Standard Workplace Precautions

and
Bio-Medical Waste Management

Standard Workplace Precautions

 Session Objectives

By the end of the session participants will be able to:

Understand the importance of Standard Workplace
Precautions

Discuss components of Standard Workplace Precautions

Discuss how to protect Health Care Workers and others

from acquiring infection

Discuss the principles of India’s Bio-Medical Waste

Management Programme

Understand the need for proper waste disposal

Standard Workplace Precautions 2

 Infectious Wastes Specifically Are
Blood and blood products in a free
flowing and unabsorbed state

Body organs

Contaminated sharps

Isolation Wastes

Laboratory wastes

Unfixed pathological tissues

Standard Workplace Precautions 3

 Case Study 1
Dr. Rajiv works in a maternity clinic. The building
is old and none of the sinks are located in or near the
examination rooms

Though Dr. Rajiv examines many clients during the day,

he does not routinely wash his hands before or after
examining them

Dr. Rajiv finds washing his hands inconvenient

and, besides, his hands don’t look dirty

Standard Workplace Precautions 4

 Case Study 1.2

Discussion Questions:
Is this an appropriate practice? Why or why not?

What are the barriers to appropriate hand hygiene

for Dr. Rajiv?

Give some suggestions for how to improve

Dr. Rajiv’s compliance?

Standard Workplace Precautions 5

 Hand Hygiene
Hands are the most common mode
of pathogen transmission
Hand washing is an extremely
important step in overall infection
control
Hand washing significantly removes
the bacterial flora and HIV from the
skin surface
Hand washing protects you and
your patients from the pathogen
transmission

Standard Workplace Precautions 6

 When should you wash your hands?
Before, during, and after preparing food
Before eating food
Before and after caring for someone who is sick
Before and after treating a cut or wound
After using the toilet
After changing diapers or cleaning up a child who has used the toilet
After blowing your nose, coughing, or sneezing
After touching an animal, animal feed, or animal waste
After touching garbage

Standard Workplace Precautions 7

 What is the right way to wash
your hands?
Wet your hands with clean running water
(warm or cold) and apply soap

Rub your hands together to make a

lather and scrub them well; be sure to
scrub the backs of your hands, between
your fingers and under your nails

Continue rubbing your hands for at least

20 seconds. Need a timer? Hum the
"Happy Birthday" or “Twinkle , Twinkle”
song from beginning to end twice
Image Courtesy GHTM/I-TECH,
Rinse your hands well under running Tambaram, Chennai
water. Dry your hands using a clean
towel or air dry.
Standard Workplace Precautions 8
 Effective Hand Washing
Areas commonly missed in hand washing

Standard Workplace Precautions 9

 Effective Hand Washing

Standard Workplace Precautions 10

 Hand Hygiene and Gloves
Gloves are not the substitute for
Hand Washing
Always wash hands before / after
removing gloves, after handling all
materials known or suspected to be
contaminated
Good hand washing: 20 seconds
with running water, soap & friction
Gloves need to be removed between
patients
Dispose of single-use items correctly
after use
Standard Workplace Precautions 11
 What is the alternate way?
Washing hands with soap and water is the best way
to reduce the number of germs on them
If soap and water are not available, use an alcohol-
based hand sanitiser, contains at least 60% alcohol
Alcohol-based hand sanitisers can quickly reduce
the number of germs on hands in some situations,
but sanitizers do not eliminate all types of germs
Apply the product to the palm of one hand
Rub your hands together
Rub the product over all surfaces of your hands and
fingers until your hands are dry
Hand sanitisers may not be as effective when hands
are visibly dirty

Standard Workplace Precautions 12

 Personal Protective Equipments (PPE)
Used in Healthcare Settings
Gloves: Protect hands
Gowns/aprons: Protect skin
and/or clothing
Masks and respirators: Protect
mouth/nose
Respirators: Protect
respiratory tract from airborne
infectious agents
Goggles: Protect eyes
Face shields: Protect face, mouth,
nose and eyes

Standard Workplace Precautions 13

 Factors Influencing PPE Selection
Type of exposure anticipated

Splash / spray versus touch

Category of isolation precautions

Durability and appropriateness for the task

Fit to the user

Standard Workplace Precautions 14

 Hand Protection: Gloves
Minimise the risk of acquiring
infections from patients
Prevent microbial flora from
being transmitted from health
care providers to patients
Glove material – vinyl, latex,
nitrile
Sterile or non-sterile
One or two pair
Gloves are not the substitutes Single use or reusable
for Hand washing

Standard Workplace Precautions 15

 Gloves
Should be available in a variety
of sizes and types
May causes hand fatigue,
if gloves don’t fit correctly
Glove integrity may be
compromised
Injury is more likely to occur
due to an ill fitting glove

