Infectious contamination of healthcare workers.

Despite widespread concern and knowledge about the need for infection prevention and control in health care, it is clear that adherence to strict infection control procedures is not always at an optimal level (El-Masri and Oldfield, 2012). Hospital Acquired Infection (HAI) may occur when these standards break down, and HAI is a commonly discussed media topic (Bates, 2012). Alarmingly, a recent outbreak of Hepatitis C in the USA, resulting from inappropriate interference by health staff with equipment (needles) (Ramer, 2012) reminds us that even when vigilant approaches are used to combat the spread of infection, the potential for contamination from blood-borne infections remains a real possibility. Blood-borne viral infections include human immunodeficiency virus (HIV), Hepatitis C virus (HCV) and Hepatitis B virus (HBV). Taking precautions alone is not sufficient; staffs need to be knowledgeable in the disease and spread of disease. It is important to note that the risk of disease spread is to both staff and patients, although most staffs are vaccinated to prevent HBV (DoHC, 2005). While discussion papers and research studies on the topics of blood-borne diseases such as HCV, HBV and HIV/Aids are reduced in number compared with the 1980s and 1990s, current literature appears to indicate that knowledge deficits exist among nurses with regard to both HCV (Frazer et al., 2011) and HIV/Aids (Delobelle et al., 2009), and education and training specifically on these topics seems to be inconsistent and in some cases minimal (Delobelle et al., 2009; Frazer et al., 2011). This editorial discusses how blood-borne viruses (BBVs) can be best prevented in the health care setting in order to highlight the need for ongoing vigilance. An increased incidence of HBV and HCV transmission in the USA is associated with unsafe medical practices (Moore et al., 2011) particularly in those persons aged over 55 (Perz et al., 2012). These two viruses are the most prevalent in the USA with an estimated 1·4 million persons chronically infected with HBV and 3·2 million persons chronically infected with HCV (Weinbaum et al., 2008). A BBV is transmitted through contact with blood or body fluids typically through sexual or household contact, intravenous drug use or other parenteral exposures (Wise et al., 2012). Within health care settings, BBV transmission occurs through direct percutaneous inoculation of infected blood via needlestick or sharps injury or by blood splashed onto broken skin or mucous membranes (Stein et al., 2003). Health care workers (HCWs) undertaking exposure-prone procedures (EPPs) are also at risk of contracting BBVs (DoHC, 2005). The average risk of occupational HIV transmissions associated with percutaneous exposure to blood is 0·32% (approximately 1 infection in 325 documented exposures to blood from HIV-infected individuals) and for mucosal exposures it is 0·03% (approximately 1 infection for each 3300) (Henderson, 2012). The risk of occupational HBV infection following a parenteral exposure from an HBV-infected source patient with circulating e antigen is between 19% and 37% (Werner and Grady, 1982). The risk of occupational infection with HCV following parenteral exposure to blood from HCV-infected source patient is estimated at 1·9% per exposure (Henderson, 2003). In 1985, following an HIV epidemic, the Centre's for Disease Control (CDC) developed recommendations for prevention of HIV transmission in health care settings known as universal precautions (UP) (CDC, 1987). Blood was identified as the single most important source of HIV and HBV (Garner and Hospital Infection Control Practices Advisory Committee, 1996). As it is impossible to identify all patients that are sero-positive to HIV, HBV or HCV, UP dictates that all patients should be regarded as a potential biohazard (Garner and Hospital Infection Control Practices Advisory Committee, 1996; DoH UK, 1998). However, body substance isolation precautions (aimed at regarding all moist and body substances as potentially infectious) are familiar to all nurses as they are in use since 1987 (Garner and Hospital Infection Control Practices Advisory Committee, 1996). CDC then produced a two tier isolation precaution system known as standard precautions (SP) (Garner and Hospital Infection Control Practices Advisory Committee, 1996; Siegel et al., 2007). The first tier is designed for the care of all patients in hospitals, regardless of diagnosis or presumed infection status. The second tier, ‘Transmission-Based Precautions’ is for patients known or suspected to be infected by a transmissible infection (Garner and Hospital Infection Control Practices Advisory Committee, 1996; Siegel et al., 2007). SP principles include hand hygiene, patient isolation, personal protective equipment (PPE), personal and environmental hygiene, appropriate management of linen and health care waste, including sharps. Hand