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 - 0.05 to 0.3% HCV - 3.0 to 10% HBV - 10 to 30%

Others atOthers at RiskRiskMunicipal workers Ragpickers Community

Viral Load in CirculationViral 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

Lab procedure

HCW at risk Source of transmission

Cleaning /washing

Support staff Puncture/contamination of skin from Contaminated glassware Sharps Contaminated work surface

Disposal of waste

Laboratory personnel support staff

Contact with infectious waste specially sharps

Transport to distant laboratory/hospital

Transport/postal staff

Broken/leaking container

Modes of Exposure to Blood Pathogens in the Modes of Exposure to Blood Pathogens in the Laboratory, contdLaboratory, contd

Interruption of TransmissionInterruption of Transmission

• Barriers

• Disinfection

• Vaccination

• Post exposure prophylaxis

• Safe biohazardous waste disposal

Good Lab Practices Good Lab Practices

• General rule - all samples be treated as potentially infectious

• Universal precautions are to be consistently used by all HCW

Universal precautions are those consistently used by all HCW

General Lab HygieneGeneral 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 usedSHARPS: • 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 SpillsIN 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 ManagementPrompt 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, 1998Ministry of Environment and Forests. GOIAmendment 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 Colour Coding &Type of Container for Disposal of Bio-Medical WastesDisposal 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/microwaving/ chemical treatment

Blue/white translucent

Plastic bag/puncture proof container

Cat 4, Cat 7 Autoclaving/microwaving 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 GlasswareBlood/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 Blood and Blood Products in Plastic warePlastic ware

– Blood bags Autoclave disposal– Tubings of bags – Microtips – Plastic vials – Microplates – Used blood bags

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.

AutoclaveAutoclave• 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 ConcernIssues of Concern

– Regular sensitization

• Adequate resources– Regular availability of supportive items

• Monitoring mechanisms– Indicators

To Health Care Workers and Community