safety precautions and infection control

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PROBLEM STATEMENTIn May 1847 Jakob Kolletschka, a Viennese doctor,

cut his f inger while doing an autopsy on a woman who had died of puerperal fever in the hospital. A few days later Kolletschka was died.

CDC annual data…

In the US Sulkin and Pike repor ted that 34 of 1342 laboratory infections occurring between 1930 and 1950 were due to mouth pipetting.

Ricketts and Karls Urbani. . .

Cholera lab workers of ten died of the disease

Brucellosis-423Q-fever-278Typhoid fever-256Hepatitis-234Tularemia-225TB-176Dermatomycosis-161

Salmonellosis-48Streptococcal infection-78Leptospira-77Shigellosis-58 Typhus-124

COMMON CAUSES OF DEATH FROM LAB ACQUIRED INFECTIONS WORLDWIDE (EXCEPT UK) 1969-89

OCCUPATIONALLY ACQUIRED HIV; CDC BY 1992 :-

Lab technician-25Nurse-26Physician-15Paramedics-7Dentist/technician-6Health attendant-6House keeper-6

“IT MAY SEEM A STRANGE PRINCIPLE TO ENUNCIATE AS THE VERY FIRST REQUIREMENT IN A HOSPITAL THAT IT SHOULD DO THE SICK NO HARM”…”THE ACQUIRED MORTALITY IN A HOSPITAL ESPECIALLY IN THOSE OF LARGE CROWDED CITIES IS VERY MUCH HIGHER THAN ANY CALCULATION FOUNDED ON THE MORTALITY OF THE SAME CLASS OF DISEASE AMONG PATIENTS TREATED OUT OF HOSPITAL WOULD LEAD US TO EXPECT”…

-FLORENCE NIGHTINGALE

HISTORYOliver Wendell Holmes, USA,1843; story

on Puerperal fever; contagious

Ignaz Phil ipp Semmelweis, Vienna, 1846; infection from autopsy rooms to labour rooms (paper in 1860)

Joseph Lister (1860); antisepsis

PRINCIPLES OF BIO SAFETY

TO protect:The patient Health care workersThe environment

(Before HIV outbreak)

Category specif ic isolation precautions

Disease specif ic isolation precautions

In 1983, CDC published a document entit led "Guideline for Isolation Precautions in Hospitals" that contained a section entit led "Blood and Body Fluid Precautions."

In1987 “Recommendations for the Prevention of Transmission of HIV in Health Care Settings” were issued

Extended to all patients as “Universal Blood and

Body Fluid Precautions” or “Universal Precautions”

In 1996

National Health and Medical Research Council (NHMRC) and Australian National Council on AIDS (ANCA) recommended adoption of the terms

“Standard Precautions ” as an alternative to Universal Precautions

And “Additional Precautions ”

Universal/standard precautions : these are the measures that must be applied during

Patient care: mucosa, breached skin

Handling any potential ly infected material: Blood and body fluids or any other secretion contaminated with blood

Components:

A. Hand washing.

B. Barrier precautions.

C. Sharp disposal.

D. Handling of contaminated material.

ADDITIONAL PRECAUTIONSUsed for patients with known or suspected of infection

in which standard precautions are not enough and which may be transmitted by

Respiratory secretions; TB, Measles, influenzaBy contact: MRSA, VREOther diseases : Creutzfeldt-Jakob disease (CJD)

They may include:Isolation in single room (MRSA)separate toi let (VRE) Addit ional personal protective equipment (e.g. par t iculate f i lter mask (N95) /powered air

purifying respirator for Inf luenza, TB)

N95, N99MASKS

LABORATORY BIO SAFETY

WHO describes this is as: practices containment principles technologies

Implemented to prevent unintentional exposure to

pathogens and toxins, or their accidental release

GOOD MICROBIOLOGICAL GOOD MICROBIOLOGICAL TECHNIQUES(GMT)TECHNIQUES(GMT)

GMT involves the use of aseptic techniques and other good microbiological practices to achieve two objectives:

Prevent handled organisms from contaminating the laboratory, and

Prevent organisms in a laboratory environment from contaminating the work.

