Standard Precautions & Mercury Spill Management. Dr. Richa Mishra, Assistant Professor Dept, of Microbiology SGPGIMS, Lucknow

Transcription

1 Standard Precautions & Mercury Spill Management Dr. Richa Mishra, Assistant Professor Dept, of SGPGIMS, Lucknow

2 OVERVIEW Briefly 3 Components, Hand hygiene Needle stick injury Personal protective equipment

3 Definition A set of precautions designed to prevent transmission of HIV, hepatitis B virus (HBV), and other blood borne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV or HCV etc

4 Blood Borne Viruses The major blood-borne pathogens of concern associated with needle-stick injury are: Hepatitis B virus (HBV) Hepatitis C virus (HCV) Human immunodeficiency virus (HIV)

5 Standard Precautions Previously called Universal Precautions Aim: to prevent the transmission of common infectious agents to healthcare personnel, patients and visitors in any healthcare setting Assumes blood and body fluid of ANY patient could be infectious

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7 Hand hygiene

8 2015 How does transmission of pathogens from hands occur? Organisms are present on the patient s skin Organisms must be transferred to hands of HCWs Organisms must survive on hands Hand washing or hand antisepsis by the HCW must be inadequate or entirely omitted

9 Organisms on patient skin/environment

10 Organism transfer from patient-hcw

11 Organism survival on HCW hands

12 Inadequate hand washing

13 Cross-transmission if hands are not clean

14 Cross-transmission.

15 Types Of Hand Washing Routine hand washing Surgical scrub

16 Routine hand washing with soap & water

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18 Areas Most Frequently Missed HAHS 1999

19 My five moments of hand hygiene

20 Moment 1 Before touching a patient -shaking hands, helping a patient to move around, getting washed, taking pulse, blood pressure, chest auscultation, abdominal palpation

21 Moment 2 Before clean/aseptic procedure-oral/dental care, secretion aspiration, skin lesion care, wound dressing, subcutaneous injection; catheter insertion,opening a vascular access system; preparation of food, medication, dressing sets

22 Moment 3 After body fluid exposure risk-oral/dental care, secretion aspiration; skin lesion care, wound dressing, subcutaneous injection; drawing and manipulation any fluid sample, opening draining system, endotracheal tube insertion and removal; clearing up urines, faces, vomit; handling waste (bandages,napkin, incontinence pads); cleaning of contaminated and visibly soiled material or areas (lavatories, medical instruments

23 Moment 4 After touching a patient -Shaking hands, helping a patient to move around, getting washed, taking pulse, blood pressure, chest auscultation, abdominal palpation

24 Moment 5 After touching patient surroundings-changing bed linen, perfusion speed adjustment, monitoring alarm, holding a bed rail, clearing the bedside table

25 Needle stick injuries Needle-stick or sharps injuries occur when a needle or other sharp instrument accidentally penetrates the skin This is called a percutaneous injury If the needle or sharp instrument is contaminated with blood or other body fluid, there is the potential for transmission of infection

26 Occupational exposure When blood or other body fluid splashes into the eyes, nose or mouth or onto broken skin, the exposure is said to be muco-cutaneous When this occurs in a work context, the term occupational exposure (to blood, body fluid or blood-borne infection) is used

27 Needle stick injuries What Types of Devices Are Most Commonly Involved in Needle-stick Injuries?

28 Hollow bore needles Hollow-bore needles (the type of needle used for giving injections or drawing blood) are implicated as the devices most often associated with the transmission of blood borne pathogen infections, because the blood remaining inside the bore of the needle after use contains a larger volume of virus than the relatively small amount of blood remaining on the outside of a solid core needle (i.e., a suture needle)

29 Needle... Which tasks involve most injuries? Dispose of needles Administer injections Draw blood Recap needles Handle trash and dirty linens

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32 Estimated seroconversion 0.3% for percutaneous exposure to HIVinfected blood 0.1% for mucocutaneous exposure to HIVinfected blood % for percutaneous exposure to HCV-infected blood with detectable RNA 30 % for percutaneous exposure of a nonimmune individual to HBeAg positive source

