Biomedical Waste - India HIV/AIDS Resource Centre

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BIOSAFETY IN BTS
Learning Objectives
• Identify Biosafety Issues in the BTS work areas
• List the key requirements for the safe disposal
of biological and chemical waste
Definition
• The use of lab practices and procedures and
equipments for safety when working with
potentially infectious microorganisms.
Why Biosafety Practices?
Protection of• Workers
• Products
• Co workers
• Lab support personnel
• Environment
• Regulatory requirements
Risk of occupational transmission of
infection depends on
• Prevalence of infected individuals in the
population
• The frequency of exposure to contaminated
medical instruments
• The relative infectivity and concentration of
the virus
• If there is an exposure to a large quantity of
blood
Risk of occupational transmission of
infection depends on ( Contd..)
• Deep needle stick injury
• Injury with hollow bore needles
• Patient samples positive for TTIS
Infectious risk to HCWs From
Percutaneous Exposure
Rule of 3’
HIV HCV HBV -
0.05 to 0.3%
3.0 to 10%
10 to 30%
Others at Risk
Municipal workers
Ragpickers
Community
Viral Load in Circulation
• HIV – 10 to 100 viral particles/ml
• HCV- 10,000 to 100,000 viral particles/ml
• HBV- 10,000,000 viral particles/ml
Modes of Exposure to Blood Pathogens in
the Laboratory
Lab
procedure
HCW at risk
Source of transmission
Collection of
blood/body
fluids
Doctors/Laboratory
technician/Nursing
staff
Needle stick injury, broken
specimen container, blood
contamination of hand with skin
lesion/breach
Transfer of
specimen
/blood unit
Laboratory technician
and transport worker
Contaminated exterior of the
container/ requisition slip
Processing of
specimen
/blood unit
Laboratory personnel
Puncture of skin or
contamination of skin/mucous
membrane from
Contaminated work surface
Spill/splash of specimen
container
Faulty techniques
Modes of Exposure to Blood Pathogens in the
Laboratory, contd
Lab
procedure
HCW at risk
Source of transmission
Cleaning
/washing
Support staff
Disposal of
waste
Laboratory
Contact with infectious
personnel support waste specially sharps
staff
Transport to
Transport/postal
distant
staff
laboratory/hosp
ital
Puncture/contamination of
skin from
Contaminated glassware
Sharps
Contaminated work
surface
Broken/leaking container
Interruption of Transmission
• Barriers
• Disinfection
• Vaccination
• Post exposure prophylaxis
• Safe biohazardous waste disposal
Good Lab Practices
• General rule - all samples be treated as
potentially infectious
Universal precautions are those consistently used by all HCW
• Universal precautions are to be consistently
used by all HCW
General Lab Hygiene
• Cleaning of work surfaces and equipment with
suitable disinfectant
• Restricted entry to work areas.
• Avoid eating, drinking in the labs.
• Avoid mouth pipetting.
• Use laminar air flow hoods where necessary.
Universal Precautions
• BARRIER PROTECTION
• HAND WASHING
• SAFE TECHNIQUES
• SAFE HANDLING OF SHARP ITEMS
• SAFE HANDLING OF SPECIMEN (blood etc.)
UNIVERSAL PRECAUTIONS (contd.)
• SAFE HANDLING OF SPILLS OF BLOOD/BODY
FLUID
• USE OF DISPOSABLE/ STERILE ITEMS
• SAFE TECHNIQUES -MECHANICAL PIPETTING
DEVICE
• IMMUNISATION WITH HEPATITIS B VACCINE
BARRIER PROTECTION
•
•
•
•
Gloves
Plastic aprons/ Lab gowns
Masks
Occlusive bandages
Gloves
• Wear well fitting disposable vinyl gloves
• Change gloves if torn or visibly contaminated
with blood
• remove gloves before handling door knobs,
telephones, pens, leaving the lab
Laboratory gowns
• Should be worn when in the lab. and should be
removed before leaving.
• Use plastic aprons while cleaning re-usables and
disposing waste.
Facial protection
• Cheap deflector masks or protective glasses
should be used if splashing of sample is
expected.
Occlusive bandage
• Cover all cuts and breaks with wash proof
bandage before patient care.
HAND WASHING
•
•
•
•
•
WASH THROUGHLY WITH WATER AND SOAP IMMEDIATELY - AFTER
CONTAMINATION WITH BLOOD/BODY FLUIDS.
AFTER REMOVING GOWN/GLOVES.
BEFORE EATING, DRINKING & LEAVING THE LAB.
LABS SHOULD BE PROVIDED WITH LIQUID SOAP DISPENSERS.
USE MOISTURISING HAND CREAM AFTER EVERY HAND WASH.
GLOVES ARE NOT A SUBSITUTE FOR HAND WASHING
Safe Handling Techniques in Lab
• Centrifuge tubes with safety caps should be used
SHARPS:
• Do not bend/ break/ recap/ manipulate or remove needles
from disposable syringe.
• Extreme care should be taken to avoid auto-innoculation.
• Chipped/broken glassware should be disposed off in
appropriate containers.
• Don’t use hands to pick up broken glass.
SAFE HANDLING OF SPECIMEN
• Collect samples in sterile screw cap plastic containers.
• Seal properly to prevent spill/leakage.
• Use sterile disposable syringes and needles/vacutainers.
