Self-Assessment Questions (SAQs) for Study Session 26
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
SAQ 26.1 (tests Learning Outcomes 26.1 and 26.2)
State if the following statement is true or false. Explain your reasoning.
‘Universal precautions are used only with very sick patients.’
Answer
The statement is false because universal precautions are standard procedures used when we manage all patients. Universal precautions should be implemented and practised by all healthcare providers and caregivers in all settings, in particular in hospitals, health centres, health posts and community settings, as well as the homes of your patients.
SAQ 26.2 (tests Learning Outcome 26.3)
Which of the following statements about the standard procedures for giving safe injections is false? In each case, explain what is incorrect.
A The more you handle an injection instrument, the more skilful you will become at avoiding the risk of needle-stick injury.
B Place a safety box close to the person giving injections, so used syringes and needles can be disposed of immediately.
C Do not manually remove a used needle from the syringe.
D Do not carry used syringes and needles around with you.
E Avoid recapping the needle after you have given an injection.
F Close the safety box when it is full, and start a new one.
Answer
A is false. The more you handle an injection instrument, the more likely you are to suffer a needle-stick injury.
B is true. Place a safety box close to the person giving injections, so used syringes and needles can be disposed of immediately.
C is true. Do not manually remove a used needle from the syringe.
D is true. Do not carry used syringes and needles around with you.
E is true. Avoid recapping the needle after you have given an injection.
F is false. Safety boxes should be closed when they are three-quarters full; you risk a sharps injury if you try to add needles or other instruments to a full safety box.
SAQ 26.3 (tests Learning Outcomes 26.1 and 26.4)
State if the following statement is true or false. Explain your reasoning.
‘If a health facility has all the personal protective equipment (PPE), the healthcare workers in that facility do not need a post-exposure prophylaxis (PEP) service.’
Answer
The statement is false. Remember that although universal precautions will decrease the occurrence of occupational exposure, there are ‘accidents’ and unanticipated exposures, which necessitate PEP for HIV. Even if a health facility has all the PPE, it needs a PEP service for its healthcare workers to prevent HIV transmission through accidental occupational exposure. If PEP is not available in a health facility, or when there is nobody trained in how to manage such cases, referral of the exposed health worker to a nearby health facility which has a PEP service should be arranged as soon as possible.
Read Case Study 26.1, and then answer the questions that follow.
Case Study 26.1 Ayelech’s story
Ayelech is a healthcare worker trained to provide a safe and clean delivery service (this is covered in the Labour and Delivery Care Module). One day she was attending a delivery in a household in her catchment area. The mother had been sick for about two months before the delivery with diarrhoea on and off, but she had persistently refused Ayelech’s counselling to be tested for HIV. Ayelech didn’t use any personal protection equipment for the delivery except gloves. After the delivery, she injected the mother with intramuscular (IM) oxytocin to help deliver the placenta and prevent excessive bleeding. Ayelech was trying to recap the needle with two hands, when she accidentally pricked her left index finger with the needle. Her finger was bleeding and it was a deep needle-stick injury, but the placenta was coming and the baby needed attention, so she ignored the injury.
SAQ 26.4 (tests Learning Outcomes 26.5 and 26.6)
- a.Was Ayelech following universal precautions? Say why or why not.
- b.Is there a risk that Ayelech could be infected with HIV? If so, what is the degree of the exposure?
- c.Explain what she should have done immediately after the injury.
- d.Explain what Ayelech should do next.
Answer
- a.No, Ayelech was not following universal precautions, because she didn’t use PPE except for wearing gloves. She also recapped the needle with two hands, instead of with one hand.
- b.Yes, Ayelech is at risk of being infected with HIV. The HIV status of the mother is not known, but the fact that she was sick makes the possibility of HIV infection more likely. It is a high-risk exposure since the needle-stick was a deep injury with a hollow needle, and the mother was sick.
- c.Immediately after the injury, Ayelech should wash the wound with soap and water and let it bleed freely. There should be antiseptic or disinfectant in the bag she takes to deliveries, and she should flush the wound with it.
- d.Ayelech should call for help for the mother and newborn, and go to the nearby health centre/hospital as soon as possible to begin PEP immediately. Ayelech should also be tested for HIV. If she is found to be positive, she doesn’t need the PEP and should be enrolled for HIV care at the health centre.
Read Case Study 26.2, and then answer the questions that follow.
Case Study 26.2 Fatuma’s story
While working in your health post, Fatuma, a 15 year-old girl, arrives with her parents. They have brought her because six hours earlier she was raped by a man whose HIV status is not known.
SAQ 26.5 (tests Learning Outcome 26.7)
- a.What do you tell Fatuma and her parents first?
- b.What will be the final advice you give to them?
Answer
- a.You should first tell Fatuma and her parents about the potential risk of HIV infection from the sexual assault, and explain that Fatuma should get PEP quickly, which you don’t have in your health post.
- b.You should refer Fatuma immediately to the nearby health centre or hospital for physical examination, PEP, and other necessary investigations and medications. You need to convince Fatuma and her parents that the legal process is a lower priority, as she has to take the PEP within 72 hours of the assault.
Summary of Study Session 26