hygiene is the most important principle to prevent the spread of infection (WHO, 2009; HPSC, 2011a, 2011b). Hand hygiene includes hand-washing with soap (or antimicrobial soap) and water or alcohol gel. It also prescribes that cuts and abrasions are covered with waterproof dressings (WHO, 2009; HPSC, 2011a, 2011b). Stein et al. (2003) illustrated that while doctors understood the importance of hand hygiene, only 7 in 10 followed it frequently in practice. Patients with a BBV should be risk assessed to determine the type of isolation required. Patients that are actively bleeding or with large open wounds require contact precaution isolation (Siegel et al., 2007). Signs alerting staff to the type of isolation should be placed on the door and appropriate PPE should be available. PPE such as gloves and/or apron are required in the event of exposure to blood or body fluids (Siegel et al., 2007). Seventy-one percent of doctors do not wear gloves when taking blood despite 83% believing it important (Stein et al., 2003). Masks are not usually necessary unless to protect from other active infectious diseases, e.g. a patient with pulmonary tuberculosis. The environment should be cleaned daily with detergent and water and disinfected in the event of blood or body fluid spill. Blood spills require appropriate action, e.g. use of spill kits with PPE; appropriate disinfection agents to kill any viruses present; disposable scoops and yellow health care waste bags. Blood spills must be managed and decontaminated to prevent persons becoming contaminated (Siegel et al., 2007). The environment and instruments can also become contaminated with blood. This can lead to infection outbreaks such as the case of podiatry instruments that were the source of an outbreak of HBV in a long-term care facility (Wise et al., 2012). Health care waste is divided into health care risk waste and health care non-risk waste (DoHC, 2010). Health care risk waste includes any item contaminated with blood. Blood-stained products must be appropriately discarded in the yellow health care risk waste stream. If blood is in liquid form, a yellow rigid spill-proof container is used. Needles and sharps should be discarded in designated sharps containers (DoHC, 2010). Needlestick injuries (NSI) or sharps injuries must be managed appropriately. US surveillance indicates more than 380 000 parenteral annual exposures to blood. This equates to nearly 1 in 10 US HCWs receiving a needlestick exposure annually (Panlilio et al., 2004). Alarmingly, Delobelle et al.'s figure (as reported by the nurses themselves in response to survey) was as high as 7 of 10. The discrepancies in figures could be due to underreporting of NSI, which does occur in health care, and it is believed that doctors are least likely to report NSI (Stein et al., 2003). It is very important for nurses in critical care who are exposed to an NSI to perform first-aid to the injury and report to their supervisor and Occupational Health /Emergency Department. Occupational exposure should be assessed and treated accordingly, for example by immunization, hepatitis B immune globulin and post exposure chemoprophylaxis for exposure to HIV. There are also emotional effects of such exposure such as stress (Henderson, 2012) which need to be dealt with as well as financial implications. The cost of management of occupational exposures to blood and body fluids can vary from $71 to $4838 per exposure (O'Malley et al., 2007). An EU directive (2010/32/EU) was published in May 2010 (Council Directive, 2010). Its objective is to achieve the safest possible work environment for HCWs through the prevention of sharps injuries. All health care organizations must comply with this directive, which becomes legally binding on 11 May 2013 (European Biosafety Network, 2010). Perz et al. (2012) determined that unsafe injection practices account for a proportion of HBV acquisitions in health care settings (e.g. use of multi-dose vials; incorrect administration of injections resulting in microscopic quantities of blood contaminating the environment). An outbreak of HCV was identified in an outpatient's clinic where myocardial perfusion imaging was undertaken (Moore et al., 2011). It was determined that a nuclear medicine technologist routinely drew flushes of saline solution from multi-dose vials using the same needle and syringe as had previously been used to administer radiopharmaceutical doses (Moore et al., 2011). In addition, Fischer et al. (2010) highlighted HCV transmission resulting from contamination of single-use medication vials used on multiple patients during anaesthesia administration. As a consequence, more than 50 000 persons required follow-up by Public Health. This investigation highlighted breaches in aseptic technique and deficiencies in oversight within outpatient settings. BBV outbreaks have also been caused through blood glucose monitoring. Five instances of HBV in UK care homes resulted from