CHAPTER ONE
INTRODUCTION
History has it that anything that the hand of Midas touched turned to gold.  There is power in the touch.  As healing can come from a touch, so also infection, disease and eventually death can come from a touch, be it for the person touching or the person being touched.
          The normal skin is designed to reduce water loss, protect against abrasions and to act as a permeability barrier1.  It is colonized by bacteria usually of two categories: Resident flora and transient flora.  The Resident flora are less likely to cause health care related infections, while the transient flora are the ones mostly implicated in healthcare associated infections.  The transient flora is gotten from hand contact with patients, their belongings, beddings, body fluids, etc.  These hands are used to transfer infection from person to person.  Because the hands play an important role in transmitting infection, hand hygiene is therefore of importance in reducing the transmission of infection.  It is for this reason that the Centre for Disease Control (CDC) added Hand Hygiene to the Universal or standard precautions.
            Health care workers who have occupational exposure to blood are at increased risk for acquiring blood-borne infections.  The level of risk depends on the number of patients with that infection in the health care facility and the precautions the health care workers observe while dealing with these patients.
            There are more than 20 blood borne diseases, but those of primary significance to health care workers are, hepatitis due to either the hepatitis B virus (HBV) or hepatitis C virus HCV) and acquired immuno-deficiency syndrome (AIDS) due to human immuno-deficiency virus (HIV)2.
            Contaminated sharps such as needles, lancets, scalpels, broken glass, specimen tubes and other instruments, can transmit blood borne pathogens such as HIV, Hepatitis B (HBC) and Hepatitis C viruses (HCV)3.
            Unsafe injections and the consequent transmission of blood borne pathogens are suspected to occur routinely in the developing world.  Furthermore, 18 studies present convincing evidence on the association of unsafe injection practices and the transmission of blood borne viruses such as hepatitis B and C, Ebola, Lassa virus infections and malaria.  Such practices account for a significant number of hepatitis B and C infections.  Quantitative information on injection use and unsafe injections (defined as the reuse of syringe or needle between patients without sterilization) was obtained by reviewing the published literature and unpublished WHO reports.  It was estimated that each person in developing countries receives an average of 1.5 injections per annum, but those confined to hospitals receive 10 – 100 times as many injections.  Of these injection, 95% are therapeutic, majority of which are unnecessary.  At least 50% of these injections are unsafe in developing countries4.
            Injection overuse and unsafe practices account for a substantial burden of death and disability worldwide5.  The circumstances leading to needle-stick injury depends partly on the type and design of the device and certain work practices.    Recapping of needles is a common cause of needle-stick injury.  It is documented that 10-25% injuries occurred while recapping a used needle6.  The recapping of needles has been prohibited under the occupation safety and Health Administration (OSHA) blood-borne pathogen standard7.
          An increasing number and variety of needle devices with safety features are now available.  Needleless or protected needle I.V. systems have decreased the incidence of needle-stick injuries by 62% - 88%8.
The prevalence of HBS Ag in healthy blood donors in Kathmandu valley has been reported to be about 1.67%9.  Sero prevalence study suggests that the overall anti-HCV positivity in blood donors is about 0.3% in Nepal10.  The prevalence of HIV sero-positivity in healthy blood donors has been reported to be about 0.2% in Nepal10.