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Protecting Health Workers From Zika During Labor and Delivery

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JAMA

May 10, 2016

Labor and delivery can be joyous for new parents and the health professionals who help bring infants into the world. But the birthing process also exposes physicians and nurses to large volumes of patients’ body fluids, reinforcing the need for extra vigilance in observing infection control measures as protection against possible Zika virus infection.

©iStock.com/Reynardt Badenhorst

The CDC recently explained that even though occupational Zika virus transmission from patient to health worker hasn’t been documented, standard precautions—hand hygiene, personal protective equipment, respiratory hygiene and cough etiquette, safe injection practices, and safe handling of potentially contaminated equipment or surfaces around patients—are essential during labor and delivery (Olson CK et al. MMWR Morb Mortal Wkly Rep. 2016;65[11]:290-292).

“Pregnant women lose an average of 500 mL of blood during uncomplicated vaginal deliveries,” the authors wrote. “Amniotic fluid volume at the time of full-term delivery typically exceeds 500 mL.” Zika virus has been detected in many body fluids, including blood and amniotic fluid.

Patients with Zika virus infection may be asymptomatic, so health workers should always use standard precautions. Protection can be based on exposure levels. Gloves may be sufficient during a vaginal examination of a pregnant woman with minimal cervical dilation and intact membranes. However, performing an amniotomy or placing an intrauterine pressure catheter requires a mask, eye protection, gloves, and an impermeable gown.

The CDC advises anesthesia professionals to wear gloves and a surgical mask when placing a catheter or administering intrathecal injections and to use additional protective measures for procedures involving significant body fluids during delivery. In fact, everyone on the team should wear the same level of protection.

Unprotected health personnel who get splashed by body fluids should report the incidents to their facility’s occupational health clinic and be assessed for Zika virus infection so more stringent safety measures can be instituted. The Zika outbreak offers health facilities another opportunity to emphasize proper infection control practices, the authors noted.

 read more at JAMA

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