33 ROLE OF PPE Personal Protective Equipment (PPE) Alone Does Not protect the Health Care Worker from needle sticks PPE, such as gloves provide a barrier, but Most personal protective equipment is easily penetrated by needles

34 PPE

35 GLOVES

36 GOWN

37 MASK

38 EYE GOGGLES

39 2 GLOVES The glove material will remove up to 86 per cent blood on the outside of a needle An inner glove will remove most of blood not removed by the outer glove Double gloving substantially reduces the risk of blood-borne virus transmission from a sharps injury

40 SO AFTER AN INJECTION. NEVER recap, bend, or manually remove the needle from a used syringe After use, syringes, needles, and other contaminated sharps should be immediately placed in a leak-proof, puncture-proof container

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42 DO NOT fill needle-disposal boxes completely full

43 MANAGING EXPOSURE If mouth or eyes are involved, wash thoroughly with water If skin is punctured, free bleeding should be encouraged and wound washed with soap or chlorhexidine and water, but not scrubbed/sucked For possible HIV exposure, urgent advice should be sought about the relative indications for antiretroviral post-exposure prophylaxis (PEP)

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45 ROLE OF BLEACH/CHLORINE BEST compound for the preparation of chlorine solutions for disinfection is household bleach Household bleach is a solution of sodium hypochlorite which generally contains 5% (50 g/litre or ppm) available chlorine

46 BLEACH/CHLORINE FRESHLY DILUTED SOLUTIONS must therefore be prepared daily Clear water should be used because organic matter destroys chlorine 1:10 bleach solution is caustic Prepare them in a well ventilated area use plastic containers for mixing and storing as metal containers corrode rapidly

47 BLEACH/CHLORINE 1:10 bleach solution(contains 0.5% chlorine concentration) - Excreta - Bodies - Spills of blood/body fluids - Vehicles and tires - It is also used to prepare 1:100 bleach solution

48 BLEACH/CHLORINE 1:100 bleach solution (which contains 0.05% chlorine concentration) - Surfaces - Medical equipment - Bedding - Reusable protective clothing before it is laundered

49 0.05% BLEACH/CHLORINE 1:100 bleach solution (which contains 0.05% chlorine concentration) is also recommended for disinfecting contaminated waste before disposal

50 Decontamination of surfaces Disinfect surfaces by wiping clean with 1:100 chlorine solution, then incinerate all absorbent material in heavy-duty garbage bags The surfaces must be rinsed with clean water after disinfection.

51 Decontamination of blood spills For spills, use 1:10 chlorine solution to inactivate pathogens before soaking up the fluid with absorbent materials These absorbent materials must then be incinerated

52 Mercury Spill Management Mercury is a shiny, silvery liquid metal Liquid mercury (evaporates) at room temperature causing elevated levels in indoor air Mercury vapor is non-irritating and has no odor, so people do not know when they are breathing it. Even mercury from a broken thermometer can cause harm, especially to children

53 Where mercury may be found? Thermometers, thermostats, blood pressure units, barometers Spilled mercury is very hard to clean up, especially if it rolls into cracks and crevices, or if it is on fabric, upholstery or other porous material

54 DON TS.. Never use a vacuum cleaner, mop or broom to clean up Avoid walking through the spill area Take children and pets to another room Leave any clothing or footwear with the spilled mercury in the affected room

55 CLEANUP Latex or vinyl gloves Flashlight/Torch Zipper-type plastic bags /plastic trash bags Wide tape (masking, duct or clear) Eyedropper 2 pieces of stiff cardboard Moisten paper towels

56 Cleaning up a small spill Wear gloves to pick up the larger pieces of broken glass and place on a paper towel Gently fold the paper towel around these pieces and place it in a zipper-type plastic bag Use stiff cardboard to push smaller pieces of glass and mercury beads into a pile Shine a flashlight at an angle to locate beads

57 Cleaning Up Check for mercury in cracks or in hard-toreach areas Use the eyedropper to collect mercury beads Wrap tape (sticky side out) around your gloved fingers and carefully use it to pick up any remaining glass or beads

58 Biohazard Symbol Universal Symbol Communicates potential exposure Typically red or orange Used explicitly for bio-hazardous waste

59 THANK YOU

60 HCRW Management.ppt 7/03