sanitation,waste management

Slide 1

Welcome 1Anupama krishnan V.P.S.V Ayurveda College Kottakkal

Dr Anupama KrishnanDept of SwasthavrithaV.P.S.V Ayurveda College Kottakkal

Sanitation,Hygiene Waste Disposal2anupama krishnan vpsv ayurveda collegee kottakkal

3anupama krishnan vpsv ayurveda collegee kottakkal


Sanitation is more important than independence


Way bck in 1923 mg Has quoted .swach bharat abhyan is amere continaurion5

Clean Past


We are sp proud of earlier civilization where there has been due considerstion for sanitation6

Incredible or Non credible


But what is current state . Land of 30000 godgodliness id near to clenliness then incredible indis is it incredible or less credible..self ciritiszm is a evolvd science7


s


Gods own10anupama krishnan vpsv ayurveda collegee kottakkal


Actually



INDUSRIALISATION


14

Great Sanitary Awakening (1800s-1900s)Growth in scientific knowledgeHumanitarian idealsConnection between povertyand diseaseWater supply , sewage removalMonitor community health status


The great sanitary awakening is the birth of modern public health:Great strides in scientific knowledge to help understand the origin and treatment of disease.Interest in humanitarian idealsAcknowledgement of the connection between poverty and disease.Even today, poverty is the single best predictor of poor health.Returning to what the Romans had figured out, new infrastructure for clean water and sewage removal Birth of a system to monitor the health status of communities

BackgroundAshton (1990) describes four phases of the development of modern-day public health:An initial environmentally-focused phase which addressed infectious diseases related to urbanization, poverty and squalor. This phase lasted from the 1840s to the late 19th century.A second phase of personal preventive medical services related to immunization, family hygiene, health education and family planning which began with the development of vaccines in the late 19th century and lasted until the 1930s.A therapeutic era that began with the development of insulin and antibiotics in the 1930s and persists until today. Its focus is on improving population health through the provision of organized medical services deploying effective therapeutic technologies.A recognition that the environment is also social, economic and psychological and that healthy public policy (Hancock, 1982) is an appropriate part of this new public health.

Sanitary revolutionClean water; water treatmentFood inspectionSoaps, disinfectants, pharmaceuticalsPersonal hygiene (bathing)Public works departments; garbage collection, landfills, street cleaningPublic health departments and regulation16anupama krishnan vpsv ayurveda collegee kottakkal

The death rate in children drops and the average life span increases over the years from less than 40 to 74.

By 1900 -- Greater acceptance of the germ theory of disease begins to shift the job of garbage removal from health departments to public works departments. Health officers, it is felt, should spend their time battling infectious diseases, not cleaning up "public nuisances" such as garbage.

Background http://www.cleaninglink.com/Cleaning_Library/history_of_sanitation.htmhttp://www.nyc.gov/html/dos/html/history/history.htmlhttp://www.astc.org/exhibitions/rotten/timeline.htm

Lack of sanitation leads to disease, as was first noted scientifically in 1842 in Chadwick's seminal Report on aninquiry into the sanitary condition of the labouring population of Great Britain 17anupama krishnan vpsv ayurveda collegee kottakkal

Sanitation ??


What does it meanSanitation[sanitshn]Etymology: L, sanitas, health science of maintaining a healthful, disease free, hazard free environment

(Mosby's Medical Dictionary, 9th edition. 2009, Elsevier)19anupama krishnan vpsv ayurveda collegee kottakkal

Use of measures designed to promote health and prevent disease development and establishment of conditions in theenvironment favorable to health.[L. sanitas, health]

19

Safe management of human excreta, including its safe confinement ,treatment, disposal and associated hygiene-related practices.

National Urban Sanitation Policy (2008)20anupama krishnan vpsv ayurveda collegee kottakkal

Sanitation is a subject matter included in Entry 6 of the State List

Article 246 of Constitution of India21anupama krishnan vpsv ayurveda collegee kottakkal

Coverage

2.6 billion people lack access to improved sanitationTwo thirds of whom live in Asia and Saharan Africa More than half live in India, lack even an unimproved sanitation facility and must defecate in the open22anupama krishnan vpsv ayurveda collegee kottakkal

Consequence Every year, 1.5 million children die due to diarrhea caused by combined effects of inadequate sanitation, unsafe water supply, and poor personal hygiene Lack of sanitation contributes to about 10% of the global disease burden


1 billion people regularly defecate in the open (United Nations) Dramatic consequences on the human health, dignity and security One out of three women around the world lack access to safe toilets24anupama krishnan vpsv ayurveda collegee kottakkal

Disparity Improved sanitation Industrialised countries 99% Developing countries 53% Developing countries - urban sanitation coverage is 71% while rural coverage is 39%.


Regional disparities in sanitation coverage are huge. 25

Causing around 1.62.5 millionDeaths annually, among children under 5 years old living in developing countries


Africa every hour 115 person die Poor hygieneSanitation Contaminated water



India most number of people in world defecating in openAmong 1 billion population in India, 55% 650 million people still defecate in open



Ganga river is dumped 1.1million litres of raw sewage dailyOne gram of faecesOne million bacteriaTen million virusHundred worm eggsThousand cysts


Is it a big dealToilet seat of public bathrooms E.coli, streptococcus, hepatitis A virus Staphylococcus, shigella bacteria sexually transmitted organismsOpen defecation and lack of sanitation Leading causes for water-borne diseases like diarrhoea and stunted growth in children


. Some bacteria and viruses that you can find in toiletseat of public bathrooms include E.coli, streptococcus, hepatitis A virus,staphylococcus, shigella bacteria and sexually transmitted organisms.