poor infection control practice in blood glucose testing (Duffell et al., 2011). HBV outbreak was also noted in a long-stay facility where blood glucose monitoring devices were not decontaminated between patients. This resulted in HBV transmission to at least six residents (Schaffzin et al., 2012). HCV has also been transmitted by shared spring-triggered capillary blood glucose monitoring (Desenclos et al., 2001). Recently, Perz et al. (2012) identified haemodialysis as another risk factor in blood-borne pathogen transmission, while several documented cases of patient-to-patient HCV transmission via colonoscope exist (González-Candelas et al., 2010). Most occupational exposures occur on wards (36%), operating theatres account for 17% of incidents (HPA, 2008). Once a BBV is diagnosed in a health care setting, a local investigation is necessary to determine whether the infection is considered as nosocomial. Under the Infectious Disease Regulations (1981) the Department of Public Health must be notified of HBV and HCV infections. A patient notification exercise (PNE) is undertaken using ‘Guidance on the management and investigation of potential exposure to BBVs in health care setting’ (DoHC, 2005). Surveillance is a key performance indicator in the management of HCAI. Early identification of outbreaks and active surveillance of occupational exposures is also necessary. Occupational exposures include percutaneous exposures, where skin has been broken by a needle or sharp, human scratches or bites and mucotaneous exposures (HPA, 2008). Between 1997 and 2008, 3773 occupational exposures to blood or other high risk body fluids were reported to the Health Protection Agency in the UK (HPA, 2008). Feedback from surveillance and good communication informs staff of risks and of appropriate precautions. A study by Donohue et al. (2012) included recommendations such as enhanced surveillance of BBV notifications; sufficient laboratory resources; improved hospital information systems; the establishment of a national register of possible incidents of BBV transmission and that findings of investigations should be published. These would contribute to the further prevention of BBV within the health care setting. Transmission of BBVs in health care settings was believed to occur most frequently during EPPs; however, there is growing evidence of patient-to-patient transmission via other routes (Donohue et al., 2012) including deficient policies and procedures, improper hand hygiene, preparation of medication in blood processing areas, blood glucose monitoring, common-use saline bags, reuse of syringes, reuse of single-dose vials and use of multi-dose drug vials (Kermode et al., 2005; Greeley et al., 2011; Donohue et al., 2012). Perz et al. (2012) concluded that health care exposures may represent an important source of new HBV and HCV infections among older adults especially in ambulatory care settings through reduced oversight and fewer infection control resources. Strategies associated with injury prevention include avoidance of unnecessary needle use; unnecessary insertion of intravenous catheters; use of needleless or protected needle infusion systems and use of safer needles (Henderson, 2012). Health care associated infections and outbreaks of BBV have occurred in health care settings therefore it is necessary that a good infection control programme is in place (HIQA, 2009). Hand hygiene and adherence to SP are important in the prevention of spread of infections (SARI, 2005; Siegel et al., 2007). Reducing occupational exposure will reduce occupational infections with BBVs (Henderson, 2012). Education of staff is essential. Stein et al. (2003) observed the attitudes and compliance of medical staff to UP and recorded reasons for non-compliance. It concluded that while 86% of nurse's s attested to UP compliance, only 41% of doctors did. Education, monitoring, sufficient resources and disciplinary action for poor compliance are all necessary to improve infection control in hospitals (Stein et al., 2003). Although safety-engineered devices have been designed to cover sharps and eliminate all ‘after-use’ injuries, NSI still occur if these devices are used incorrectly. Thorough training and monitoring of the correct use of these safety devices is required (Perry et al., 2004). This training, together with regular education on blood-borne diseases, and infection prevention and control policies and procedures in the critical care unit lead to better management and prevention of BBV and increased safety for both staff and patients. Where direct educational update on the topics is not readily available, critical care nurses may take the initiative to perform independent learning on the topic in line with the development of their professional portfolio. Professional literature and readings on the topic are widely available and act as a good resource for the nurse looking to explore this topic within their portfolio.