Standard Workplace Precautions 16

 Example of Gloves that are too TIGHT

Will cause fatigue Pulls too tightly across the

as fingers try to flex palm; Will cause fatigue at
thumb joint

Standard Workplace Precautions 17

 Example of Gloves that are too LOOSE

Gloves that are too large pose a danger as excess glove

material can catch on something and tear
Tactile sensitivity during procedures is greatly reduced as well

Standard Workplace Precautions 18

 Do’s and Don’ts of Glove Use
Work from “clean to dirty”
Limit opportunities for “touch contamination” - protect
yourself, others and the environment
Don’t touch your face or adjust PPE with contaminated
gloves; Don’t touch environmental surfaces except as
necessary during patient care
Change gloves
During use if torn and when heavily soiled (even during
use on the same patient); After use on each patient
Discard in appropriate receptacle
Never wash or reuse disposable gloves

Standard Workplace Precautions 19

 Gowns or Aprons

Purpose of use
Material:
Natural or man-made
Reusable or disposable
Resistance to fluid penetration
Clean or sterile

Standard Workplace Precautions 20

 Face Protection

Masks – protect nose and mouth

Place over nose, mouth and chin. Fit
flexible nose piece over nose bridge.
Secure on head with ties or elastic
and adjust to fit
Should fully cover nose and mouth
and prevent fluid penetration

Goggles – protect eyes

Should fit snuggly over and around eyes
Personal glasses not a substitute for
goggles

Standard Workplace Precautions 21

 Sequence for Donning PPE

Gown first
Mask
Goggles or face shield
Gloves

Standard Workplace Precautions 22

 Sequence for Removing PPE

Gloves
Face shield or goggles
Gown
Mask

Standard Workplace Precautions 23

 Biomedical
Waste Disposal

24
 Definition

Bio-medical waste means any waste which is

generated during the diagnosis, treatment (or)
immunization of human beings (or) animals or in
research activities pertaining thereto or in the
production (or) testing of biological.

Standard Workplace Precautions 25

 Health care waste facts….
It means all waste generated from hospital
85% non-hazardous wastes
10% infectious wastes
5% non-infectious but hazardous
Persons at risk:
Medical doctors, nurses, health care, auxiliary and
hospital maintenance personnel
Workers in support service – lab, imaging services,
laundries and transportation
Workers in waste disposal facilities – hospital workers
Patients in health care institutions
Visitors to health care institutions
Standard Workplace Precautions 26
 Case Study 2
Ms. Indira Ganesh, as the new district supervisor,
made her first visit to the Maternity Clinic.
Upon visiting the waste disposal site, she found
a large pit, half full with a layer of leaves and other
garden debris. She also saw a gardener dump a
wheelbarrow full of debris into the pit.
Then, she found a pile of medical waste, against
the outside fence, consisting of bloody dressings,
waste from the labour room and exposed needles
attached to IV tubing.
What are the waste-disposal issues here?
What could be done about this situation?
Standard Workplace Precautions 27
 Operationalisation of
Waste Disposal: Key Strategies
Segregatio
n of Waste
Treatment
and
Disposal

Collection
and
Storage

Transp
ortation

Standard Workplace Precautions 28

 Operationalisation of Waste Disposal
Strategies in the institutions
Generation of waste

Source segregation in color coded bags

Collection from all the hospital facilities

Onsite treatment (where ever necessary)

Storage in the designated storage room

Weighing

Transportation by private / govt. agency

Standard Workplace Precautions 29

 Types of Bio-Medical
Hazardous Waste
Infectious
All Body Fluids
Anatomical parts and lab specimens
Sharps
Toxic
Chemicals and pharmaceuticals
Genotoxic waste
Radioactive
Genotoxic waste

Standard Workplace Precautions 30

 Categories of waste
Waste
Treatment and
Category Waste Category Type
Disposal Options
No

1 Human Anatomical Waste Incineration / deep burial

2 Animal Waste Incineration / deep burial

Microbiology and Autoclaving / microwaving /

3
Biotechnological Waste incineration
Incineration / destruction and
4 Waste Sharps
disposal in secured landfills
Discarded Medicines & Incineration / destruction and
5
Cytotoxic drugs disposal in secured landfills

Courtesy: Tamilnadu Health System Project

Standard Workplace Precautions 31
 Categories of waste
Waste
Treatment and
Category Waste Category Type
Disposal Options
No

6 Soiled wastes Incineration / deep burial

Disinfection / auto /
7 Solid wastes micro waving and
mutilation/shredding
Disinfection and discharge
8 Liquid wastes
into drains