32

Impact Diseases faecooral transmission pathwaySoil transmitted helminths - human roundworm, human whipworm, hookworms Infections every year in kidsAnaemia in pregnant women


Cause of failureAbout 50% of toilets built by a large government programme are not used for their intended purpose In India, for example, many toilets are used as firewood stores or goat sheds


Even when appropriate toiletsRECENT STUDY SHOWS 34

GainsImproved sanitation reduce rates of diarrhoeal diseases by 32%37%Reduce case by 391 milloion world wide


Major preventable killer,reduces by a third35

School attendanceSafeSeparateClean latrines


Enrollment and maintan of girl students more sustainable 36

Adequate sanitation good hygiene and safe water - fundamental to good health and to social and economic development


Where do we stand


Kerala CallsAbout 93,046 households do not have access to sanitary toilets About 32,425 of these households use shared toilet facilities Open defecation - 60,621 Adding to the fecal load in the environment


In absolutrvtermsThere by adding39

Keralacalls

Septic Tanks constructed rural areas or urban areas not as per IS Code (IS 2470: Part I) Without any impermeable floor making them Soak Pits in the technical sense In localities where the water table isgenerally high, an overflow pipe is found to be provided at the outlet of the Septic Tank directly feedinga canal or a drain or a water b40anupama krishnan vpsv ayurveda collegee kottakkal

Ray of hope ..Kerala Total Health and Sanitation MissionClean Kerala program under Rural Development DepartmentWithin three years - 413,000 latrinesKerala currently highest coverage of individual household latrines in India


41

State Level Sanitation Committee


Government of Kerala established

42

Suchitwa Mission Kudumbashree General Education Department Health & Family Welfare DepartmentKerala State Pollution Control BoardKerala Water Authority Town Planning Department


Suchitwa missionPackage of Practices Personal hygieneSafe disposal of human excretaHome sanitation food hygieneSafe handling drinking waterLiquid waste managementSolid waste managementCommunity environmental sanitation


Goal of KeralaState Sanitation StrategyEnsuring 100 percent hygienically safe sanitationAwareness sustained behavioral changeAchieving Open Defecation Free CitiesImproved Institutional governance Human resource capacities for city-wide Sanitation


ENHANCED ,Move towards

45

RoleSocial scientistsBehaviour change ExpertsHealth professionals Individual people


TOLIET SCAM46

FOCUS47anupama krishnan vpsv ayurveda collegee kottakkal

47

Community Led Total Sanitation

Ignite community awareness Encourages a cooperative participatory approach ending open defecationCreating a clean, healthy, and hygienic environment from which everyone benefits


v open defecation contaminates environment and the water and food ingested by householders

48

Activities undertaken to assure the conditions in which people can be healthy

Organized community efforts to prevent, identify and counter threats to the health of the public.


Why Ayurveda Public Healththe science and art of pre-venting diseases, prolonging life, promoting health ,efficiency through organized community efforts. (CEA Winslow ,1920)50anupama krishnan vpsv ayurveda collegee kottakkal

50

Ayurveda Role Environmental sanitationControl of community infections Healthy lifestyle , personal hygieneEarly diagnosis, preventive treatment


Activity Explore Survey hand washing practices Observe behavior of people using public toilets (flush before using urinal, wash hands after using urinal) DiscoverWay people wash their hands ( wash rigourously, use of soap )Peoples view on open defecation and urination52anupama krishnan vpsv ayurveda collegee kottakkal

52

ThinkWays to promote encourage people to wash hands Surroundings after visiting toilet Spreading awareness about different toilet manners ActHow clean are your hands? Putting up posters of toilet etiquettes near washbasins Appointing hand-wash monitors53anupama krishnan vpsv ayurveda collegee kottakkal

United Nations has dedicated November 19th for promoting World Toilet Day

Bring into limelight plight of all those people who do not have access to a toilet - despite this being their basic right


Food Sanitation


Process of handling food in ways that are clean and healthy






BHOOMIYUDE AVAKASHIKAL60

Food we Serveanupama krishnan vpsv ayurveda collegee kottakkal61

Storing food like this?






Food Infection - microbial infection resulting from ingestion of contaminated foods

Food Intoxication - type of illness caused by toxins


Under favorable condition certain bacteria produce chemical compounds called toxins

67

Food Spoilage - means original nutritional value, texture, flavor of food are damaged, food become harmful to people and unsuitable to eat.

Food borne Illness A disease carried or transmitted to people by food.


Types of food contaminantsBiological Contaminant

Physical Contaminant

Chemical Contaminant


Biological contaminant - may cause a food borne illness (bacteria, viruses, fungi, parasites, biological toxins)

Examples Sea food toxins Mushroom toxinsClostridium BotulinumSalmonella bacteria


Preventing Biological contaminantPurchase foods only on reputable supplierDo not use wild mushroomsMaintain good personal hygiene Observe proper hand washingClean and sanitize equipmentMaintain clean and sanitize facilitiesControl pests ** Cooking does not destroy toxins**


Physical Contaminant any foreign object that accidentally find its way into food

HairStaple wireDustMetal shavingsNailsEarringsHair clipsPlasticsMetal

Glass fragmentsInsectsExtraneous vegetable matterStones


Preventing Physical ContaminantsWear hair restraintAvoid jewelry cooking holding foodsDo not carry pencil or penDo not wear nail polish or artificial nailsClean can openers


Chemical Contaminant a chemical substance that can cause food borne illness. Substances normally found in restaurant

Toxic metalsPesticidesCleaning productSanitizersPreservatives


Preventing Chemical Contaminants

Store chemicals in original containers to prevent accidental misuse, as well as leakage into foodMake sure labels are clearly identify chemical contents of chemical containersWash hands thoroughly after working with chemicals


Utensils and equipment containing potentially toxic metals

LeadCopperBrassZincAntimonyCadmium


Main Causes of Food Borne IllnessCross- ContaminationTime-Temperature AbusePoor Personal Hygiene


Cross Contamination

Microorganisms are transferred from one surface or food to another

Hand to foodFood to foodEquipment to food


PreventingHand to food Wash hands properlyCover cuts, sores and woundsKeep fingernails short, unpolished & cleanAvoid wearing jewelry, except for plain ring


When to wash hands?Before:

Beginning food preparationPutting on disposable glovesServing customers

After:Arriving at work and after breakUsing the restroom, washing sinksEating, drinking, smoking, chewing tobacco and gumsUsing the telephoneUsing handkerchief or tissue

Using handkerchief or tissue Handling inventory Handling raw foods Touching or scratching a part of the body Coughing, sneezing Handling garbage Touching dirty surfaces80anupama krishnan vpsv ayurveda collegee kottakkal