BackgroundPPE (gowns, gloves and masks) is used in standard precautions (SP) as well as for contact, droplet or airborne isolation. Improper PPE use can lead to self-contamination and transmission of infectious agents, and at our institution the quality of PPE use has not been well assessed. For quality improvement purposes, we conducted an evaluation of healthcare worker (HCW) PPE use and knowledge of SP.MethodsTwo phases, direct observations and a survey, were completed between December 2018 and February 2019 in inpatient areas. Direct observations of PPE use were done by Infection Prevention nurses (IPs) in contact and droplet isolation rooms during daytime hours using an internally developed observation tool (Figure 1). Observations focused on 3 stages of PPE use: donning, in room clean/dirty activities and doffing. A survey consisting of 15 questions was developed to assess staff knowledge of SP in specific clinical scenarios, perceptions of current practices and barriers to use. The survey was distributed by IPs to HCWs during their regular rounds. Data were recorded and tabulated using RedCap electronic survey tool.Results106 observations and 107 surveys were completed. Observations showed appropriate PPE worn in 84% (n = 83) and hand hygiene (HH) post doffing in 95% (n = 79). Common gaps included no HH pre-donning [33% n = 43], PPE not changed between dirty and clean tasks (29% n = 2), incorrect mask removal (20% n = 16) and doffing gloves post-gowns [19% n = 69]. In the survey, answers to SP questions suggest PPE is overused in patients with diarrhea or respiratory illness but underused in draining wound management (Figure 2). HCW felt more compliant than their colleagues in both HH and PPE (Figure 3). The largest misperception was that gowns should be doffed pre-gloves (40% n = 40). Reasons for not using PPE included time (26%, n = 27), and perception that PPE is unnecessary (16%, n = 10). 75% (n = 80) of HCW felt adequately educated about PPE.ConclusionAt our institution, significant gaps still exist in HCW knowledge and use of PPE. Future QI work should focus on increasing HCW knowledge of standard precautions, HH pre-donning, changing PPE when appropriate in room as well as proper doffing order. The perception that HCW felt adequately educated despite significant gaps may be a barrier.DisclosuresAll authors: No reported disclosures.

