Safety now Thalassemia Center

1. Safety now Thalassemia Center

2. Protect Yourself • Know blood borne pathogens • Follow standard precautions • Get the Hepatitis B vaccine • Know what to do in case of an exposure

3. What Fluids ARE Considered a Risk for Bloodborne Pathogenes (BBP) • Blood or any body fluid visibly contaminated with blood • Semen • Vaginal secretions • Spinal, pleural, peritoneal pericardial, amniotic and synovial fluids • Breast milk (not all agree) • Saliva from dental procedures

4. What Fluids ARE NOT Considered a Risk for BBP • Urine • Sweat • Nasal discharge • Saliva (non dental) • Feces • Tears • Vomit But ALWAYS use gloves when cleaning up any of these fluids

5. Concentration of HBV in Body Fluids HighModerate Low/Not Detectable BloodSemen Urine SerumVaginal FluidFeces Wound exudatesSaliva Sweat Tears Breast Milk

6. How Are They Spread? • contaminated fluids in contact with open skin (cuts, abrasions) • contaminated sharp objects that cut or puncture the skin • contaminated splash with eyes, mouth, or nose • sharing needles • sexual contact

7. Hepatitis B Virus • 100 times more infectious vs. HIV • Can live on dried surfaces for one week • 6-30% chance of infection from an exposure (puncture wound) • 85-90% of those infected will recover in 6-8 weeks • 10-15% will become carriers and develop chronic liver disease • Vaccine preventable – 3 doses, highly effective

8. Hepatitis C Virus • Risk for exposure from a contaminated puncture wound - 3.3% - 10% • Most transmission is transfusion or IV drug use related • About 4 million people are infected • Chronic infection develops in 80% • Not vaccine preventable

9. HIV • Very fragile virus and will not survive long outside the body • Risk of transmission through a needlestick or cut with HIV infected blood is 0.3%. A splash to the eyes or nose or mouth is 0.1% • Risk to non-intact skin to HIV infected blood is estimated to be less than 0.1%

10. Standard Precautions • Hand washing • Barrier protection • Gloves • Mask, Eye Protection ,Face Shield • Gown • Practice Safe Clean Up In All Situations • Patient Care Equipment • Linen • Occupational Health and Blood borne Pathogens • Patient Placement

11. Table 2-1. Standard Precautions: Key Components Handwashing (or using an antiseptic handrub) 􀁸􀀃 After touching blood, body fluids, secretions, excretions and contaminated items 􀁸􀀃 Immediately after removing gloves 􀁸􀀃 Between patient contact Gloves 􀁸􀀃 For contact with blood, body fluids, secretions and contaminated items 􀁸􀀃 For contact with mucous membranes and nonintact skin Masks, goggles, face masks 􀁸􀀃 Protect mucous membranes of eyes, nose and mouth when contact with blood and body fluids is likely Gowns 􀁸􀀃 Protect skin from blood or body fluid contact 􀁸􀀃 Prevent soiling of clothing during procedures that may involve contact with blood or body fluids Linen 􀁸􀀃 Handle soiled linen to prevent touching skin or mucous membranes 􀁸􀀃 Do not pre-rinse soiled linens in patient care areas Patient care equipment 􀁸􀀃 Handle soiled equipment in a manner to prevent contact with skin or mucous membranes and to prevent contamination of clothing or the environment 􀁸􀀃 Clean reusable equipment prior to reuse Environmental cleaning 􀁸􀀃 Routinely care, clean and disinfect equipment and furnishings in patient care areas Sharps 􀁸􀀃 Avoid recapping used needles 􀁸􀀃 Avoid removing used needles from disposable syringes 􀁸􀀃 Avoid bending, breaking or manipulating used needles by hand 􀁸􀀃 Place used sharps in puncture-resistant containers Patient resuscitation 􀁸􀀃 Use mouthpieces, resuscitation bags or other ventilation devices to avoid mouth-tomouth resuscitation Patient placement 􀁸􀀃 Place patients who contaminate the environment or cannot maintain appropriate hygiene in private rooms

12. Standard PrecautionsWHY To prevent the transmission of infectious agents. • from patient to patient. • from patient to health worker • Form health worker to patient