Food to Food ContaminationWhen harmful organisms from one food contaminate other foods. (raw meats, thawing meat on top of the shelf where it can drip on the other foods)


Preventing food to food contaminationWash fruits & veg, in a cold running waterDo not let raw meat and raw vegetables be prepared on same surface at same time


Equipment to Food Contamination

Use separate cutting boards for different foods (meat- veg)Prepare raw foods in separate area from fresh and ready to eat foodsClean & sanitize equipment, work surfaces & utensils after preparing each foodsUse specific containers for various food products.Make sure cloth paper towel use for wiping spills not used for any other purposes


Time Temperature AbuseFood is exposed to Temperature Danger Zone (41F - 140F) for more than 4 hrsFood is not stored, prepared or held at a required temperatureFood is not cooled low enough fastFood is prepared in advance and not set to a safe required internal temperature while the food is on hold


Potentially Hazardous FoodsFood items support rapid growth of food borne disease microorganisms areHigh in protein High in moisture pH ( 4.5 or higher)


FishMeat (beef, pork, lamb)Milk & milk productsCooked rice, beansTextured Soy ProteinAnd meat alternatives

Sea foods Sprouts & raw seeds Sliced melonsEggsBaked/boiled potatoesGarlic in Oil Mixture


86

Food products requiring refrigeration should be stored at temperature of 40F (4.4C) or belowSafe temperatures 40F (4.4C) or below and 140F (60C) or aboveAny temperature between 41F (5C) and 139F (59C) is in the DANGER ZONE


Food products may have danger zone during some periods of preparationFood is being mixed with other ingredients, chopped, or formed - danger zoneAt each stage of preparing and servingProduct may be exposed to unsafe temperatures and chance of becoming contaminated


Goal in temperature control - minimize time PHF are in danger zoneThree hours cumulative time is maximum such food can be in the danger zone and not be a health hazardAfter 4 hours in danger zone, enough bacteria may have grown in food to cause foodborne disease outbreaks


Items such as flour, sugar, rice should be stored in their original containers Placed in metal containers with tightly fitting lids ,protected from excessive heat ,moistureImproper storage - rodent or insect infestation or from deterioration by excessive heat or moisture


Acid food or beverages, potato salad, tomato juice, lemonade, citrus fruit drink, or other acidified drinks, must never be stored or served in galvanized container

Capable of dissolving the zinc which can cause heavy metal poisoning


Poor Personal Hygiene


Food handlers are carriers of disease causing bacteria. Food service personnel can contaminate food.

92


93

When to wash hands?

Using handkerchief or tissue Handling inventory Handling raw foods Touching or scratching a part of the body Coughing, sneezing Handling garbage Touching dirty surfaces


Good Personal HygieneMedicines should be kept inside Locker and away from foodsClean and cover cuts and woundsNever use bare hands when handling ready to eat foodsDisposable gloves should be used onceTake a bath everydayWear appropriate attireRefrain from wearing jewelry, make ups, and nail polishObserve proper hand washing procedures at all times95anupama krishnan vpsv ayurveda collegee kottakkal

When tasting foods, use a spoon other than the one used for stirring . Use a clean spoon for each person tasting and for each time food tasted


anupama krishnan vpsv ayurveda collegee kottakkal97Employee responsibilitiesNo food or drink in storage, processing & packaging areasNo use of gum or tobacco in food handling areasInjuries, infections, disease must be reportedWash hands thoroughly

RememberFoods containing enough microorganisms or toxins to cause food borne diseases May not have any changes in odor, taste, or appearance


LOOKS CAN BE DECEPTIVE.FIRST IMPRESSION NED NOT B BST98

Semiperishable Food. Vegetables, such as potatoes and onions, are stored in a dry place ondunnage so air can circulate around them, thus retarding decay and spoilage.(1) Screened food boxes may be used to keep such items as bread for a short period. Thesescreened boxes are suspended to permit free circulation of air and to protect the food from insects and



Hospital SanitationEnsure proper treatmentReduce suffering NOT more harmDaily cleaning everywhereWeakened ppulation 5 % to 30 %


Develop avoidable infection101

Nosocomial Infections or hospital acquired infections Acquired during or as a result of hospitalizationAny patient who develops an infection after 48 hours of hospitalization considered to have nosocomial infection


Healthcare-associated infections (HAIs) occur worldwide

1.4 million people worldwide suffer from infections acquired in hospital103anupama krishnan vpsv ayurveda collegee kottakkal

AFEECTS DEVELPOING DEVELOPED103

People who carry bacteria without evidence of infection (fever, increased white blood cell count) are colonized

If an infection develops, it is usually from bacteria that colonize patients


104People who carry bacteria without evidence of infection are colonized.If an infection develops, it is usually from bacteria that colonize patients.Bacteria that colonize patients can be transmitted from one patient to another by the hands of healthcare workers.

Iceberg Effect

Infected

Colonized105anupama krishnan vpsv ayurveda collegee kottakkal

105 This iceberg graphically represents colonization versus infection. Those patients that are infected with an organism represent just the tip of the iceberg of patients that are colonized or infected. Just because a patient is not infected, or showing signs of infection, does not mean that they do not carry organisms that could be transferred to another patient if proper hand hygiene and other infection control precautions are not taken.

Bacteria that colonize patients can be transmitted from one patient to another by the hands of healthcare workers

Bacteria can be transmitted even if the patient is not infected


Hands of healthcare providers most common vehicle for the transmission ofMicroorganisms from patient to patientPatient to equipment and environment

Equipment and environment to the patient own body107anupama krishnan vpsv ayurveda collegee kottakkal

Providers hands continuously touch surfaces and substances including inanimate objects

Patients intact or non-intact skin, mucous membranes, food, waste, body fluids and healthcare providers own body


During the delivery of healthcare,healthcare

108

Key TermsPatient zone- includes the patient, surfaces and items that are temporarily and exclusively dedicated to him/her

Health care area- all surfaces in health care setting outside of patient zone


Key TermsThe patient zone- includes the patient, surfaces and items that are temporarily and exclusively dedicated to him/her

The Health care area- all surfaces in the health care setting outside of the patient zone