The principles of GMT should generally be applied

to al l types of work involving microorganisms and

t issue cultures, regardless of containment level.

Only authorized persons should be allowed to enter the laboratory working areas

Lab doors should be kept closedChildren should not be allowed to

enter working areasAccess to animal houses should be

specially authorizedNo animals should be admitted

other than those involved in the work of the Lab

GOOD MICROBIOLOGICAL TECHNIQUES

DO’S

Avoid the use of aerosol-generating procedures when working with infectious materials

Think safety at al l t imes during laboratory operations.

Use aseptic techniques. Hand washing

Always keep an appropriate spil l kit available in the lab.

DON’T

Never mouth pipette.

Never recap a used needle.

Never leave materials or contaminated lab ware open to the environment outside the BSC.

Never discard contaminated,

infectious waste materials

without being

decontaminated or

steri l ized.

Never eat and drink

Risk Group 1:Bacil lus sp, non diarrhoeagenic E Coli

Risk group 2: E.Coli, Klebsiella, acinetobacter, Mycobacterium leparae, MAC, All parasites, Trichophyton, adenovirus, coronavirus

Risk Group 3:MTB, Yersinia, rickettsia, brucella, retroviruses, coccidioides, histoplasma

Risk Group 4: (viruses only)Ebola, Marburg, KFD, Lyssa

BASICS OF INFECTION BASICS OF INFECTION CONTROLCONTROL

Prevention of nosocomial infection is the responsibil i ty of al l individuals and services provided by healthcare sett ing.

A comprehensive, ef fective and suppor ted program is essential for reducing infection risk and increasing hospital safety.

It should include surveil lance, preventive activit ies and staf f training.

I . National program developed by Ministr y of Health: to suppor t hospital programs. It sets national objectives, develops and updates guidelines recommended for health care.

I I . Hospital programs including:

1) major preventive ef for ts; keeping in mind

patients and staf f .

2) It must be suppor ted by senior management

And provided with suf f icient resources.

3) It must develop a yearly work plan to

assess and promote all good health care

activit ies.

I n f e c t i o n C o n r t o l T e a m I n f e c t i o n c o n t r o l c o m m i t t e e I n f e c t i o n c o n t r o l m a n u a l

H o s p i t a l P r o g r a m

INFECTION CONTROL TEAMINFECTION CONTROL TEAM

The optimal structure varies with hospitals types, needs and resources.

Hospital can appoint epidemiologist or infectious disease special ist, microbiologist to work as infection control physician.

Infection control nurse who is interested and

has experience in infection control issues.

Team should have authority to manage an ef fective control program.

Team should have a direct repor ting with senior administration.

Infection control team members or are responsible for day-to-day functions of IC and preparing the yearly work plan.

They should be exper t and creative in their job.

INFECTION CONTROL COMMITTEEINFECTION CONTROL COMMITTEE

It is a mult idisciplinary committee responsible for monitoring program policies implementation and recommend corrective actions.

It includes representatives from dif ferent concerned hospital depar tments & management. They meet bimonthly.

It establishes standards for patient care, i t

reviews and assesses IC repor ts and identif ies

areas of intervention.

INFECTION CONTROL MANUALINFECTION CONTROL MANUAL

Every Hospital should have a nosocomial infection prevention manual compil ing recommended instructions and practices for patient care.

This manual should be developed and updated in a t imely manner by the infection control team.

It is to be reviewed and accepted by infection

control committee.

INFECTION CONTROL RESPONSIBILITYINFECTION CONTROL RESPONSIBILITY

Role of every hospital depar tment and service units must be identif ied, documented as manuals kept in accessible place.

Job description of every hospital staf f; def ining detai ls of his duties must be discussed before employment. Infection control precautions should be par t

of the routine work and stressed for that.

S u r v e i l l a n c e P r e v e n t i v e A c t i v i t i e s S t a f f T r a i n i n g

P r o g r a m C o m p o n e n t s

NOSOCOMIAL INFECTION NOSOCOMIAL INFECTION SURVEILLANCE SURVEILLANCE

Nosocomial infection rate in a hospital is an indicator of quality and safety of care.