13. Stop Infection Break the Chain Infection Infection Infection Reservoirs Entry Exit Host Trans mission

14. Standard PrecautionsApply to 1) blood 2) all body fluids, secretions, and excretions except sweat, regardless of whether or not they contain visible blood; 3) non-intact skin 4) mucous membranes

15. Standard Precautionswhen ?with whom? • All the time • with all the patients

16. Hand washing Why By what When How

17. Hand Washing • Why: • Hand washing is your first defense in infection control.

18. Handwashingwhat to use ? • Handwashing with soap and water in non-health care settings • When health care personnel's hands are visibly soiled, they should wash with soap and water. • When health care personnel's hands are not visibly soiled , use alcohol-based handrubs • Handrubs and hand washing should be observed before and after each patient.

19. Hand Washing When: 􀂃 After contact with blood or other body fluids 􀂃 Before and after handling a patient 􀂃 Between glove changes 􀂃 Before and after eating/smoking 􀂃 After using the rest room

20. Types of hand washing: • Social Hand washing • Hygienic hand washing or Antiseptic hand washing • Surgical Hand washing • Alcohol hand rub

21. Hand Washing How to do It Right! • First wet Wet hands under running water and apply nonabrasive soap • Next Vigorously rub palms,back of hands, between fingers, and wrists for 15 – 20 seconds • Rinse well and dry your hands dry with paper towel (not cloth towel or other fabric) • Avoid chapped and cracked hands if possible. Use a water-based hand lotion frequently. Petroleum-based products and Vaseline break down latex. • 4.

22. Why alcohol based hand rub? • Alcohol-based hand rubs take less time to use than traditional hand washing. • Alcohol-based handrubs significantly reduce the number of microorganisms on skin and are fast acting • Allergic contact dermatitis due to alcohol hand rubs is very uncommon.

23. Efficacy of Hand Hygiene Preparations in Killing Bacteria Better Good Best Antimicrobial soap Plain Soap Alcohol-based handrub

24. Questions ?

25. Personal Protective Equipment (PPE) • Is specialized clothing or equipment worn or used by you for protection against a hazard. • It helps to interrupt the transmission of micro-organisms between patients and staff.

27. Gloves • Wear gloves (clean, nonsterile ) when touching • blood, • body fluids, secretions, excretions, • contaminated items. • just before touching mucous membranes • just before touching nonintact skin • Change gloves • between tasks and procedures on the same patient • after contact with material that may contain a high concentration of microorganisms • Remove gloves promptly • after use, • before touching noncontaminated items and environmental surfaces • before going to another patient,

28. Gloves • Does not eliminate the need for hand hygiene. • Hand hygiene does not eliminate the need for gloves. • Gloves reduce hand contamination by 70 percent to 80 percent • Gloves should be changed before and after each patient. • Hands must be washed after removal because gloves may be punctured and your hands are easily contaminated as the gloves are taken off. • Gloves must be discarded after each procedure.

29. WEAR-Mask-Eye Protection -Face Shield To protect eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. Such activities are not commonly encountered in ward settings • respiratory suction • scrubbing of instruments • endoscopy, • management of women in labor • surgical procedures, particularly orthopedic and cardiac surgery.

30. Wear a gown • Wear a gown to protect skin and to prevent soiling of clothing during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. • Select a gown that is appropriate for the activity. • Remove a soiled gown as promptly as possible, and wash hands • Avoid actions which may splash, spray or splatter or create droplets. Never pipette or suction infectious materials by mouth.

31. Practice Safe Clean Up In All Situations: • Do not • recap used needles • remove used needles from disposable syringes by hand, • bend, break, or otherwise manipulate used needles by hand. • pick up sharps with bare hands - use tongs/dust pan and broom • DO • Use gloves • Place disposable sharp items in appropriate puncture-resistant containers for disposal, • place reusable syringes and needles in a puncture-resistant container for transport to the reprocessing area. • Always handle trash as if a sharp might be present • Use mouthpieces, resuscitation bags, or other ventilation devices as an alternative to mouth-to-mouth resuscitation methods • Take care when • using needles, scalpels, and other sharp instruments • handling sharp instruments after procedures; • cleaning used instruments; • disposing of used needles. Never,

