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Learning Objectives
Describe strategies for preventing HIV transmission in the healthcare setting Describe universal precautions Identify key steps and principles involved in the decontamination of equipment and materials Hospital waste management rules
Percutaneous
Mucous membrane Non-intact skin
0.3%
0.1% <0.1%
Blood-borne Pathogens
In addition to HIV, blood-borne pathogens include
Hepatitis B and C Syphilis Malaria Bacterial infections like Brucellosis
Who is at risk?
All Health Care Personnel,
Including emergency care providers, Laboratory personnel, Autopsy personnel, Hospital employees, Interns and medical students, Nursing staff and students, Physicians, surgeons, dentists, labour and Delivery room personnel, laboratory technicians, Health facility sanitary staff and clinical waste handlers and Health care professionals at all levels.
Infection Control encompasses the processes and activities that identify and reduce the risks of acquiring and transmitting endemic or epidemic infections among individuals
Universal Precautions Definition Safe or good clinical practices applied universally in caring for all patients, regardless of the diagnosis in order to minimise or avoid exposure to infection
Universal Precautions
Applied universally in caring for all patients
Hand washing
Decontamination of equipment and devices Use and disposal of needles and sharps safely (no recapping) Wearing protective items Prompt cleaning up of blood and body fluid spills Systems for safe collection of waste and disposal
Attaining and maintaining appropriate staffing levels Providing protective equipment and materials
Barrier Nursing
Gloves should be used for
Touching blood or other body fluids Touching mucous membrane Touching non-intact skin of all patients. For handling items or surfaces soiled with blood or body fluids Performing venepuncture
Hand Hygiene
Recommended Practice
Soap and water hand washing using friction under running water for at least 15 seconds Using alcohol-based hand rubs (or antimicrobial soap) and water for routine decontamination
PEP Following occupational HIV exposure, short-course of ARV drugs can be used to reduce the likelihood of infection Register occupational exposures
Ensure that HIV counseling, testing, and ARV drugs are available Educate healthcare workers
For the eye Irrigate exposed eye immediately with water or normal saline. Sit in a chair, tilt head back and ask a colleague to gently pour water or normal saline over the eye. If wearing contact lens, leave them in place while irrigating, as they form a barrier over the eye and will help protect it. Once the eye is cleaned, remove the contact lens and clean them in the normal manner. This will make them safe to wear again Do not use soap or disinfectant on the eye.
For mouth:
Spit fluid out immediately Rinse the mouth thoroughly, using water or saline and spit again. Repeat this process several times Do not use soap or disinfectant in the mouth Consult the designated physician of the institution for management of the exposure immediately.
Donts
Do not panic Do not put pricked finger in mouth Do not squeeze wound to bleed it Do not use bleach, chlorine, alcohol, betadine, iodine or any antiseptic or detergent
Key Points
Universal precautions apply to all patients, regardless of diagnosis Key components of UPs include
Hand washing Safe handling and disposal of sharps Use of personal protective equipment Decontamination of equipment Safe disposal of infectious waste materials Safe environmental practices
I am a lab tech. I worked 11-7 shift for the past 9 and half years. My job includes drawing blood, testing blood and urine samples in a hospital laboratory, and preparing blood transfusions for patients who need blood products. On 31/12/93 at 3.55am I was called to the emergency room to draw blood on an hiv+ drug abuser, it seems she was out of cash but wanted more 'pain meds". The doctors wanted blood tests first to find out what was she sick with.
I ended up trying to draw her blood and she became violent, jerking her arm around after I had a needle in her vein and was getting blood out of her arm. She managed to get the dirty needle stabbed into my left thumb. When I saw that needle in my hand I felt a chill go down my spine and dreaded I would become positive too. Well by march of 1994 I was hiv+. Since then I have tried many of the hiv meds on the market. Many have given me allergic reactions, some have simply been ineffective, others the virus has grown resistant to.
It's a month to month battle. So far my t counts are holding and my viral load is between non detected and 10,000. I am married and had a son aged 18 months at the time I was infected. He's now 9.5 years old and the pride of my life. How can I ever tell him mom may not be around much longer? On October 28, 2000 we were blessed with the birth of a daughter. Beautiful is her description by anyone who has seen her. Tonight I received the results of her 1 year hiv test. It is positive."
The powers confirmed by section 6,8 & 25 of the Environment (Protection) Act 1986, the Central Govt. has made The Biomedical Waste (management & Handling) Rules to safeguard the Public & health care workers from the risk arising due to Biomedical Waste. The penalties are same as specified in Environment (Protection) Act 1986
Application of Rules
These rules apply to all persons who
Generate, Collect, Receive, Store , Transport, Treat, Dispose, or Handle biomedical waste in any form.
Defination
Bio-medical waste- Any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining to in the production of testing of biologicals, and including categories mentioned in schedule 1.
Biologicals- Any preparation made from organisms or micro organisms or product of metabolism and biochemical reaction intended for use in the diagnosis, immunization or the treatment of disposal of human beings or animals or in research activities pertaining to. Occupier- in relation to any institution generating bio-medical waste, which includes a hospital, nursing home, clinic, dispensary, veterinary institutions, animal house, pathological laboratory, blood bank by whatever name called, means a person who has control over that institution and/or its premise.
Duty of Occupier
It shall be the duty of every occupier of an institution generating biomedical waste, to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment.
2 3
Discarded Medicines & Cytotoxic Drugs Soiled Waste (Items contaminated with blood & body fluids) Solid Waste (waste generated from disposable items)
Incineration/destruct & drugs disposed in secured landfills Incineration & autoclaving/microwaving Disinfection with chemical treatment/autoclaving/ microwaving
9 10
Blue/White translucent
Black
Penalty
(1) Whoever fails to comply with, shall in respect of each such failure, be punishable with imprisonment for a term which may extend to five years with fine which may extend to one lakh rupees, or with both, and in case the failure continues, with additional fine which may extend to five thousand rupees for every day during which such failure continues after the conviction for the first such failure . (2) If the failure referred to in sub-section (1) continues beyond a period of one year after the date of conviction, the offender shall be punishable with imprisonment for a term which may extend to seven years.