Guidance for Occupational Health Services in Medical Centers

Notes From the Field: Occupationally Acquired HIV Infection Among Health Care Workers—United States, 1985–2013

ASE Statement on the Reintroduction of Echocardiographic Services during the COVID-19 Pandemic

The novel coronavirus SARS-CoV-2 has rapidly spread across the world from its origin in Wuhan, China in late 2019. The resultant disease (COVID-19) has placed an enormous burden on healthcare systems because of the high transmission rates, prevalence of severe disease and mortality [1]. The risk of viral transmission to healthcare workers has been a concern since the start of the outbreak and the first person to raise concerns about the illness to the international community was Dr Li Wen-Liang, an ophthalmologist in Wuhan who sadly died of the disease that he likely contracted whilst at work [2].

Active implications for dermatologists in 'SARS-CoV-2 ERA': Personal experience and review of literature.

Introduction:Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV2). COVID-19 is highly contagious, potentially fatal, and a global public health concern. Combining optimized personal protective equipment (PPE) use and hand hygiene is the best strategy for preventing COVID-19 in health care workers (HCWs).Methods:We conducted a national cross-sectional web-based survey of HCWs in the infection control program (IPC) in Thailand between May 5, 2020 and May 15, 2020. The primary objective was the prevalence of optimized PPE use amongst HCWs. The secondary objective was identification of the independent predictors of optimized PPE use.Results:We received a response from 46% of HCWs (756/1650), and all those who responded were nurse or HCWs who were registered in the IPC network. Five HCWs were excluded because of missing data, and 751 were included in the final analysis. The prevalences of PPE use were 22% (168/751) for optimized PPE use, 78% (583/751) for non-optimized PPE use, 35% (263/751) for PPE overuse, and 43% (320/751) for PPE underused. In univariate analysis, optimized PPE use was significantly associated with age, education level, knowledge of appropriate negative pressure room selection, and knowledge of apparently milder symptom severity in children than adults. In multivariate analysis, independent predictors of optimized PPE use were knowledge of appropriate negative pressure room selection (aOR = 1.95, 95% CI = 1.18-3.22), the difference in symptom severity between children and adults (aOR = 0.55, 95% CI = 0.37-0.81), and education level (aOR = 1.54, 95% CI = 1.04-2.27).Conclusion:The prevalence of optimized PPE use amongst HCWs was 22%. Independent predictors of optimized PPE use were COVID-19 knowledge-based factors and education level. Therefore, the continued education training program should be implemented to ensure maintenance of appropriate practices during the COVID-19 pandemic.