109

Patient zonePatient Immediate surroundings - surfaces that are touched by or in direct physical contact with the patient-Bed rails-Bedside tables-Bed linens-Tubing-Medical equipment


The patient zoneThe patient zone contains:Patient XImmediate surroundings - surfaces that are touch by or in direct physical contact with the patient-Bed rails-Bedside tables-Bed linens-Tubing-Medical equipment

110

Any item designed for reuse or temporarily exposed to patient decontaminated when entering leaving patients surroundings

Computers Shared bathrooms Tables or equipment Wheelchairs


The Patient zones is not a static geographical area it changes and accompanies the patient in the health care area where every the patients stays or goes

The patients surroundings are contaminated by the patients own flora therefore any item designed for reuse or temporarily exposed to the patient should be decontaminated when entering and leaving the patients surroundings

Things such as :ComputersShared bathroomsTables or equipment used for physical therapy Wheelchairs111

Health-care Area

Is everything outside of patient zone

Hand hygiene while caring for patients helps to protect wider health care environment from contamination by patients germs


The Health-care AreaIs everything outside of the patient zone:Hand hygiene while caring for patients helps to protect the wider health care environment from contamination by patients germs

112

Adherence to hand hygiene recommendations is the single most important practice for preventing the transmission of microorganisms in healthcare and directly contributes to patient safety.113anupama krishnan vpsv ayurveda collegee kottakkal

Clean Care is Safer Care

Ensure that infection control is acknowledged universally as a solid Essential basis towards patient safety and supports the reduction of healthcare-associated infections ..


GOAL114

InterventionHand scrub with chlorinated lime solution

Hand hygiene basin at the Lying-In Womens Hospital in Vienna, 1847.115anupama krishnan vpsv ayurveda collegee kottakkal

115 In May 1847 Semmelweiss insisted that students and physicians clean their hands with a chlorine solution, similar to the one pictured here, between each patient in the clinic.

Hand hygiene removal of visible soil and removal or killing of transient microorganisms from handsAll humans carry microorganisms on their skinTwo groups Transient and Resident flora


Hand hygiene includesmaintaining the good skin integrity resulting from a hand care program Hand hygiene includessurgical hand preparation.maintaining the good skin integrity resulting from a hand care program Hand hygiene includes

surgical hand preparation.All humans carry microorganisms on their skin. These have been divided into two

116

Transient (or contaminating) microorganisms contaminate the upper layers of skin Acquired during direct contact with patients, healthcare providers, contaminated equipment or environmentTransient microorganisms may also be easily passed on to others or to objects in environment and are a frequent cause of HAIs117anupama krishnan vpsv ayurveda collegee kottakkal

Resident flora are found in deeper layers of skin and are more resistant to removalDo not generally cause HAIsBeneficial to good health of skin


Why learn Hand Hygiene? Hand hygiene is the most important way to prevent the spread of germsReduce number of germs on hands and helps reduce spread of germs to family, friends, coworkers, patients, residents or clientsUsing appropriate hand hygiene prevents contamination of the patients, clients, or residents environment


119

How to perform hand hygiene

Alcohol-based hand rub

Soap and water

Without water when hands are soiled120anupama krishnan vpsv ayurveda collegee kottakkal



Steps on how to wash hands when visibly soiled (otherwise, use hand rub.. Duration of40-60 seconds)Step 0 - Wet hands with water.Step 1- Apply enough soap to cover all hand surfaces.Step 2 - Rub hands palm against palm.Step 3 - Right palm over left dorsum with interlaced fingers and vice versa.Step 4 - Palm against palm with fingers interlaced.Step 5 - Backs of fingers to opposing palms with fingers interlocked.use towel129anupama krishnan vpsv ayurveda collegee kottakkal

Step 6 - Rotational rubbing of left thumb clasped in right palm and vice versa.Step 7 - Rotational rubbing, backwards and forwards, with clasped fingers of right handin left palm and vice versa.Step 8 - Rinse hands with water.Step 9 - Dry hands thoroughly with a single use towel


Effective Hand HygieneKills or removes transient microorganisms on the skin and maintains good hand health Hand sanitizing with a 70 to 90% alcohol-based hand rub (ABHR) Preferred method (when hands are not visibly soiled) for cleaning hands131anupama krishnan vpsv ayurveda collegee kottakkal

ABHR in healthcare settings takes less time than traditional hand washinglviii and has beenshown to be more effective than washing with soap (even using an antimicrobial soap) andwater when hands are not visibly soiled lix, lx, lxi

131

Effective Hand HygieneAlcohol-based hand rub (ABHR)Should contain 70 90% alcoholTakes less time than hand washingMore effective than hand washing with soap and water when hands are not visibly soiled132anupama krishnan vpsv ayurveda collegee kottakkal

Common types of alcohols used include ethanol,isopropanol or combinations Antimicrobial action of ethanol and isopropanol similarEthanol has greater activity against viruses than isopropanolWHO recommended formulations contain either 75% v/v isopropanol, or 80% v/v ethanol


Mechanical rubbing action is important to kill transient microorganisms Less drying to hands than soap and water


Efficacy of ABHRDepends on the quality of product, the amount of product used, timeSpent rubbing ,hand surface rubbedNOT be used with water, water willDilute alcohol and reduce its effectivenessABHR should NOT used immediately after hand washing with soap and water


Hand washing with soap and running waterPreferred when hands are visibly soiled alcohol is inhibited by organic matterMechanical action of washing, rinsing and drying removes most transient microorganisms


Efficacy of Soaps

Plain soaps act on hands by emulsifying dirt and organic substances (e.g., blood, mucous), which are then flushed away with rinsing

Atleast 15 seconds of lathering with soap is required to remove transient flora


Antimicrobial agents in plain soaps are only present as a preservative.137

Antimicrobial soaps have residual antimicrobial activity Not deactivated by presence of organic materialAntimicrobial soap may be considered for use in critical care areas138anupama krishnan vpsv ayurveda collegee kottakkal

Studies have shown that antimicrobial soap is more effective than plain soap andwaterclxvi, clxvii, clxviii, clxix, clxx in critical care settings such as intensive care units and burn units.

