Published on February 21, 2016
1. INFECTION CONTROL, STANDARD PRECAUTIONS, BIOMEDICAL WASTE MANAGEMENT Vidya V S MSc Nursing 1st year
2. Introduction • “The very first requirement in a hospital that it should do the sick no harm" - Florence Nightingale • Health care associated infections(HCAI)- economic loss prolonged hospital stay & adverse patient outcomes. Infection control Biomedical waste management Standard precaution
3. Health care associated infections(HCAI) • Infections that are acquired by the patients while he is in the hospital either from other patients, the environment or members of hospital staff.
4. Health Care Associated Infections Commonly occurring types • Urinary tract infections. • Surgical wound infections. • Respiratory tract infections. • Catheter related blood stream infections. • Meningitis. • Gastroenteritis.
5. Common organisms • Staphylococcus aureus • Enterococcus • Pseudomonas aeruginosa • Klebsiella • E- coli • HIV • HBV • HCV • CMV • candidia
6. • Low resistance of patient to infections. • Invasive procedures/interventions. • Inappropriate anti-microbial usage. • Drug resistance of endemic microbes. • Contaminated environment. Risk due to
7. Sources of HCAI PATIENT E N V I R O N M E N T Exogenous IV medicationOther patients Endogenous Air Hospital staff Fomite Apparatus
8. Risk areas Nurseries ICUs Dialysis units Transplant unit ED Oncology wards Operation theatre Delivery rooms Post op wards
9. Infection control • What is an Infection ? • What is Control ? • Infection control ?
10. Measures practiced by health care personnel to prevent spread, transmission and acquisition of infection between clients, from health care providers to clients and from clients to HCP. Based on Infection control - definition Standard precaution Additional precaution
11. Breaking the Chain of infection
12. Aseptic practices • Hand washing. • Use of barrier nursing –gloves, gown, mask, goggles etc. • Adopting universal and standard precautions. • Care of indwelling devices.
13. Aseptic practices(contd…) • Proper decontamination, disinfection and sterilization of equipment. • Isolation of infected patients. • Environmental cleaning. • Proper disposal of hospital waste.
14. Hand washing • Social/routine Hand washing • Aseptic Hand washing • Surgical Hand washing
15. Hand washing Vs Hand rub Hand washing • Hands visibly soiled. • Before eating or handling food. • After handling contaminated linens , equipment, organic material. • Entering and exiting from clinical setting.
16. Hand rub • Hands not visibly soiled. • After touching clients intact skin. • After touching any inanimate objects.
17. How to Handwash?
18. Decontamination Decontamination Sterilization Steam Dry heat Chemical Cleaning Disinfection Boiling Chemical Steam
19. Disinfection and Sterilization Disinfection : Reduce the number of microorganisms on an object or surface but not the complete destruction of all microorganisms or spores. Sterilization : Procedures, which would remove all microorganisms, including spores, from an object.
20. Disinfectants commonly used • 2% glutaraldehyde (cidex) • 5% phenol • Isopropyl alcohol (bacillol) • Hydrogen peroxide • 1% sodium hypochlorite solution • Calcium hypochlorite (bleaching powder)
21. Sterilization Methods • Dry heat Autoclave • Ethylene oxide • 2% Gluteraldehyde • Gamma radiation
22. Changes observed over a period of time • A switch over to digital thermometers from clinical thermometers. • Using distilled H2O ampoules to dissolve injections rather than using common stock solutions.
23. Current trends(contd…..) • Wet mopping over dry sweeping. • Revised steps of Hand washing. • No more fumigation with formaldehyde. • Dry bottles for Cheatle forceps rather antiseptic solution filled bottles.
24. Infection control Biomedical waste management Standard precaution
25. Standard Precaution As defined by CDC “ Set of practices designed to prevent the transmission of HIV, Hepatitis B and other blood borne pathogens (bacteria & virus). ” Blood & other body fluids of all persons are considered potentially infectious.
26. Body fluids include • Blood • Vomit • Saliva • Feces • Drainage • Secretions from mucous membrane • Semen Sweat and tear mixed with blood
27. Standard precaution steps • Hand washing • Personal protective equipment • Decontamination • Waste disposal
28. Hand hygiene Hand washing is the single most effective measure in infection control. 80% of the diseases are spread through hands.
29. Personal protective equipment • Gloves • Gown • Mask • Protective eye wear • Face shield • Apron
30. Prevention & management of Sharp injury and Spillage • Never recap the needles. • Cannulas with safety needle guards. • Post exposure prophylaxis treatment. • Use of PPE.
31. Proper Disposal of PPE
32. Any waste generated during diagnosis, treatment or immunization of human beings or animals. Waste management is the Collection, transport, processing or disposal, managing and monitoring of waste material. BIOMEDICAL WASTE MANAGEMENT
33. Sources-health care waste Government and Private hospitals Nursing homes Physician’s office/clinics Dispensaries Primary Health Centers Medical research and training establishments Mortuaries
34. Hazards • Organic portion ferments and attracts fly breeding. • Injuries from sharps - health care personnel and waste handlers. • Risk of infections to medical, nursing and other hospital staff. • Development of resistant strains of microorganisms.
35. • Increase in risk associated with hazardous chemicals and drugs to persons handling wastes. • Poor waste management encourages unscrupulous persons to repacking and reselling. • Poor infection control - nosocomial infections in patients (HIV, Hepatitis B & C). Hazards(contd….)