To the Editors: Standard infection control precautions and centralized prevention/education has improved health care outcomes for patients and health care workers (HCWs).1–3 In resource-limited health care settings, implementation of these practices is challenging and transmission of highly resistant organisms within health care facilities is described.4–7 High rates of needle stick injuries8 and unsafe injection practices9 occur in clinics and hospitals where blood borne infections such as hepatitis and HIV are common; postexposure prophylaxis is infrequently accessed.10 Alcohol gels are perceived as expensive and may be unavailable, and many settings lack appropriate hand-washing facilities.11 Personal protective equipment is often absent, and medical equipment may be old and in disrepair. Strict standards for environmental controls are difficult to maintain, and health care facilities themselves are often archaic. International recommendations are available for infection control, but programs are not consistently regulated and have few monitoring and enforcement programs.12–14 The National Institute of Allergy and Infectious Diseases (NIAIDs) supports 6 networks conducting HIV-related clinical research. Many clinical research sites (CRSs) are located outside of the United States in resource-limited settings. CRS that have access to the patients and resources necessary to perform high-quality research are limited and usually engage in diverse research. A single site might have studies focusing on the prevention of mother-to-child transmission of HIV, intensive pK studies involving new drugs for multiresistant organisms, and protocols testing second-line antiretroviral therapy. Standard clinical care is provided in often-crowded facilities, where research subjects are present for many hours. Anecdotal observations have suggested that there are significant variations in infection control practices among the sites. METHODS A survey of the infection control resources and practices at the CRS outside of the United States was undertaken, led by the Office of HIV/AIDS Network Coordination. Sites were asked about a formal infection control program, staff safety, respiratory hygiene and tuberculosis control, hand hygiene capabilities, injection practices, and blood safety. RESULTS Overall, 74 sites were offered the survey, and 32 returned completed surveys. Twenty-three of 32 AIDS Clinical Trials Group sites completed the survey. Selected results are summarized in Figure 1.FIGURE 1: Selected infection control practices at international NIAID-funded HIV clinical research sites.Infection Control Organization Eighty-six percent of sites had an infection control policy, of these 55% were specific to the CRS. Seventy-five percent of sites had an infection control officer, directly employed by the sites, half the time. The sites without an infection control policy frequently did not have policies addressing the domains surveyed. Respiratory Sixty percent of sites reported a triage system to identify participants with potential respiratory infections. Commonly, the study participant was placed in a well-ventilated area and provided a mask. Less than half of respondents (45.2%) conduct protocol procedures with participants with known or suspected tuberculosis (TB) in a separate clinical area. Natural and mechanical ventilation were common methods of ensuring respiratory hygiene. N95 masks were available in the general clinic, in 39% of sites (12/31). Ultraviolet lights were present in 8/29 general clinical areas and 4/13 dedicated sputum collection areas indoors. A dedicated space for sputum collection was present in 55% of the CRSs. Space for sputum collection was most commonly an area outside (approximately 55%) or a dedicated sputum collection area inside (approximately 45%). In the space for sputum collection, natural and mechanical ventilation were used as infection control measures. Twenty-five percent of sites reported surgical masks worn by patients. Staffs were provided N95 masks 50% of the time in the dedicated sputum collection area; 2/11 sites reported that N95 respirators were available. Educational material on cough hygiene was available at 40% of the respondent sites. Forty-five percent of sites had TB surveillance programs for staff and routinely screened staff for TB infection 71% of the time. Hand Hygiene All sites reported sinks with running water; most had manual soap dispensers (25/32) and paper hand towels (27/32). Hand sanitizers were available at half of the sites. Water basins filled remotely were used in some areas in 15/32 sites, bar soap in 13/32 sites, and cloth hand towels in 11/32 sites. Blood Safety All sites reported a policy for management of needle stick injuries, and all sites had appropriate postexposure prophylaxis for HIV. The source patient is tested for hepatitis B at 58% of sites and hepatitis C at 39% of sites. Postexposure protocols for hepatitis B were present in 42% of sites. Most sites reported a needle recapping policy (71%), and 58% used safe needle systems. Sharps containers were generally available. DISCUSSION Healthcare-associated infections are an important cause of morbidity for patients, and health care providers in resource limited settings. A recent meta-analysis suggested that rates of indicator healthcare-associated infections might be more than double those of resource rich settings.15 Our survey suggested important areas for improvement in the delivery of health care associated with NIAID-sponsored clinical trials. There is good evidence that organizational support for infection control reduces the transmission of infectious agents and reduces mortality and morbidity in the acute care setting.16,17 Critical elements include staff trained in the principles of infection prevention, surveillance, and enforcement of preventative measures. Prevention of occupational illnesses requires preemployment assessments and immunization for vaccine-preventable illnesses. A quarter of the sites did not have appropriate personnel tasked with infection prevention. Those sites that did not have specific policies related to infection control also did not have policies to address most of the infection control domains. TB transmission in the health care environment is well described. The association with HIV infection is important, and instances of transmission clusters of highly resistant TB have been documented.18,19 A review examining the incidence and prevalence of latent TB infection among HCW in low- and middle-income countries suggested that HCW were at significant risk for TB disease compared with the general population.20 Even in areas where transmission of TB has been described, infection control procedures may be lacking. In eThekwini Municipality, Durban, RSA, only a quarter of primary health clinics triaged patients with cough. This is consistent with our experience. Patients with known or suspected TB are seen in the same facility as patients without TB, and segregation of individuals who might be infectious is not commonly undertaken. Cough hygiene has been promoted in resource-rich settings as a way of reducing spread of respiratory pathogens, fewer than half the sites had information available about cough hygiene. Hand hygiene is a critical measure to reduce health-care-acquired infections. Improvement of hand hygiene practices has been associated with reduced infection rates in hospitalized patients.21 In 2009, the WHO described best practices for hand hygiene and methodologies for local manufacture of inexpensive hand sanitizing gel.22,23 The multimodal strategy was tested in a reference hospital in Mali and found to be feasible, affordable, and effective.24 The WHO has ongoing efforts to promote hand hygiene using alcohol-based hand rubs throughout the world; however, a recent survey in Uganda of attitudes toward infection control gel for hand hygiene was perceived to be expensive and unavailable.11 In our survey, hand hygiene practices varied widely; alcohol-based gel was not generally available. The use of hand basins with standing water accompanied by bar soap and multiuse towels was striking. HCW are at risk for infection with blood borne pathogens, and needle stick injuries are common. One survey in Malawi suggested that half of nurses had a needle stick injury within the previous year.25 This rate is similar to rates in resource-rich settings before the widespread adoption of engineered needle-safe solutions.26 The consequences of outdated needle practices combined with high prevalence rates of HIV, hepatitis B, and hepatitis C may be catastrophic.27 Although postexposure prophylaxis is available for injuries that might be capable of transmitting HIV, it is unknown to what extent the work force is at risk for hepatitis B, as the information is not collected before employment. Participation in research should not place patients at more risk when compared with the local standard of care. The concentration of patients with communicable diseases drawn to the research site to participate in clinical protocols and the need for prolonged face-to-face interactions could lead to an increased risk for preventable infections in the research setting compared with the clinical environment. Arguably, research settings should set and demonstrate higher standards for clinical care, even when these levels cannot be implemented immediately throughout the health care system. Ethicists have commented that researchers should not replicate unacceptably low local standards but should seek to establish competent levels of care that can ultimately be feasibly implemented in the health system, for the benefit of all patients.28,29 Our survey demonstrated important areas for improvement in infection prevention. There are good precedents in the resource-limited setting for developing standards for hand hygiene and the prevention of blood borne illnesses. The most pressing need is for a protocol for the prevention of TB transmission. This has been developed and is being implemented at our sites. TB infection control, however, is best undertaken in an environment of other infection prevention efforts. NIAID and other research sponsors have a unique opportunity to model better health care infection control practices; it is hoped that this will lead to improved health care outcomes.

