UNIVERSAL INFECTION CONTROL PRECAUTIONS.

1.1   Introduction

1.2   Risk Assessment 

1.3   Universal Infection Control Precautions 

1.4   Protective Clothing

1.5   Hand Hygiene

1.6   Isolation Facilities

“MANAGEMENT OF OCCUPATIONAL EXPOSURE (Including POST- EXPOSURE PROPHYLAXIS (PEP)”

What is Occupational exposure?

Occupational exposure refers to exposure to potential blood-borne infections (HIV, HBV and HCV) that may occur in health care settings during patient care. Post exposure prophylaxis (PEP) refers to comprehensive medical management to minimize the risk of infection among Health Care Personnel (HCP) following potential exposure to blood-borne pathogens (HIV, HBV, HCV). This includes counselling, risk assessment, relevant laboratory investigations, first aid and depending on the risk assessment, the provision of short term (4 weeks) of prophylactic antiretroviral drugs, with follow up and support.

PATIENTS’ EDUCATION ON ARV TREATMENT ADHERENCE AND MONITORING OF ARV THERAPY

• To guide pharmacists in providing appropriate education and drug related information to patients and to discuss the role of treatment adherence in the success of ART.

Objectives

·         To understand the importance of imparting education and drug related information to patients

·         To appreciate that providing information about prescribed medicines promotes appropriate use, increases compliance and leads to effective and successful therapy

·         To  discuss the importance of patient adherence to first line ART

·         To understand patient barriers to adherence

·         To determine ways of promoting patient adherence

·         To list methods of assessing adherence

·         To illustrate relevant drug related patient information pertaining to ART and OIs medicines

Among various tasks assigned under Pharmacist’s role in the Operational Guidelines for ART Centers (March 2008), three specific tasks related to patients’ education on ARV medicines and monitoring of ARV therapy are:

·   

ADVERSE DRUG REACTIONS TO ARV& OI DRUGS AND PHARMACOVIGILANCE

Any drug my produce unwanted or unexpected adverse reaction. Detection, recording and reporting of these reactions is of vital importance. Doctors, pharmacists and nurses have the responsibility to participate in this programme. Adverse reactions are significant cause of morbidity, mortality and can affect adherence to treatment schedule and increase risk of resistance and relapse of disease.

DRUG-DRUG INTERACTIONS WITH SPECIAL REFERENCE TO ARV & OI DRUGS

A drug interaction occurs when one drug is given with or shortly after another drug alters the effect of one drug or both drugs. Drug interactions pose one of the common problems as often patients take more than one drug at a given time. It is estimated that a hospitalized patient receives an average of 5 - 10 drugs. When several drugs are given together, interactions are bound to occur.  This module highlights

GOOD DISPENSING PRACTICES

            The aim of this module is to lay down guidelines for pharmacists to adopt good dispensing practices for a pharmacy.

Objectives To understand the importance of good dispensing practices To understand various components and steps in good dispensing practices To understand common dispensing errors with their consequences To understand how good dispensing practices help in establishing a professional relationship with patients To understand how to maintain Antiretroviral Drug Dispensing Register

GOOD STORE MANAGEMENT

            The aim of this module is to lay down guidelines for pharmacists to adopt an effective system for storage and stock management.

Objectives To understand various steps in receiving, handling and storage of medicines and related  supplies To understand means and patterns of storage, stock control and expiry monitoring and minimize losses through expiration and deterioration To understand how storage of medicines directly affects their quality To protect from loss, damage, theft, or wastage To maintain reliable and continuous supply from source to user ·         To keep accurate inventory records. To provide stock movement information for   forecast needs.

           

QUANTIFYING DRUG REQUIREMENTS

The basic goal of national AIDS Control Programme is to halt and reverse the epidemic in India over the next 5 years by integrating programmes for prevention and care, support & treatment.  Keeping above in mind, the main objective of anti-retroviral (ART) center is to provide comprehensive services to eligible persons with HIV/AIDS including providing continuous ARV drugs free of cost.  Drug management is truly a cycle involves four basic functions: selection, procurement, distribution and

IMPORTANT PHARMACOLOGICAL CONSIDERATIONS OF ANTIRETROVIRAL (ARV) DRUGS & OPPORTUNISTIC INFECTIONS (OIs) DRUGS

Substantial advances have been made in antiretroviral (ARV) therapy since the introduction of first agent, zidovudine in 1987. Since then there are many ARV agents available in market. Research on viral dynamics, such as viral load and resistance, has made clear that combination therapy with most efficient and potent agents reduce viral replication as well as emergence of resistance. Thus administration of highly active ARV therapy (HAART) includes 3 – 4 ARV agents from different

RATIONAL USE OF MEDICINES AND ROLE OF PHARMACISTS IN PROMOTING RATIONAL USE OF MEDICINES

Guidelines for pharmacists to promote rational use of medicines

Objectives:

To provide information to pharmacists on

    >  the importance of rational use of medicines;

    >  the adverse impact and factors influencing the rational use of medicines;

    >  the national guidelines for HIV/AIDS;

    >  the useful role pharmacists can play in promoting rational use of medicines; and

    >  the importance of patient education.

Opportunistic infections

In western world widespread use of HAART (highly active antiretroviral therapy) has led to dramatic decline in the incidence of commonly occurring opportunistic infections (OIs) seen in pre-HAART era, now this is being replicated in developing countries like India. Opportunistic infection may be the presenting feature of HIV infection or it may develop during course of diagnosed HIV infection. Various OIs can complicate course of untreated as well as treated HIV infection. Tuberculosis,

Management of HIV-AIDS in children

Pre ART care

Care of the HIV infected child starts with pre-ART care. Pre-ART care includes:

• Assessment of  growth and nutritional status
• Assessment of immunization status and provide appropriate immunization.
• Ensure that the child is on cotrimoxazole prophylaxis
• Assessment for signs and symptoms of opportunistic infections including TB.
• Assigning stage of disease using WHO clinical staging and immunological criteria and assess whether the child fits the criteria for starting ART

Practice Guidelines and National ART Programme & Prevention of AIDS

Introduction:

As the HIV pandemic is entering its third decade, over 60 million people have been infected by the virus, nearly 25 million have died and as of December 2007, 33 million people globally were living with HIV. During the initial years of epidemic, major focus of attention was on preventive strategies and “Care and Support” of infected individual was limited mainly to management of Opportunistic Infections (OIs). During last 10-15 years there have been significant advances in our understanding of molecular biology of virus and the pathogenesis of disease in. The advent of antiretroviral drugs in early 1990’s began a revolution in the

National AIDS Control Programme III and overview of Care Support & Treatment program

Objectives of Session: •       Key Components under NACPIII •       Care, Support and Treatment programmes under NACPIII •       To understand  linkages between different services

Chapter outline:

1.      Introduction

2.      Goals & oOjectives of NACP III

3.       Components of NACP III

3.1Targetted Intervenetion for High Risk Groups

ACRONYMS

ART: Antiretroviral Therapy

ARV: Antiretroviral

ATT: Anti-Tuberculosis Therapy

AIDS: Acquired Immuno Deficiency Syndrome

Ab: Antibody

ADR: Adverse Drug Reaction