TOPIC 4 HANDLING HEALTH PROTECTION & SAFETY PRACTICES FOR MEDICAL STAFF & WASTE HANDLERS TRAINING & PUBLIC EDUCATION

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1 TOPIC 4 HANDLING HEALTH PROTECTION & SAFETY PRACTICES FOR MEDICAL STAFF & WASTE HANDLERS TRAINING & PUBLIC EDUCATION Who Is AT RISK? Basic Questions Key Points General Principles Waste Handling Minimum Approach Enhancements Training & Public Education

2 WHO IS AT RISK? Staff Needle-sticks Blood splatter Pathogenic aerosols Patients Improperly discarded sharps found in linens Exposure to accidental spills WHO IS AT RISK? HC Facilities are ideal for disease transmission Health-care staff are constantly exposed to potentially infectious materials. Patients may have infections that are easily transmitted. Patients may be more susceptible to infections due to illness. Services are provided in a limited physical space.

3 WHO IS AT RISK? Community Exposure of waste pickers on open dumpsites Unearthing of anatomical remains by animals Exposure to contaminated sharps Beach wash-ups Waste bags found by children Reuse by illicit drug users BASIC QUESTIONS Are all staff aware of the potential risk associated with HCW? Who trains & checks new staff? Are all staff immunized against, at least, hepatitis B? What protective clothing is available to medical staff/waste handlers? What is being done now to prevent needle-stick injuries? What is being done now to clean up spills of body fluids quickly?.

4 KEY POINTS Among the 35 M health workers worldwide, about 3 M receive percutaneous exposures to bloodborne pathogenes each year. Ensure that all staff are aware of safe medical practices when treating patients & risks associated with handling HCW. Most needle-stick injuries are related directly to poor working practices. If serious incidents of infection occur = something is wrong.. KEY POINTS Principal routes for transmission: Air Water Food / ingestion Vectors Physical contact the most common transmission route

5 Chain of Infection 1. Presence of infectious agent 2. Sufficient amount of infectious agent 3. Susceptible host 4. Mode of transmission Direct contact, aerosols, vehicle-borne 5. Portal of entry KEY POINTS Broken skin, mucous membranes, respiratory tract, etc. KEY POINTS 3 distinct types of contact transmission of infection to patients: From the hands of medical staff From contaminated equipment used on patients From poorly cleaned surfaces & rooms Main source of contact transmission of infection to medical staff & waste handlers: Needle-stick injuries

6 KEY POINTS 36% of percutaneous injuries occur due to 2- handed recapping needles. (study in 98 HC facilities in a country in Eastern Mediterranean Region) Medical staff & worker safety Training of staff Provision of protective clothing & equipment Establishing immunization, post-exposure treatment & regular medical surveillance Protective clothing Strongly recommended: overalls, industrial standard aprons & gloves, leg protectors and/or strong boots Advisable (for risk of exposure to uncontained waste or if working with waste treatment equipment): safety glasses, face masks, helmets

7 Use personal protective equipment (PPE) Gloves Shoes or boots with thick soles and good traction Coveralls or aprons Safety glasses Face shields Respirators Use gloves Use heavy-duty utility gloves. Select gloves that are resistant to cuts, abrasions, and common chemicals. Select gloves that allow a good grip. Gloves should fit well and not hinder tasks. Check for allergies (e.g., latex).

8 Use gloves: WHY? Barrier against germs in blood, body fluids, tissues, and other healthcare waste Protection against many chemicals Prevent spread of diseases to others Use gloves: WHEN? When handling healthcare waste When sealing bags and containers When transporting healthcare waste When storing healthcare waste

9 Use gloves: HOW? Check for tears and holes in the gloves; discard gloves with cuts or holes. Wash gloves if they become contaminated. Always wash hands after removing gloves. Waste Handling Identify bags through colour and marking. Keep healthcare waste segregated. Never place a yellow bag inside a black bag. Never empty the contents of an untreated yellow bag into another bag. Take special care when handling sharps containers to avoid punctures. Use personal protective equipment.

10 Handling yellow / red bags When 3/4 th full, tightly close or seal bag. Pick up bag by the neck only. Put it down in a way so they can be picked up by the neck again. Bags should should not touch the body. Do not throw or drop bags. Handling sharps containers When 3/4 th full, close and remove container. Check all sides for any holes or protruding needles before lifting the container. If there are holes in the container, carefully place the container inside a larger puncture-resistant container.

11 Handling contaminated linen Check contaminated linens carefully for any sharps. Handle all used linen using gloves, arms sleeves, and coveralls. When removing soiled linen, gather the linen so the contaminated area is on the inside. Contaminated linen should be washed in hot water (at least 88 C) for at least 20 minutes. Needle-stick injury Hand hygiene Equipment hygiene Building hygiene

12 MINIMUM APPROACH Wash hands. Ensure safe collection of sharps. Wear gloves. Wear a mask, eye protection & a gown & plastic apron. Cover cuts/abrasions with waterproof dressing. Promptly & carefully clean up blood/body fluids Set up a safe system of HCWM & disposal. In lower income / rural areas: provide hepatitis B vaccination to all staff. MINIMUM APPROACH Wash hands: WHEN? Immediately after arriving for work. Always after handling healthcare waste. After removing gloves and/or coveralls. After using the toilet or before eating. After cleaning up a spill. Before leaving work.

13 MINIMUM APPROACH Wash hands: HOW? 1. Wet hands and apply soap. 2. Work up lather on palms, back of hands, sides of fingers, and under fingernails. 3. Scrub vigorously with soap for seconds. 4. Rinse well. 5. Dry with a clean towel or allow to air-dry. ENHANCEMENTS Routine immunizations Immunize HC workers early in their careers. Use a 0, 1 & 6 month schedule of 3 injections. If possible, conduct post-vaccination testing. Personal protective equipment Provide adequate supplies in each medical area. Involve staff in selection. Train staff in correct use. Senior medical staff: role models Monitor staff compliance. Dispose of used personal protective equipment safely.

14 ENHANCEMENTS Minimization of risk of infection from a needle-stick injury Effective response when an occupational exposure occurs Develop guidelines for first aid reporting mechanism procedure to follow for postexposure prophylaxis & f/u testing. Disseminate guidelines to all staff. ENHANCEMENTS Ensure all staff have access to postexposure information, education & communication. Provide support & counselling to those exposed. Provide post-exposure prophylaxis Analyse reported cases of exposure to improve practices.

15 TRAINING & PUBLIC EDUCATION Training Training of new staff Annual refresher seminar TRAINING & PUBLIC EDUCATION Public education Posters, handouts and verbal instructions yellow bags/containers with the universal biohazard symbol means potentially infectious healthcare waste. Do not place regular garbage into bags or Yellow containers with the biohazard label. Do not open or handle healthcare waste containers. Keep children away from healthcare waste containers Report any spills or accidents involving healthcare waste immediately; avoid contact with spilled contents.

16 Questions and Comments by Audience