138

If hands are visibly soiled and running water is not availableUse a moistened to wetted to remove visible soil, followed by ABHR139anupama krishnan vpsv ayurveda collegee kottakkal

Soap Formulations and Product Selection

Liquid products should be dispensed in a disposable pump/cartridge that are discarded when empty.Dispenser should never be topped-up or refilledBar soaps for hand hygiene should NOT be used in healthcare facilities except for personal use by a single patient140anupama krishnan vpsv ayurveda collegee kottakkal

but is not required and not recommended in other care areas.

140

In this case, the soap should be supplied in small pieces that are single-patient use

Bar should be stored in a soap rack to allow drainage and dryingDiscarded on patient discharge


Hand Hygiene Indications

Before initial contact with a patient or items in their environment; this should be done on entryRoom or bed space, even if patient has not been touched Before putting on gloves;Before preparing, handling or serving food or medications to a patientAfter care involving contact with blood, body fluids, secretions and excretions of a patient,Immediately after removing gloves and before moving to another activity


Immediately after removing gloves and before moving to another activity When moving from a contaminated body site to a clean body site during healthcare After contact with a patient or items in their immediate surroundings when leaving,even if Patient has not been touchedWhenever in D O U B T..


When to perform Hand Hygiene


144

My Five Moments for Hand Hygiene


Before touching a patientWHEN? Clean your hands before touching a patientWHY? To protect the patient against harmful germs carried on your hands146anupama krishnan vpsv ayurveda collegee kottakkal

protect the patient from harmful organisms carried on your hands.

Before taking temperature, blood pressure or pulse

Before making someone comfortable in bed147anupama krishnan vpsv ayurveda collegee kottakkal

Before clean or aseptic procedureWHEN? Clean your hands immediately before performing a clean or aseptic procedure.WHY? To protect the patient against harmful germs, including the patient's own


Clean your hands immediately before any aseptic or clean procedure to protect the patient against harmful organisms.

Handling dressings or touching open wounds Performing invasive proceduresPrevents the patients own organisms from entering his or her body.149anupama krishnan vpsv ayurveda collegee kottakkal

After body fluid exposure riskWHEN? Clean your hands immediately after an exposure risk to body fluids (and after glove removal).WHY? To protect yourself and the healthcare environment from harmful germs of patient150anupama krishnan vpsv ayurveda collegee kottakkal

Clean your hands immediately after an exposure risk to body fluids (and after glove removal)

Contact with blood, bodily fluids, non-intact skin or mucous membranes, Removal of glovesContact with contaminated items151anupama krishnan vpsv ayurveda collegee kottakkal

After touching a patientWHEN? Clean your hands after touching a patient and patients immediatesurroundings.WHY? To protect yourself and healthcare environment from harmful germs from the patient152anupama krishnan vpsv ayurveda collegee kottakkal

Clean your hands when leaving the environment after touching patient.

Shaking handsTransferringMaking someone comfortable in bedHelp protect yourself and the health care environment from harmful patient organisms.153anupama krishnan vpsv ayurveda collegee kottakkal

After touching patient surroundingsWHEN? Clean your hands after touching any object or furniture in the patientsimmediate surroundings even if patient has not been touched.WHY? To protect yourself and healthcare environment from harmful germs from patient.


Clean your hands when leaving after touching any object or furniture in the patients environment

Contact with roomContact with equipmentContact with wheelchair or stretcher155anupama krishnan vpsv ayurveda collegee kottakkal

Point-of-care Place where three elements occur together: PatientHealthcare provider Care or treatment involving patient contact


. Point-of-care products should be accessible without leaving the patient.156

Intact skin is the bodys first line of defence against infection Careful attention to hand care essential part of the hand hygiene program Dermatitis, cracks, cuts or abrasions can trap bacteria and compromise hand hygieneDermatitis also increases shedding of skin squames and, therefore, shedding of bacteria157anupama krishnan vpsv ayurveda collegee kottakkal

. A common barrier to compliance with handhygiene is the adverse effects of products on the skin.

157

30% of healthcare providers report symptoms or signs of dermatitis 85% give a history of having skin problemspromoting skin integrity through providing good hand hygiene products correct techniques for hand hygiene vital for safety of both healthcare provider and patients


ImpedementsLong nails are difficult to clean, can pierce glovesHarbour more microorganisms

Keep natural nails clean and short nail should NOT show past end of the fingerArtificial nails and nail enhancements should NOT be worn


Nail polish or nail polish worn longer than 4 days can harbour microorganisms that are NOT removed by hand washing, even withNail polish should NOT be worn by those having direct contact with a patientBare below elbows


Impedements

Rings, hand jewellery, bracelets and wrist watches should not be worn when performing hand hygiene. Jewellery, which hides bacteria and virusesRings, which increase the number of microorganisms present on handsIncrease risk of tears in gloves Eczema, which often starts under a ring as irritants may be trapped under ring causing irritation


Hand Hygiene Policies and Procedures

indications for hand hygiene how to perform hand hygiene selection of products used for hand hygieneappropriate placement of hand hygiene productsmanagement of product dispensing container hand care programuse of ABHR as the preferred method of hand hygienehand hygiene compliance and feedback162anupama krishnan vpsv ayurveda collegee kottakkal

For each healthcare setting, a written hand hygiene policy and procedure should be developed thatincludes the following162

Technique for Hand WashingThe following procedure should be used for handThe following procedure should be used for hand washing (refer to Appendix B, Techniques forPerforming Hand Hygiene, for more information):a) remove hand and wrist jewellery; long sleeves or jewellery should not interfere with, orbecome wet when performing, hand hygiene;clxxxiiib) wet hands with warm (not hot or cold) running water;c) apply liquid or foam soap;d) lather soap covering all surfaces of hands for a minimum of 15 seconds;clxxxiv frequentlymissed areas are finger tips, between fingers, backs of hands and base of the thumbs;e) thoroughly rinse soap from hands using running water;f) dry hands thoroughly with a paper towel; andg) turn off taps with paper towel, to avoid recontamination of the hands.163anupama krishnan vpsv ayurveda collegee kottakkal