9 Incineration ash Disposal municipal landfill

Disinfection and discharge

10 Chemical waste
into drains

Courtesy: Tamilnadu Health System Project

Standard Workplace Precautions 32
 Colour Coding
Colour Container
Waste category Treatment at Final
coding for Type
Type Hospital Disposal
bags/bins

Waste sharps Plastic bag auto claving /

Blue Broken glass, 1% sodium microwaving
Ampoules, vials & sutures hypochlorite and
15L
Broken needles, Puncture proof solution mutilation /
25L
needles, blades, scalpels, container (twin shredding
50L
lancet, etc bin system)
Solid waste auto claving /
Disposable waste items like 1% sodium microwaving
Red (big) tubing’s, catheters, intra Plastic bag hypochlorite and
50L venous sets, plastic saline solution mutilation /
bottles, pouches etc., shredding
Micro biology and
Red (small) biotechnology waste Incineration /
15 L 6.Soiled waste Plastic bag NIL deep burial
25L Blood and body fluid
contaminated items

Standard Workplace Precautions

 Colour Coding
Colour Container
Waste category Treatment at Final
coding for Type
Type Hospital Disposal
bags/bins

Yellow
Human waste
Incineration /
15L Plastic bag NIL
deep burial
25L Animal waste
50L

Expiry drugs,
Black
cytotoxic drugs Disposal in
Incineration ash Plastic bag NIL secured
15L
landfill
25L
Chemical waste
Green
As
undertaken
15L Municipal Waste Plastic bag NIL
by municipal
25L
agencies
50L

Standard Workplace Precautions 34

 Segregation of Waste
Make available colour-coded
bins and bags in patient care
areas

Segregation should take place

at source

Follow colour-codes for

different categories of waste Image Courtesy GHTM, Tambaram, Chennai

Personnel should use Follow the colour codes,

protective gear while handling as advised by the
the waste respective state
governments

Standard Workplace Precautions 35

 Safety Precautions
for Waste Management
Training and education of waste handlers and drivers

Strict protocols on sharps handling and disposal

Written protocols/colourful posters as reminders

for the health care staff

Limit access to only trained persons with personal

protective gear

Eliminate steps that require unnecessary handling

hazardous wastes

Standard Workplace Precautions 36

 Commonly used disinfectants
in the laboratory
Technicians should know the procedures
to prepare the following disinfectants:

Ethyl alcohol (70%)

Glutarldehyde (2%)

Sodium hypochlorite solution (1%, 10%)

Polyvidone Iodine (PVI) 10%

Standard Workplace Precautions 37

 Recommended strength of the
Sodium hypochlorite solution
Spills [10%]

Surface contamination

1% (smooth surface)

10% (porous surface)

Liquid infectious waste

(with large amount of organic matter) [10%]

Sharp container for sharps [1%]

Standard Workplace Precautions 38

43
 Management of spills
Put absorbent material down on spillage area

Flood with 10% sodium hypochlorite solution upon

and around the spill and leave for 30 minutes

Place the absorbent material in the biohazard bag

meant for infectious waste

Reapply the disinfectant solution to all exposed

surfaces

Thorough wash of the area with soap and water

Standard Workplace Precautions 39

 No to Recapping of Needles

Standard Workplace Precautions 40

 Sharps safety

Standard Workplace Precautions 41

 Splashes to the EYE

Demonstrate how to do it
Flush the eye for 5 minutes with clean water
(for microorganisms)
Flush at least for 15 minutes (for chemicals)

Standard Workplace Precautions 42

 Handling & Disposal of
HIV positive dead body
Avoid direct contact with blood and body fluids

Wear protective gear- gloves, apron. Disinfect with

1% sodium hypochlorite all needle puncture holes,
wound drainage and dress with impermeable
dressings

Plug all orifices with swabs soaked in 1% sodium

hypochlorite solution. Wash and disinfect the body
with 1% sodium hypochlorite solution

Do not embalm the body. Cover the body with robust

plastic sheet (150um thick) and cover it tightly with
tapes or zipper

Standard Workplace Precautions 43

 Handling & Disposal of
HIV positive dead body
Clean the outside plastic sheet with 0.1% sodium
hypochlorite if soiled. Soiled linen should be bagged
and sent to laundry

It should be disinfected with sodium hypochlorite

before washing. Hands should be washed thoroughly
after removing gloves and protective clothing

Standard Workplace Precautions 44

 Key Points
Compliance with Standard Work Precaution procedures
is the mainstay of preventing exposure to HIV and other
blood borne pathogens
Follow national guidelines on bio-medical waste
management to safely dispose of infected waste
Segregate hazards into separate waste streams
at source and disposal of the infected waste to safety
ensure a safe working environment
Training and reminders ensure compliance to
waste disposal
Hands that heal should never harm…!

Standard Workplace Precautions 45