36. To reduce hazardous nature of waste. To reduce volume of waste. To prevent misuse or abuse of waste. To ensure occupational safety and health. To consider aesthetics. Purposes of waste disposal
37. Principles of waste management • Segregate the waste. • Disinfect and mutilate sharps. • Adopt safer technologies as autoclave and microwave. • Don’t burn chlorinated plastics.
38. Principles of waste management(contd..) • Prevent reuse of disposables. • Motivate and train all hospital personnel. • Practice universal precaution. • Follow the biomedical waste rules.
39. Waste management 3 R’s recycle reuse reduce
40. Waste Hierarchy
41. Steps - Waste Management Handling Segregation Mutilation DisinfectionStorage Transportation Final disposal
42. Handling & Segregation Rules and regulations governing the disposal of wastes The Government of India – The Biomedical Waste (Management and Handling) Rules 1998.
43. Category Types Management Category 1 Human Anatomical Waste Incineration/Deep Burial Category 2 Animal waste Incineration/Deep Burial Category 3 Microbiology and biotechnology waste Local Autoclaving Hospital waste categories
44. Hospital waste categories(contd..) Category Types Management Category 4 Waste Sharps Chemical Disinfection Autoclaving/ Microwaving, Mutilation and Shredding Category 5 Discarded medicines and cytotoxic drugs Incineration/Destruction and disposal in land fills Category 6 Soiled waste (contaminated with blood and body fluids including cotton, dressings, soiled plasters) Autoclaving/ Microwaving/ Incineration
45. Hospital waste categories(contd..) Category types management Category 7 Solid waste (tubes, catheters, IV sets) Chemical Disinfection/Autoclaving/ Microwaving, Mutilation and Shredding Category 8 Liquid waste (Waste generated from laboratory and washing, cleaning, disinfection) Disinfection by chemical treatment and discharge into the drains Category 9 Incineration ash Land fills Category 10 Chemical waste Chemical disinfection and discharge into the drains
46. Colour codes Color coding Waste Category Treatment options Red Human and animal wastes Incineration/ Deep Burial Yellow Highly infectious waste biodegradable wastes. Incineration/ Deep Burial
47. Colour codes(contd..) Color coding Waste Category Treatment options Blue Infected plastics ( Cat 4 in puncture proof container & Cat 7) Autoclave/Microwave/ Chemical Treatment Destruction/Recycling and Shredding Black General waste (food waste, garden waste, Discarded medicines, Cytotoxic drugs, Incineration ash and chemical waste) (Cat 5,9 & 10) Disposal in secured land fills
48. Colour coding
49. Waste storage Storage facility should have sufficient capacity. location - within hospital premises. Radioactive waste must be stored separately. Untreated biomedical waste not to be kept beyond 48 hrs (Permission required for >48 hrs). Protect human health & environment.
50. Waste transportation Points to be remembered: Before taking the bags it should be tied and labeled. Waste handlers should not touch any other articles. A covered cart with biohazard symbol to carry the waste to the central area of collection.
51. Waste Treatment and Disposal Available Treatment and Disposal Methods Chemical Technology Thermal Technology Autoclave Hydroclave Incinerator Microwave
52. Waste Treatment and Disposal(contd..) Mechanical Technology Compaction Grinding/ Shredding Plasma torch Technology Deep burial
53. Waste Treatment and Disposal(contd..) Biological Method Land filling Open dumps Sanitary land fill Worm composting
54. Final disposal Black bags Disposed along with other municipal waste. Yellow bags Incinerated & resultant ash collected to be used in land fills. Blue bags Autoclaved, shredded & finally dispensed.
55. Specific wastes • Dead fetus • Mutilated organs • Placenta • Dead bodies • Cytotoxic drugs • Radio active substances • Expired countable drugs & sutures • Immunization vials
56. Staff safety considerations Separate trolleys for transporting waste within the hospital. All workers involved in the work are aware of the hazardous nature of the work. Provided with all protective equipment. Immunized against tetanus and hepatitis B.
57. Training on biomedical waste management Overall aim of training: • To develop awareness of health, safety and environmental issues relating to health care waste. • Roles & responsibilities of health care personnel in overall management program should be highlighted.
58. Four main categories for which separate training activities are designed Hospital managers & administrative staff Medical doctors Nurses Cleaners, porters, auxiliary staff &waste handlers
59. Biomedical waste management issues Implementation of bio-medical waste regulation - unsatisfactory. Lack of segregation practices. Incorrect methods of waste disposal. Dumping of waste in river and sea. Recycling of disposables without even being washed.
60. Biomedical waste management issues.. Using same wheel barrow for all categories of waste. Trolley movement around patient care units. No mechanism for ensuring waste treatment within prescribed time limits. No proper training of employees in some hospitals.
61. Responsibilities of health care Institutions • Set up biomedical waste treatment facilities - incinerators, autoclave and microwave system. • Make an application to the concerned authorities for grant of authorization. • Report immediately any accident to the prescribed authority.
62. Responsibilities of health care Institutions (contd…) • Maintain records about the generation, collection reception, storage, transportation, treatment, disposal and/or any form of handling bio medical waste. • Submit a report during the preceding year by 31 Jan every year.
63. Role of infection control nurses • Visits all wards and high risk units. • Checking nursing supervisor’s register and records for cases suggestive of infection. • Collection of sample from different areas of the hospitals & sending them to the lab.
64. Role of infection control nurses(contd..) • Daily visit to microbiology lab to ascertain results of sample collected. • Monitoring & supervision of infection among hospital staffs. • Training of nursing & paramedical personnel on correct hygiene practices & aseptic technique.
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