Technique for Using an ABHRThe following procedure should be used forensure hands are visibly clean (if soiled, follow hand washing steps);b) remove hand and wrist jewellery; long sleeves or jewellery should not interfere with, orbecome wet when performing, hand hygiene.c) apply one to two full pumps of product onto one palm; the volume should be such that 15seconds of rubbing is required for drying;d) spread product over all surfaces of handsclxxix; frequently missed areas are finger tips,between fingers, backs of hands and base of the thumbs; ande) continue rubbing hands until product is dryclxxx, clxxxi; this will take a minimum of 15 seconds ifsufficient product is used.Hands should be fully dry before touching the patient or the care environment/equipment for theABHR to be effective.clxxxiiB. Technique for Hand Washing164anupama krishnan vpsv ayurveda collegee kottakkal

Sink use

Hand hygiene sinks shall not be dedicated to any other purposeSinks used for cleaning equipment or disposing of any waste fluids of any sort shall not be used for hand hygiene165anupama krishnan vpsv ayurveda collegee kottakkal

Hand hygiene sinks shall be constructed of a non-porous material such as porcelain, enamel, vitreous china, or 18+ gauge stainless steel Granite and marble are not acceptable materials for hand hygiene sinks166anupama krishnan vpsv ayurveda collegee kottakkal

Traps shall be metal, and gaskets shall be plastic or neoprene onlyTraps shall be 40 mm diameter. Overflows shall not be used, as difficulty of sanitizing them presents an unacceptable contamination risk.


StandardWash hands before and after all patient or specimen contactHandle the blood of all patients as potentially infectiousWear gloves for potential contact with blood and body fluids168anupama krishnan vpsv ayurveda collegee kottakkal

Prevent needle stick/sharp injuriesWear personal protective equipment (PPE) while handling blood or body fluidsHandle all linen soiled with blood and/or body secretion as potentially infectious169anupama krishnan vpsv ayurveda collegee kottakkal

Wear a mask for TB and other contagious respiratory infections Correctly process instruments and patient care equipmentMaintain environmental cleanlinessFollow proper waste disposal practices170anupama krishnan vpsv ayurveda collegee kottakkal

Lets Review 5 Moments of Hand Hygiene are:1. Before initial patient or patient environment contact2. Before aseptic or clean procedures3. After body fluid exposureAfter contact with patient After contact with patient environment


GlovesGloves should NOT be used in place of proper hand hygiene Hand hygiene should be performed before donning gloves and after glove removalDry hands completely before donning gloves same pair of gloves should NOT be used for the care of more than one patient Gloves should be removed immediately and discarded after activity




Gloves should be changed or removed when moving from a contaminated body site to a clean body site within the same patientGloves should be changed or removed after touching a contaminated environmental surface Disposable gloves should NOT be washed or re-used175anupama krishnan vpsv ayurveda collegee kottakkal

Wear gloves ,contact with blood or infectious materials, mucous membranes, non intact skin, potentially contaminated intact skin

Disposable medical examination gloves for providing direct patient care176anupama krishnan vpsv ayurveda collegee kottakkal

(for example, with stool or urine in anincontinent patient) could occur.

176

Remove gloves after contact with a patient and /or the surrounding environment(including medical equipment) using proper technique to prevent hand contamination. Do not wear same pair of gloves for care of more than one patient.Do not wash gloves for the purpose of reuse177anupama krishnan vpsv ayurveda collegee kottakkal

Change gloves during patient care if the hands are moved from a contaminated body site (for example, perineal area) to a clean body site (for example, face).178anupama krishnan vpsv ayurveda collegee kottakkal

General Hand Basins -detergent and waterLockers - detergent and water as necessary and after patient discharge.Mattresses and Pillows -covered with an impervious plastic cover Wiped over with detergent and water if visibly contaminated179anupama krishnan vpsv ayurveda collegee kottakkal

Daily cleaning of mops thoroughly washed in a bucketContaining HOT water and detergentSqueeze as much water out of mop as possible and shake strands loose Leave hanging to dry in the sun Bucket should be turned upside down to allow overnight drainage


Toilet Brushes Should be rinsed in flushing water, and stored to dryWalls Remove visible soiling with detergent as necessaryClinic Trolleys Clean with a cloth dampened with detergent and water181anupama krishnan vpsv ayurveda collegee kottakkal

Bed used by the patient, and other equipment used for the patient should disinfected before use for another patient. Disinfection procedures should be carried out daily Sheets, pillow cases, and blankets should be changed on a daily basis and more often if soiling occursLinen should not be shaken in order to prevent182anupama krishnan vpsv ayurveda collegee kottakkal

How to prepare a disinfectant cleaning solution A disinfectant cleaning solution is one that contains both a disinfectant and a detergent (soap Chlorine-containing solutions NOT be mixed with cleaning solutions containing an acid (for example, phosphoric acid),ammonia or ammonium chloride (NH2Cl) Release chlorine gasTemporary illness (nausea, tearing, headache or shortness of breath)183anupama krishnan vpsv ayurveda collegee kottakkal

What is the single most important reason for healthcare workers to practice good hand hygiene?

To remove visible soiling from handsTo prevent transfer of bacteria from the home to the hospitalTo prevent transfer of bacteria from the hospital to the home To prevent infections that patients acquire in the hospital184anupama krishnan vpsv ayurveda collegee kottakkal

184 The correct answer is #4, to prevent infections that patients acquire in the hospital. All answers are good reasons to practice good hand hygiene. Improved adherence to hand hygiene has been shown to terminate outbreaks in healthcare facilities, reduce the transmission of antimicrobial resistant organisms, and reduce overall infection rates.

Healthcare-associated organisms are commonly resistant to alcohol.Strongly agreeAgreeDont knowDisagreeStrongly disagree185anupama krishnan vpsv ayurveda collegee kottakkal

185 The correct answer is disagree, or strongly disagree. To date, there have been no reported cases of organisms resistant to alcohol.

When a healthcare worker touches a patient who is COLONIZED, but not infected with resistant organism HCWs hands are a source for spreading resistant organisms to other patients.Strongly agreeAgreeDont knowDisagreeStrongly disagree186anupama krishnan vpsv ayurveda collegee kottakkal

186

When a healthcare worker touches a patient who is COLONIZED, but not infected with resistant organisms the HCWs hands are a source for spreading resistant organisms to other patients.Strongly agreeAgreeDont knowDisagreeStrongly disagree187anupama krishnan vpsv ayurveda collegee kottakkal

187 The correct answer is strongly agree or agree. Patients that are colonized but not infected with bacteria can still contaminate the hands of healthcare workers, who can then spread the organisms to other patients unless proper hand hygiene is practiced.