Surveil lance to monitor this rate is essential to identify problems and evaluate control activit ies

The ult imate aim is the reduction of infection rate and their costs.

The term surveil lance implies that observational data are regularly analyzed.

KEY POINTS IN SURVEILLANCEKEY POINTS IN SURVEILLANCE

Active surveil lance (Prevalence and incidence studies)

Targeted surveil lance (site, unit, priority -oriented)

Appropriately trained investigators

Standardized methodology

Risk- adjusted rates for comparisons

ORGANIZATION FOR ORGANIZATION FOR SURVEILLANCESURVEILLANCE

W a r d a c t i v i t yd e v i c e s o r p r o c e d u r e s

f e v e r & i n f . s i g n sa n t i b i o t i c s & c h a r t s

L a b o r a t o r y r e p o r t sc u l t u r e & s e n s i t i v i t yr e s i s t a n c e p a t t e r n s

s e r o l o g i c t e s t s

D a t a e l e m e n t s & a n a l y s i sp a t i e n t d a t a & i n f e c t i o n

p o p u l a t i o n & r i s k sc o m p u t e r i z a t i o n o f d a t a

D a t a c o l l e c t i o n a n d a n a l y s i s

ORGANIZATION FOR ORGANIZATION FOR SURVEILLANCESURVEILLANCE

p r o m p t , r e l e v e n t t o t a r g e t g r o u p M e e t i n g s & d i s s c u s s i o n s D i s s e m e n a t i o n b y c o m m i t t e e

F e e d b a c k & d i s s e m e n a t i o n

STAFF HEALTH PROMOTION AND STAFF HEALTH PROMOTION AND EDUCATION:EDUCATION:

1. HCW are at r isk of acquiring infection, they can also transmit infection to patients and other employee.

2. Employee health history must be reviewed, immunizations recommendations to be considered.

3. Release from work if sick, occupation injury must be notif ied.

4. Continuous education to improve practice,

better per formance of new techniques.

UNCETDG ICAO IATA

TRANSPORT OFINFECTIOUS SUBSTANCES

Scientific background to the 13th revised edition of the UN Model Regulations regarding the requirements for transporting infectious

substances

2003

AIR TRANSPORT OF INFECTIOUS SUBSTANCES

International Air Transportation Association (IATA) Infectious Substances Shipping Guidel ines

Biomedical Waste

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Biomedical wasteDefinition:

Biomedical waste is defined as waste that is generated during the diagnosis , treatment or immunization of human beings and are contaminated with patients body fluids.(WHO)

Biomedical waste incudes :

-Syringes ,needles, ampoules,

-Organs and body parts

-Dressings ,disposable plastics

-Microbiological waste.

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Aims of biomedical waste managements

• To protect the risk of spreading diseases. • To protect health & well being of health care workers & the

community.• To protect injury & potentially fatal infection.• To provide environment friendly waste management

solutions.• To promote the quality & sustainability of the environment.

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Sources of biomedical waste

• Government hospitals.

• Private hospitals.

• Nursing homes.

• Physicians/ dentist clinic.

• Dispensaries.

• Medical research and training establishments.

• Blood banks ,collection centres, laboratories.

• Animal houses ,slaughter houses.

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Hospital wasteHospital wastes - considered as hazardous ► A variety of potentially hazardous ingredients : antibiotics, microorganisms ,Cytotoxic drugs , corrosive chemicals & radioactivesubstances -part of hospital waste

Distribution Of hospital waste

WHO Regional office south east Asia NHRC 80 % general waste, 75—90 % Non hazardous or general waste 15 % pathological & infectious waste, 10—25 % as hazardous waste. 1 % sharps, 3 % hazardous ,chemical or pharmaceutical waste & < 1 % special waste like radioactive or cytotoxic , pressurized containers

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Classification of Hospital waste:- According to WHO guidelines:-According to WHO guidelines:-• Infectious waste• Pathological waste• Sharps• Pharmaceutical waste• Genotoxic waste eg. certain cytotoxic or radioactive waste from

oncology & radiotherapy unit• Chemical waste• Pressurized containers• Radioactive waste• General waste

