INFECTION CONTROL, STANDARD PRECAUTIONS,

BIOMEDICAL WASTE MANAGEMENT

Vidya V SMSc Nursing 1st year

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

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.

Health Care Associated InfectionsCommonly occurring types• Urinary tract infections.• Surgical wound infections.• Respiratory tract infections.• Catheter related blood stream

infections.• Meningitis. • Gastroenteritis.

Common organisms• Staphylococcus aureus• Enterococcus• Pseudomonas aeruginosa• Klebsiella• E- coli

• HIV• HBV• HCV• CMV• candidia

• Low resistance of patient to infections.

• Invasive procedures/interventions.• Inappropriate anti-microbial usage.• Drug resistance of endemic

microbes.• Contaminated environment.

Risk due to

Sources of HCAI

PATIENT

ENVIRONMENT

Exogenous

IV medicationOther patients

Endo

geno

us

Air

Hospital staff Fomite

Apparatus

Risk areas

Nurseries ICUs Dialysis units Transplant unit ED

Oncology wards Operation

theatre Delivery rooms Post op wards

Infection control• What is an Infection ?

• What is Control ?

• Infection control ?

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

Breaking the Chain of infection

Aseptic practices• Hand washing.• Use of barrier nursing –gloves, gown,

mask, goggles etc.• Adopting universal and standard

precautions.• Care of indwelling devices.

Aseptic practices(contd…)

• Proper decontamination, disinfection and sterilization of equipment.

• Isolation of infected patients.• Environmental cleaning.• Proper disposal of hospital

waste.

Hand washing

• Social/routine Hand washing

• Aseptic Hand washing

• Surgical Hand washing

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.

Hand rub• Hands not visibly soiled.• After touching clients intact skin.• After touching any inanimate objects.

How to Handwash?

Decontamination Decontamination

Sterilization

Steam

Dry heat

Chemical

Cleaning Disinfection

Boiling

Chemical

Steam

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.

Disinfectants commonly used

• 2% glutaraldehyde (cidex)• 5% phenol• Isopropyl alcohol (bacillol)• Hydrogen peroxide• 1% sodium hypochlorite solution• Calcium hypochlorite (bleaching powder)

Sterilization Methods• Dry heat Autoclave• Ethylene oxide• 2% Gluteraldehyde • Gamma radiation

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.

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.

Standard Precaution

Infection control

Biomedical waste management

Standard precaution

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.

Body fluids include

• Blood• Vomit• Saliva• Feces

• Drainage• Secretions from

mucous membrane

• SemenSweat and tear mixed with blood

Standard precaution steps

• Hand washing• Personal protective equipment• Decontamination• Waste disposal

Hand hygiene

Hand washing is the single most effective measure in infection control.

80% of the diseases are spread through hands.

Personal protective equipment

• Gloves• Gown• Mask• Protective eye wear• Face shield• Apron

Prevention & management of Sharp injury and Spillage

• Never recap the needles.• Cannulas with safety needle guards.• Post exposure prophylaxis treatment.• Use of PPE.

Proper Disposal of PPE

Any waste generated during diagnosis, treatment or immunization of human beings or animals.Waste management is theCollection, transport, processing or disposal, managing and monitoring of waste material.

BIOMEDICAL WASTE MANAGEMENT

Sources-health care waste Government and Private hospitals Nursing homes Physician’s office/clinics Dispensaries Primary Health Centers Medical research and training

establishments Mortuaries

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.

• 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….)

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

Principles of waste management

• Segregate the waste.• Disinfect and mutilate sharps.• Adopt safer technologies as

autoclave and microwave.• Don’t burn chlorinated plastics.

Principles of waste management(contd..)

• Prevent reuse of disposables.• Motivate and train all hospital

personnel.• Practice universal precaution.• Follow the biomedical waste rules.

Waste management 3 R’s

recycle

reuse

Waste Hierarchy

Steps - Waste Management

Handling

Segregation

Mutilation

DisinfectionStorage

Transportation

Final disposal

Handling & Segregation

Rules and regulations governing the disposal of wastes

The Government of India – The

Biomedical Waste (Management and

Handling) Rules 1998.

Category Types Management

Category1

Human Anatomical Waste Incineration/Deep Burial

Category2

Animal waste Incineration/Deep Burial

Category3

Microbiology andbiotechnology waste

Local Autoclaving

Hospital waste categories

Hospital waste categories(contd..)Category Types ManagementCategory

4Waste Sharps Chemical Disinfection

Autoclaving/ Microwaving,Mutilation and Shredding

Category5

Discarded medicines andcytotoxic drugs

Incineration/Destruction anddisposal in land fills

Category6

Soiled waste (contaminatedwith blood and body fluidsincluding cotton, dressings,soiled plasters)

Autoclaving/ Microwaving/Incineration

Hospital waste categories(contd..)

Category types managementCategory

7Solid waste (tubes,catheters, IV sets)

ChemicalDisinfection/Autoclaving/Microwaving, Mutilation andShredding

Category8

Liquid waste (Wastegenerated from laboratoryand washing, cleaning,disinfection)

Disinfection by chemicaltreatment and discharge intothe drains

Category9

Incineration ash Land fills

Category10

Chemical waste Chemical disinfection and discharge into the drains

Colour codesColorcoding

Waste Category Treatmentoptions

Red Human and animal wastes

Incineration/Deep Burial

Yellow Highly infectious waste biodegradable wastes.

Incineration/Deep Burial

Colour codes(contd..)Colorcoding

Waste Category Treatmentoptions

Blue Infected plastics( Cat 4 in puncture proof container & Cat 7)

Autoclave/Microwave/Chemical TreatmentDestruction/Recycling and Shredding

Black General waste (food waste, garden waste, Discarded medicines, Cytotoxic drugs, Incineration ash and chemical waste)(Cat 5,9 & 10)

Disposal insecured landfills

Colour coding

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.

Waste transportationPoints 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.

Waste Treatment and Disposal

Available Treatment and Disposal Methods Chemical Technology Thermal Technology

Autoclave Hydroclave Incinerator Microwave

Waste Treatment and Disposal(contd..)

Mechanical TechnologyCompactionGrinding/ Shredding

Plasma torch Technology Deep burial

Waste Treatment and Disposal(contd..)

Biological Method

Land filling Open dumps Sanitary land fill

Worm composting

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.

Specific wastes• Dead fetus• Mutilated organs• Placenta• Dead bodies• Cytotoxic drugs• Radio active substances• Expired countable drugs & sutures• Immunization vials

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.

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.

Four main categories for which separate

training activities are designed

Hospital managers & administrative staff

Medical doctors Nurses Cleaners, porters, auxiliary staff

&waste handlers

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.

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.

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.

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.

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.

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.

Thank you