot 107–129 102 791–953
Military (active and reserve) 2,600 94 361
Truck driver 2,544–3,365 530 157–208
Protective service 2,000 219 108
Firefighter 1,100 102 93
US workforce 136,000 5,780 42.5
Healthcare worker 6,200–9,100 157–353 17–57
Sheetmetal worker 172–207 8 39–46
Bartender 339–427 10 23–29
Lawyer 490–920 6 7–14
Waiter 1,893–1,981 9 5

*Numbers represent average of annual deaths during 3-year period, 2000–2002. Range of number employed reflects 2 different federal databases
(see text). Rates expressed per 1 million workers . [Kent A. Sepkowitz ]
 Postexposure prophylaxis (PEP)
• Recommendations for HBV PEP management
include initiation of the HB vaccine series to
any susceptible, unvaccinated person who
sustains an occupational blood or body fluid
exposure. PEP with hepatitis B immune
globulin (HBIG) and/or HBV series should be
considered for occupational exposures after
evaluation of the HBsAg status of the source
and the vaccination and vaccine-response
status of the exposed person.
 Postexposure prophylaxis (PEP)
• Recommendations for HIV PEP include a basic 4-
week regimen of two drugs (zidovudine and
lamivudine) for most HIV exposures and an
expanded regimen that includes the addition of a
third drug for HIV exposures that pose an increased
risk for transmission. When the source person's
virus is known or suspected to be resistant to one or
more of the drugs considered for the PEP regimen,
the selection of drugs to which the source person's
virus is unlikely to be resistant is recommended.
 References
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• (2)Gailiene G, Cenenkiene R.
• Department of Infection Control, Hospital of Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania. greta.gailiene@kmuk.lt
• (3)
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