NHRC classified health care waste only 3 categories

• Non-hazardous waste or General waste• Hazardous or contaminated waste• Sharps (Whether infected or not)9/18/2014

Classification of waste

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Hospital waste

Hazardous Non-hazardous

Potentiallytoxic

Infectious biodegradableNonbiodegradable

Peels of fruits and vegetables -wrapping foils

-Plastic foils

-cytotoxic drugs

-toxic chemicals

-Radioactive

waste

• Infectious

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Sharps Non-sharps

Hypodermic needles with syringes attached

-disposable knives, scalpels, blades, scissors,

forceps

-glass Pasteur pipettes, slides & cover slips

-broken glass, ampoules & vi

Non-sharps

• Patient contaminat

ed

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Laboratory

plastics

disposable syringes

-IV sets

Catheters

ET tubes

Non-plastics

-cotton

-gauze

-dressing

Laboratory

Specimens:

-blood

-body fluids

-pus

-food samples

-secretions

-excretions

Microbiological lab waste:

-all cultures made from specimen

-all other stock organisms

-used disposable loops, rods,

pipettes

-paper towel & tissues

-disposable gloves & gowns

- Tissues

- Anatomical parts

- Animal carcasses

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Categories of persons exposed to risk of infection

• Patients attending the health care facilities.

• Medical and paramedical person providing health care.

• Persons involved in collecting and disposing the waste material.

• Those involved in cleaning the instruments, floor surfaces and washing of glass wares and linen.

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Health hazards associated with biomedical waste management

• Injuries from sharps to all categories of hospital persons.(HIV and HBV)

• Nosocomial infection in patient from poor infection control and poor hospital waste management.

• Risk of infections outside hospitals for waste handlers, scavengers and general public.

• Risk associated with hazardous chemicals.

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Hospital waste management

• The general principle involved in the treatment of hospital waste is that all infectious or potentially infectious waste must be rendered non infectious before leaving the hospital.

• Whole hospital kept clean & in satisfactory state of hygiene to prevent spread of infection from patients to patient, health care workers or vice versa ,

• prevention of infection outside hospital , careful management of waste from the point of generation to safe disposable is of paramount importance.

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Management of Hospital wasteSteps:

1. Identification / Categorization

2. Handling

3. Segregation (Separation)

4. Storage & transportation

5. Waste treatment Chemical /Incineration /Autoclaving /Microwaving

/plasma torch/hydroclaving

6. Disposal

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1. Identification / CategorizingAlso known as Waste survey

• Important component of waste management. • Help evaluating both type & quantity of waste. • Determine the points of generation & type of waste

generated each points. • To find out type of disposable carried out. • Determine the type of disinfection needed. • Appropriate way of identifying biomedical wastes &

sorting them into colored plastic bags or containers

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Categories of Bio-medical WastesCategory

Type of waste Treatment & disposable option

1 Human anatomical wastes(Human tissues,organs & body parts )

Incineration /Deep burial

2

Animal wastes(Animal tissues, organs, body parts, carcasses ,bleeding parts , experimental animal used research waste by veterinary hospital)

Incineration /Deep burial

3

Microbiology & Bio-technology wastes(Waste from laboratory cultures, stocks or specimens of micro organisms , live attenuated vaccines, human & animal cells used in research , waste from biological production, toxins)

Autoclaving /Microwaving /Incineration

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Contd..

4

Waste sharps ( Needles, syringes , scalpels, blades,glass etc capable puncture & cut)

Chemical (Disinfection) Autoclaving

5

Discarded medicines & cytotoxic drugs Incineration/ Destruction in landfills

6Soiled wastes( items contaminated with blood& body fluids eg. cotton , dressing)

Incineration / Autoclaving

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Contd..

7

Solid wastes (eg . tubing, catheters , IV set)

Disinfection by chemical treament/ Autoclaving

8

Incineration ash Disposable in municipal land fills

9

Chemical wastes ( used in biological production, in disinfection)

Chemical treatment &discharge into drains for liquid & secured land fills for solids.

