Bio safety in Health care practices

Learning objectives:

Infection Control Precautions: Used to reduce transmission of microorganisms in Hospital & laboratory

Infection control precautions includes

1.       Standard precautions

a.       hand hygiene &

b.      personal protective equipment  (PPE)

2.       Transmission based precautions

Standard Precautions:

·         Standard Precautions are the minimum infection prevention practices that apply to, all patient care regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered.

·         They are the set of work practices used to minimize transmission of HAI (health care associated infection) s.

·         They include measures to be used when providing care to/handling –All individuals, all specimens (blood or body fluids), all needles and sharps.

·         Standard precaution  = Universal precautions  +  Contact transmission(skin/mucosal) prevention

Objectives of Standard Precautions

There are two objectives

1. The first  is to prevent cross infection.
2. The second objective is to protect HCW from blood borne as well as other contagious infection. 

Components of standard precautions

1.      Universal precautions 

2.      Hand hygiene

3.      Personal protective equipment

4.       Spillage cleaning

5.      Respiratory hygiene and cough etiquette

6.      Transmission-based precautions:

7.      Biomedical waste including sharp handling

8.      Disinfection

Universal precautions

    Blood, blood products, all body fluids, and materials contaminated with them areconsidered as infectious for HIV, HBV, HCV, and other blood borne pathogens. Universal precautions includes use of appropriate precautions to prevent exposure to skin and mucous membranes.

 

·         Wear gloves, gowns/aprons, masks, and goggles, while handling all potentially infectious material.

·         Take special care of handling sharp objects (like needles, lancets, scalpels, etc.) to avoidinjuries:

o   Avoid unnecessary use of sharps and needles

o   Disposable needles should be used

o   Handle hollow bore needles with care as it may lead to deep injuries

o   Never recap needles

o   Never break/bend needles by hand

o   Needles/sharps should not be left on trolleys and bed side tables and must be disposedof immediately

o   Never pass used sharps from one person to another directly

• ·         Dispose sharps in a puncture resistant container containing 1% sodium hypochlorite solution.
• ·         Thoroughly wash hands with water and soap after removing gloves, after handling infectious materials, before leaving the laboratory area, and immediately after any contamination of skin surfaces.
• ·         Work surfaces should be decontaminated with 0.1 % sodium hypochlorite solution.
• ·         Laboratory personnel should refrain from mouth pipetting, eating, drinking, or smoking inthe work area.
• ·         Access to the laboratory should be limited to trained personnel only.
• ·         Food and drink must be stored in refrigerators in areas other than the work area.
• ·         All HCPs must be immunized against HBV.
• 
  

      Hand hygiene

Hands are the main source of transmission of infections during healthcare.Hand hygiene is therefore the most important measure to avoid the transmission of harmful microbes and prevent healthcare-associated infections.

·         Hand hygiene is a general term that applies to either handwashing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis.

·         Indications for hand hygiene:

    1. When hands are visibly soiled.
    2. After barehanded touching of instruments, equipment, materials, and other objects likely to be contaminated by blood, saliva, or respiratory secretions.
    3. Before and after treating each patient.
    4. Before putting on gloves and again immediately after removing gloves.
    5. Gloves are not a substitute for hand washing.

Personal Protective Equipments (PPE)

Used to protect the skin and mucous membranes of Health Care Worker(HCW)s from exposure to blood and/or body fluids; & from the HCW’s hands to the patient during sterile and invasive procedures.

 

Spillage management:

Blood spillage may occur because a laboratory sample breaks or because there is excessive bleeding during phlebotomy. In this situation, clean up the spillage and record the incident, using the following procedure.

• Evacuate the contaminated area
• Wear a pair of non-sterile gloves preferably heavy duty ones
• Mark the contaminated area with a chalk or pen
• Use a pair of forceps or tongs or a pan and brush to sweep up as much of the broken glass (or container) as possible. Do not pick up pieces with your hands (even with gloves)
• Discard the broken glass in a sharps container. If this is not possible due to the size of the broken glass, wrap the glass or container in several layers of paper and discard it carefully in a separate container. Do not place it in the regular waste container
• Use disposable paper towels / absorbent material (gauze pieces, cotton, blotting paper, etc.) to absorb as much of the sample as possible
• Saturate the area again with 1% sodium hypochlorite (which should be prepared daily) from the periphery to the centre. Wait for 15-20 minutes
• Discard the absorbent material and wipe the area clean with a disinfectant
• Clean and disinfect the forceps/tongs/ brush and pan
• Remove gloves and discard them
• Wash hands carefully with soap and water and dry thoroughly with single-use towels
• Record the incident in the incident book if a sample was lost, or persons were exposed to blood and body fluids

Respiratory hygiene and cough etiquette

• Should be followed by anyone with signs and symptoms of a respiratory infection, regardless of the cause.
• Cover the nose/mouth with single-use tissue paper when coughing, sneezing, wiping and blowing noses
• If no tissues are available, cough or sneeze into the inner elbow  rather than the hand
• Follow hand hygiene after contact with respiratory secretions and contaminated objects/materials
• Keep contaminated hands away from the mucous membranes of  the eyes and nose
• In high-risk areas of airborne transmission such as pulmonary medicine OPD: Give mask to the patients with cough and make separate queue away from the general queue
• Sputum collection should be done in an open space or in a well- ventilated room\

Transmission-based precautions:

Standard precautions are used for all patients regardless of their diagnoses to ensure protection of the health care worker and the patient.  For certain highly transmissible or epidemiologically important pathogens, transmission-based precautions are used in addition to standard precautions:

a)   Contact precautions:

- For protection against skin-to-skin contact and physical transfer of microorganisms to a host from a source e.g. :Discharging wounds are common source of Methicillin Resistant Staphylococcus Aureus (MRSA)

- Precautions:    Isolation, hand washing, use of gloves

b)   Precaution from droplet infections

- For infectious agents with droplet nuclei > 5 microns, through cough or sneezing e.g., Pertussis, Influenza, Meningococcal  meningitis

- Precautions: -isolation room, use of surgical mask

c)    Precautions from airborne transmission

- For infectious agents with droplet nuclei < 5 microns e.g., Tuberculosis, Measles, Chickenpox

- Precautions: -Isolation rooms with negative pressure, Air cycling >12/hour, HEPA filters

-Use respirators or N95 mask, patient will use a surgical mask

d)   Reverse isolation

 - barrier protection to protect patients that are highly susceptible to infection.