Cover cuts with waterproof bandages.
• Transfer leaked samples to fresh container, rewrite patient
information on the new container.
• Reject requisition slip contaminated with blood or handle
using gloves in case of emergency.
Safe Handling of Spills
IN CASE OF BLOOD SPILLS
• COVER THE AREA WITH PAPER TOWELS OR GAUZE SPONGES TO ABSORB
THE LIQUID.
• Cover the spill AREA WITH DISINFECTANT SOLUTION .
(0.5-1 % Sodium Hypochlorite –freshly prepared).
- LEAVE IT FOR 30 MIN
- With 4% hypochlorite solution leave for 10 minutes.
• WASH THE AREA THROUGHLY WITH SOAP AND WATER.
• CONTAMINATED MATERIAL TO BE DISPOSED OFF AS INFECTIOUS WASTE.
Prompt Accident Management
• Spillage
• Rupture of blood bag in the centrifuge,
breakage of tubes.
• Leakage of blood bag in transport containers.
• Needle stick injury; blood splashes
Biomedical Waste
• Biomedical Waste means any waste, which
is generated during diagnosis, treatment or
immunization of human beings or animals
or in research activities pertaining thereto
or in the production or testing of biologicals
and including categories mentioned in
Schedule I
Biomedical Waste Management
• Improper disposal / treatment of un-segregated and
segregated medical waste is a potential hazard
affecting the health of the patients, health care
workers, the community as well as the
environment.
• A notification regarding Biomedical Waste
(Management & Handling) Rules,1998 has been
published by the Ministry of Environment & Forests.
Safe Disposal
•
•
•
•
Segregation
Disinfection
Storage
Disposal
Biomedical Waste (management and handling ) Rules, 1998
Ministry of Environment and Forests. GOI
Amendment of the Rules is under process
Categories of Bio-Medical Waste
Option
Waste category
Treatment & disposal
Category 1
Human anatomical waste
Incineration/deep burial
Category 2
Animal anatomical waste
Incineration/deep burial
Category 3
Microbiology & Biotechnology
waste
Local autoclaving/
microwaving/ Incineration
Category 4
Waste sharps
Disinfection (/autoclaving/
microwaving and
mutilation/shredding
Category 5
Discarded Medicines and
Cytotoxic drugs
Incineration/destruction
and drugs disposal in
secured landfills
Category 6
Solid waste (items contaminated
with blood and body fluids)
Incineration
autoclaving/microwaving
Categories of Bio-Medical Waste Contd…
Option
Category of waste
Treatment
Category 7
Solid waste
(Tubings, catheters,
intravenous sets etc.)
Disinfection by chemical
treatment autoclaving
/microwaving and
mutilation/ shredding
Category 8
Liquid waste
Disinfection by chemical
treatment and discharge
into drains
Category 9
Incineration Ash
Disposal in municipal
landfill
Category 10
Chemical waste
Chemical treatment and
discharge into drains for
liquids and secured landfill
for solids
Colour Coding &Type of Container for
Disposal of Bio-Medical Wastes
Color
coding
Type of
container
Waste
category
Treatment options
as per schedule I
Yellow
Plastic bag
Cat 1, Cat 2, Cat
3, Cat 6
Incineration/deep
burial
Red
Disinfected
container/plastic
bag
Cat 3, Cat 6, Cat
7
Autoclaving/microwavi
ng/ chemical treatment
Blue/white
translucent
Plastic
bag/puncture
proof container
Cat 4, Cat 7
Autoclaving/microwavi
ng chemical treatment
and
destruction/shredding
Black
Plastic bag
Cat 5 and Cat 9
and Cat 10
(Solid)
Disposal in secured
landfill
Disinfection
• Reduction in the number of pathogenic microbes so that the
material/object/surface becomes safe for handling
• Advantages of Na hypochlorite
–
–
–
–
Bactericidal
Virucidal
Easily available
Affordable
• Disadvantages
– Corrodes metal
– Deteriorates rapidly
Disinfection of Glassware
Blood/plasma/serum/fluids in glass containers
- Sample vials
- Test tubes
•
Discard in plastic bins containing 1% sodium hypochlorite ( 10, 000 ppm chlorine)
Disinfected blood/fluids
Glassware treated in chromic acid
Wash down with running tap water
Dry in hot air oven ( Temp 160C)Wash thoroughly
Blood and Blood Products in
Plastic ware
–
–
–
–
–
–
Blood bags
Autoclave
Tubings of bags
Microtips
Plastic vials
Microplates
Used blood bags
disposal
Immerse in 1% Na Hypochlorite
for 30 minutes
Shredding
Safe Disposal of Sharps
• Dispose off your own sharps.
• Discard needles in puncture -proof rigid
containers after disinfection in 0.5-1% fresh
sodium hypochlorite solution.
• Don’t dispose in any other container.
• Dispose when container is 3/4 full.
Autoclave
• Saturated steam under pressure is used to decontaminate
infectious material.
• It consists of a insulated pressure chamber in which saturated
steam is used to elevate the temperature
• A pressure of 15psi at 121oC for 30 minutes is required
• Adequacy of disinfection to be checked with strips of B.
Stearothermophilus.
Issues of Concern
– Regular sensitization
• Adequate resources
– Regular availability of supportive items
• Monitoring mechanisms
– Indicators
To
Health Care Workers
and Community
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