32. Engineering Controls: • Safe needle devices • Needle less IV connectors • Sharp Safe containers

33. One hand scoop method

34. Retractable Needle

35. Safety shield

36. Sharp Safe Policy: • Used sharps should be handled as little as possible to minimize the risk of injury. • Needles must not be re-sheathed. If a needle and syringe needs to be disassembled then it should first be re-sheathed using a single handed technique. • Sharps must be discarded immediately after use into a designated sharps container. • Sharps must never be carried in the hand to the point of disposal, but either carried in a tray or a sharps container brought to the point of use. • They should not be passed by hand between staff. • Needles should not be removed from syringes but discarded as a single unit. • The bins must never be more than ¾ filled, sharps protruding from the aperture of a sharps bin present a major hazard to other users. • Bins must be securely closed and labeled with the date and point of origin before being sent for disposal.

37. Where blood or other potentially infectious materials are present, never • Eat • Drink • Smoke • apply cosmetics • or handle contact lenses

38. Practice Safe Clean Up In All Situations: • Use biohazard label for all infectious waste • Use leak proof, closable, puncture resistant and labeled Containers • Separate Biohazard waste from regular waste • Keep Bagged biohazard waste in the container through out disposal

39. Practice Safe Clean Up In All Situations:Patient-Care Equipment • Handle used patient-care equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and environments. • Ensure that single-use items are discarded properly. • Reusable equipment should be decontaminated after use.

40. Environmental hygiene: Cleaning and disinfection of the environment: • Concurrent cleaning – all surfaces should be cleaned using the approved disinfectant. • Terminal cleaning – after discharge of the patient with infection, room should be disinfected using approved disinfectant.

41. Care of Linen: • Used linen is potentially an infection risk especially if it is contaminated with blood or body fluid substances. • Handle, transport, and process used linen soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures and contamination of clothing, and that avoids transfer of microorganisms to other patients and environments • Render the linen “safe” by heat disinfection (usually the linen is thermally disinfected at the highest temperature the material will withstand 65º C for at least 10 minutes or 71 º C for at least 3 minutes).

42. Patient Placement • Place a patient who contaminates the environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control in a private room. • If a private room is not available, consult with infection control professionals

43. Screening and Immunization: New Employees: • All new employees are screened by Staff Clinic for Hep B and HIV. • Chest X-ray will be done to rule out pulmonary Tuberculosis. • New employees in high risk areas - Nasal screening done.

44. In the Event of a Sharps Injury • Wash the area thoroughly with soap and water. • Cover with a waterproof dressing. • Inform your In Charge or Supervisor. • Document the injury on an incident form. • If known – note the details of the patient on whom the object has been used. • Report to the Employee Health Department staff clinic) or Emergency room. Inthe Event of a conjunctiva/ Mucous Membrane splash: • If splashed with blood/ body fluids irrigate with copious amounts of water; • follow steps 4 – 6 above

45. COLOUR CODING OF WASTE DISPOSAL BAGS • BLACK BAG : For Disposing all types of General Wastes : • Papers • Tissue papers • Paper Towels • Wrappers of hospital supplies • Bottles • Tin cans; Food wastes

46. Waste Disposal: Pathological/Clinical Waste: This is defined as waste which is contaminated with potentially infectious substances e.g., blood, fecal matter, human tissue, used dressings etc. This waste should be disposed off in a Biohazard Bag (YELLOW BAG). Non pathological Waste/ Non Clinical Waste: • This includes items such as office paper, paper towels, wrapping for sterile packs and other health care waste which is not contaminated with probably infectious substances. • This waste should be disposed of in a BLACK BAG.

47. YELLOW BAG : For Disposing Pathological Wastes (Any waste contaminated with Blood & Body fluids, secretions, excretions and sharps etc.) :

48. SINGLE PATIENT USE DEVICES

49. Contd….. Blood spill kit and Mercury spill kit: These are available with the domestic staff and they are trained to use these kits. Cleaning other facilities and equipments is done on a routine basis. EMC (Equipment Maintenance Center): All equipments are sent to EMC for cleaning and disinfection .

50. Contd…… Items that undergo sterilization are sent to CSSD situated outside the hospital complex. After the sterilization process the items are Packed and returned to the respective areas, ready for use.