Use of artificial nails by healthcare workers poses no risk to patients.Strongly agreeAgreeDont knowDisagreeStrongly disagree


188

Use of artificial nails by healthcare workers poses no risk to patients.Strongly agreeAgreeDont knowDisagreeStrongly disagree


189 The correct answer is disagree, or strongly disagree. Even after careful handwashing, healthcare workers often harbor substantial numbers of potential pathogens in the subungual spaces. A growing body of evidence suggests that wearing artificial nails may contribute to transmission of certain healthcare-associated pathogens. Healthcare workers who wear artificial nails are more likely to harbor gram-negative pathogens on their fingertips than are those who have natural nails, both before and after handwashing.

Glove use for all patient care contacts is a useful strategy for reducing risk of transmission of organisms.Strongly agreeAgreeDont knowDisagreeStrongly disagree


190

Glove use for all patient care contacts is a useful strategy for reducing risk of transmission of organisms.Strongly agreeAgreeDont knowDisagreeStrongly disagree


191 The correct answer is strongly agree, or agree. For many years, authorities have recommended that healthcare workers wear gloves for three reasons: to reduce the risk of healthcare workers acquiring infections from patients, to prevent flora from being transmitted from healthcare workers to patients, and to reduce contamination of the hands of healthcare workers by flora that can be transmitted from one patient to another.

It is acceptable for healthcare workers to supply their own lotions to relieve dryness of hands in the hospital.Strongly agreeAgreeDont knowDisagreeStrongly disagree192anupama krishnan vpsv ayurveda collegee kottakkal

192 The correct response would be to either disagree, or strongly disagree. According to the HICPAC hand hygiene guideline, only hospital-supplied lotions should be used, as some lotions may affect the integrity of latex gloves and the efficacy of antimicrobial soaps or alcohol-based handrubs used in the facility.

Hygiene


Hygiene is healthy habits that include bathing, keeping the mouth clean, keeping the skin protected from the sun and washing hands frequentlyHygei GreekIndustrial revolution 1750- 1850


Hygiene and BehaviorHygiene is a key factor in reducing risk of sanitation-related diseasesHygiene behaviorMaking behavior changes requires actions Information about how and why personal and community behaviors will reduce disease transmission risks Encouragement to make positive changes in their hygiene behavior Hygiene education is essential to achieve hygiene behavior change


UNICEF Hygiene Improvement Framework


Hygiene Awareness and PromotionFocus on behavior change by communicating key hygiene practices like hand washingEncourage children, youth and mothers to be agents of change in their families and communities


ImplementationLife skills training programsCurriculum development Integrated sanitation Hygiene education in schoolsMaternal and child health education


Enabling ConditionsThe most obvious enabling condition for personal hygiene is the availability of water

However, for behavioral change to occur and be sustained there is a need to continue hygiene promotion until the new behavior has become entrenched199anupama krishnan vpsv ayurveda collegee kottakkal

Hygiene Promotion Key PrinciplesTarget a small number of risk practicesTarget specific audiences Identify the motives for changed behavior Hygiene messages need to be positive Identify appropriate channels of communication Decide on a cost-effective mix of channels Hygiene promotion needs to be carefully planned, executed, monitored and evaluated.


Identifying Behavioral Domains for HygieneFive Behavioral Domains (Boot and Cairncross, 1993)Disposal of human faecesUse and protection of water sourcesWater and personal hygieneFood hygieneDomestic and environmental hygiene201anupama krishnan vpsv ayurveda collegee kottakkal

Identifying Behavioral Domains for HygienePersonal Hygiene Behaviors: Washing of hands / cleaning of nails Washing of face Body wash / bathing Hygiene after defecation Washing and use of clothes, towels and bedding202anupama krishnan vpsv ayurveda collegee kottakkal

Personal Hygiene Measures(Benenson, 1990)Washing hands in soap and water immediately after fecacation/urination ,always before handling food or eating Keeping hands and unclean articles, or articles that have been used for toilet purposes by others, away from mouth, nose eyes, ears, genitalia, and wounds Avoiding the use of common or unclean eating utensils, drinking cups, towels, handkerchiefs, combs, hairbrushes and pipes 203anupama krishnan vpsv ayurveda collegee kottakkal

avoiding exposure of other persons to spray from the nose and mouth as in coughing, sneezing, laughing or talking washing hands thoroughly after handling a patient or his/her belongings and keeping the body clean by sufficiently frequent soap and water baths


School Hygiene Program StrategyStriving for a common goal, common purpose, common policy and common planning

Focusing child as the key resource

Focusing schools as the knowledge centre

Focusing on education for behavior change

Acknowledging teacher as the facilitator

Concentrating on result oriented/effective delivery system

Recognizing - community is an equal partner


Hygiene Promotion for ChildrenChildren learn through:Helping (e.g., with chores)PlayingBeing creativeDealing with others (interaction and communication)PlayingExercising


Benefits of School Hygiene and SanitationEffective learningIncreases enrolment of girlsReduces incidence of disease and worm infectionsEnvironmental cleanliness Implementing childrens rights207anupama krishnan vpsv ayurveda collegee kottakkal

()


208




2

,

3-4


-

-


Pea-sized amount of fluoride toothpaste






?


?