Infection control in health care facilities

A descriptive, retrospective study of 567 accidental blood exposures in healthcare workers in three West African countries

Assessment of Management Policies and Practices for Occupational Exposure to Bloodborne Pathogens in Dialysis Facilities

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Background: Hospital is one of the health services demanded according to standards by the community. But hospitals also have a high risk of infection, both due to treatment and medication. Of the many health workers, nurses are one who plays a role in the quality of service. In improving quality, nurses' behavior needs to be considered as a form of hospital prevention against infection. Measures that can prevent infection by washing hands and using PPE properly. Objective: Knowing the description of hand washing behavior and the use of nurses' personal protective equipment about the risk of spreading nasocomial infections. Method: Descriptive research using quantitative descriptive methods with total sampling techniques and using univariate test analysis. The subjects of this study were 67 respondents. Data collection was carried out by observation method regarding hand washing behavior and the use of nurses' personal protective equipment in hospitals.Results: The results of the study of 59 respondents studied found that 30 nurses behaved obediently (50.8%) while nurses who did not comply with the moment of hand washing amounted to 29 people (49.2%). With respondents who had a handwashing step behavior adhering to six steps amounted to 31 people (52.5%), while nurses who did not comply with six steps of hand washing amounted to 28 people (47.5%). While respondents who had compliant behavior in the use of PPE amounted to 34 people (57.6%), while nurses who did not comply in the use of PPE amounted to 25 people (42.4%). Conclusion: Inpatient nurses in hospitals have the majority of behaviors that comply with hand washing and the use of PPE (personal protective equipment) Keyword: Personal Protective Equipment; Hand Washing; Nasocomial Infection; Behavior Abstrak Latar Belakang : Pelayanan kesehatan yang diberikan oleh rumah sakit harus mematuhi standar yang diharapkan oleh Masyarakat.. Namun fasilitas kesehatan tersebut juga memiliki resiko tinggi terhadap infeksi, baik karena perawatan maupun pengobatan. Dari banyaknya petugas kesehatan, perawat ialah salah satu yang berperan dalam mutu pelayanan. Dalam meningkatkan mutu, perilaku perawat perlu diperhatikan sebagai bentuk dari pencegahan rumah sakit terhadap infeksi. Tindakan yang dapat mencegah terjadinya infeksi dengan cuci tangan serta penggunaan APD dengan benar. Tujuan : Mengetahui Gambaran Perilaku Cuci Tangan dan Penggunaan Alat pelindung diri Perawat Tentang Risiko Penyebaran Infeksi Nasokomial. Metode : Studi deskriptif dilakukan dengan metode deskriptif kuantitatif, teknik total sampling, serta analisis uji univariat pada 67 responden. Pengambilan data dilakukan dengan metode observasi mengenai perilaku cuci tangan dan penggunaan Alat pelindung diri perawat di Rumah sakit.Hasil : Hasil penelitian dari 59 responden yang diteliti didapatkan 30 orang perawat berperilaku patuh (50.8%) sedangkan perawat yang tidak patuh terhadap momen cuci tangan berjumlah 29 orang (49.2%). Dengan responden yang memiliki perilaku langkah cuci tangan patuh terhadap enam langkah berjumlah 31 orang (52.5%), sedangkan perawat yang tidak patuh terhadap enam langkah cuci tangan berjumlah 28 orang (47.5%). Sedangkan responden yang memiliki perilaku patuh dalam penggunaan APD berjumlah 34 orang (57.6%), sedangkan perawat yang tidak patuh dalam penggunaan APD berjumlah 25 orang (42.4%). Kesimpulan : Perawat rawat inap yang ada di Rumah Sakit memiliki perilaku mayoritas patuh terhadap cuci tangan maupun penggunaan APD (alat pelindung diri) Kata kunci: Alat Pelindung Diri; Cuci Tangan;Infeksi Nasokomial;Perilaku;

Blood-borne viruses in health care workers: Prevention and management