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2. Handling of wastes

• Precautions while dealing infectious wastes:- - Bins & bags labeled with biohazard symbol - personnel involved provided with protective wear &

properly trained. -Polythene bags , bins should change when they are ¾ th

full -Polythene bags sealed /tied at top whenever transported

within or outside hospital. -Disposables items like gloves ,syringes, IV bottles,

catheters etc have to be shredded, cut that they not recycled/reused.

-Extreme care taken while handling sharps

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Handling of sharps :-

•Put Heavy duty glove while dealing sharps

•Sharps should not be left casually on counter tops, food trays or beds can result injury

•Recapping needles should be discouraged

•Specific color coding should be used with biohazard sign.

•Infectious & non infectious kept separately .

•Collect sharps in puncture proof containers.

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3. Segregation (Separation)

Biomedical waste must be stored in a secure environment all the times.

The various types of biomedical waste should be segregated from each other .

Fluid waste should be contained separately from solid waste.

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RED BIN

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YELLOW BIN

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BLACK BIN

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DISPOSAL OF SHARPS

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4. Storage & Transportation of wastes

► storage site

• Situated on ground floor near rear entrance.

• sufficient capacity at least for 2 days.

• With good flooring, light, ventilation , water supply & drain.

• Full time store keeper must be there.

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Transportation of waste:

1.Container properly sealed & Labelled .

2. Double Bagging are picked at neck

3. Manual handling better avoided.

4. After removing of bags container must be disinfected.

5. Waste bags should be transported in covered wheeled

container.

6. Vehicles used must be label with biohazard sign.

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7. Yellow bags ( Hazardous waste) & Black bags ( General

waste) collect on separate trolleys while transport.

8. The collection route shall be the most direct from one to the

final collection

9. All vehicles are decontaminated , cleaned & disinfected

after use.

10.Waste should be transported during low patient flow.

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Yellow bags ( Hazardous waste) & Black bags ( General

waste) collect on separate trolleys while transport.

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Packing & shipping infectious substancesUS public health service label requirements

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Etiological agent

Biomedical materialBiomedical material

In case of damage Or leakage

Notify Director CDCAtlanta,GA

404 -633- 5313

5. Waste treatment Chemical Disinfection:

Is required for for plastic, rubber and metallic items before they are send to final disposal.

1% hypochlorite solution is used.

Autoclave:

Is effective for microbiology and biotechnology waste. Microwave irradiation:

also useful in sterilizing the infected disposable waste. Shredder: For plastic material cut the plastic waste into

small pieces of 1cm size.

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6. DISPOSALIncinerationPrinciple• It is a high temp ( 800 – 900 ^0 c), dry oxidation process which

reduces organic & combustible waste into inorganic , incombustible matters.

• Incineration is burning of contaminated waste to destroy and kill micro-organisms.

• Used for the waste that cannot be reused or recycled or disposed in landfill site.

• Demerits – toxic air emission .- presence of heavy metal in ash.

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Plasma arc technology:

• Operates on principle of an electric arc between two electrodes.

• There is no burning and no formation of ash.

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Landfill:-

1 open dumps: not recommended.

2. Sanitary landfills:

Most satisfactory where suitable land is available.

Adequitely compacted & covered with earth soil at the end of working day.

Points to be remembered for landfill:

1Site should be away from residental areas or water sources.

2 there should be appropriate engineering preparation.

3 Have easy transportation facility.

4.Constant supervision.

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Pits for sharps:-Pits for sharps:-

• To avoid recycling of sharps their burial in safe pit is an effective & economical

• Ideal pit 5 ft deep circular with 3 ft Diameter Slab on top Pit plastered from inside

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Deep burial

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REFERENCES:-Topley and wilson’ microbioloy and

microbial infections,vol.2,4 9 t h ed.Microbiology and infection control for health

professionals. Gary Lee and Penny Bishop,3 r d ed.

Laboratory Biosafety Manual 3 r d WHO 2004WWW.CDC.gov/biosafety http://www.who.int/research/en/ http://en.wikipedia.org/wiki/BiosafetyHandbook of bioterrosim and biodefense

-Erik De Clercq and Earl R Kern

THANK YOU! HAVE A NICE DAY!!