?10 10 5 10


? 5


Washing HandsOne of the most effective behaviors to prevent diarrhoea, roundworm and whipworm. Rarely done at the most crucial times and rarely done most effectively (with soap). (Is soap really needed?)Hands get most dangerously contaminated fron human faces and soil (possibly containing worm eggs). Crucial times for handwashing to reduce transmissions are: after defecation and after contact with childrens faeces before handling food and after handling high risk food such as raw meatbefore eating and before feeding childrenbefore handling water. Effective handwashing requires thorough rubbing of the hands while using soap and sufficient water to rinse it off. If soap is not available, ash or earth is nearly as effectiveWater alone is effective, especially of water is clean223anupama krishnan vpsv ayurveda collegee kottakkal

Hand Hygiene

right timeright way


It is just a matter of performing this simple task at the right time and in the right way.224


- -2- ( ), ( ) []

--


- 10


-


-

()



/,

/


15 , 3-4



( )

(/)




Five Fallacies - Hygiene Promotion

Behaviour change is easy

Knowledge change=behaviour change

Experts know how to change behavior

A whole variety of hygiene practices should be encouraged

Hygiene promotion is a cheap add-on to water programmes


Waste

Waste238anupama krishnan vpsv ayurveda collegee kottakkal

Over 160,000 Metric Tons (MT) of municipal solid waste is generated daily in the countryPer capita waste generation in cities varies from 0.2 kg to 0.6 kg per dayEstimated to increase at 1.33% annually239anupama krishnan vpsv ayurveda collegee kottakkal

1,400 km2 of land, which is equivalent

2047 size of city - Delhi


Over 8 million tons/year of hazardouswaste is generated 60% of these wastes, 4.8 milliontons/year recyclable3.2 million tons/year is non-recyclable241anupama krishnan vpsv ayurveda collegee kottakkal

Biomedical Waste(BMW)anupama krishnan vpsv ayurveda collegee kottakkal242

W


DEFINITION Waste generated in diagnosis, treatment or immunization of human beings or animals, in research or in the production or testing of biological products including all categories of infected and toxic waste that is potential threat to human beings and environment


It is defined as244

How BMW generated? DiagnosisTreatmentImmunizationBiomedical researchProduction & testing of biological products245anupama krishnan vpsv ayurveda collegee kottakkal

Specifying,it is During245

HEALTH HAZARDS Diseases TB,Hepatitis B/C, Tetanus,etc

Pollution Soil,water,air

Increase in green house gases

Public sensitivity


Because of the Health hazards due to unsafe methods of disposal of HCW.First and foremost hazard is the spread of diseses. Even soil,water,air are also not exempted from sever damage.pollution caused to these components of envrnmnt has created an alarming situation. Majority of hospitals dispose their waste on open land.Methane is a natural byproduct of decomposition of solid waste from landfills.it adds to increase inGr Hs Gas- water vapour,CO2,methane,nitrous oxide,chloro fluoro carbons,ozone incresing temp of earth day by day causing another major concern. So classify and treat accordingly rather than blindly dumpind into waste lands.Public waste- visual impact caused due to the impropr waste disposal methods is creating a booming issue of public sensitivity246

Classification of biomedical waste into categories

Colour coding & type of containers

Proforma of label used on container/bag

Proforma of label for transport of waste container/bag

Standards for treatment & disposal

Deadlines for creation of waste treatment facilities247anupama krishnan vpsv ayurveda collegee kottakkal

CATEGORIES1.Human anatomical waste

2.Animal Waste


explaining248

3.Microbiology & Biotechnology waste

4.Waste sharp


5.Discarded medicine & cytotoxic medicine

6.Solid waste (Cotton,dressing plaster etc)


7.Solid waste (Catheters,Intravenous set etc)

8.Liquid waste


Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities)251

9.Incineration ash

10.Chemical waste


Ash from incineration of any bio-medical waste) chemicals used in production of biologicals, chemicals used in disinfection, as insectricides, etc.252




255





3 rd schedule indicates label for bags for collection & transport259

Steps in ManagementGeneration SegregationTransport StorageTreatment Disposal

anupama krishnan vpsv ayurveda collegee kottakkal260

Generation

Source/point of generation

Generator Doctor Nurse Technician Others


Generation denotes, pt bystanders etc261

Segregation

Process of segregation of diff types of waste as per treatment & disposal.

Generator is responsible


Aware: infectious,hazardous,contain sharp & can cause injury,wearing proper protective equipment,already handled the waste262

TransportSite of generation to site of treatment & disposal

2 type:- Intramural transport : Generation site - temp storage Extramural transport : Temp storage - final trtmnt & disposal263anupama krishnan vpsv ayurveda collegee kottakkal

Wast trnsprt Involves.Intra- gen site to temporarily stored before final treatment and disposal.. Extra- temp storage area to final place of trtmnt and disposal263

Storage

Storing waste before it is sent for final treatment or disposal

In hospital/ outside hospital

Max period : 48 hrs264anupama krishnan vpsv ayurveda collegee kottakkal

If time is to be prolonged permission from competent authority is needed264

Treatment of BMWThermalMechanicalChemicalIrradiationBiological


Human anatomical wasteBody parts, organs

Animal waste Researches Gomutra,Ajamamsa- vasti Jalouka

WASTES IN AYURVEDA HOSPITALS


Which can be included under the modern categories are as follows266

Microbiology & biotechnology waste Laboratory -blood, sputum

Waste sharp Needles for siraveda, prachana Probe, panchaloha shalaka


Discarded medicine



Different types of sharp268

Solid waste (Cotton,dressing plaster) Cotton,gauze,ksharasootra, bandages,gloves

Solid waste (Catheters,Intravenous set) Catheters, glycerine syringe,vastinetra



Liquid waste Medicines -asava,arishta,grita,taila etc Avagaha,Kayaseka Blood from siraveda Waste water from kitchen ,bathroom



Forms the major wastes of our hospitals, dravyas for270

Incineration ashIncinerator

Chemical waste Disinfectants, insecticides



UNIQUE WASTES

Kizhi CPS,PPS,JPS,SPS

Churna Kashaya, Upanaha, Udwartana

Taila Pizhichil, Dhara

Other medicated liquids Dhanyamla.arishta, asavas


Sewage

Incineration

Land fill


Burned in incnrtr..rest go for land fill273

Biogas plant


Treating capacity 800kgFood and toilet waste Avoid lemon, oninon, egg shellMethane production 40m3Preparation Food and Kashayam275anupama krishnan vpsv ayurveda collegee kottakkal

Effluent Treatment Plant


Collection,screening,aeration,chlorination276

ETP



Treated water FlushingCleaningHerbal garden279anupama krishnan vpsv ayurveda collegee kottakkal


Thanks

Thanks281anupama krishnan vpsv ayurveda collegee kottakkal
