STANDARD SAFETY MEASURES

DEFINITIONS

• Standards

– A standard is a predetermined level of excellence that serves a guide

for practice.

• Safety

– Safety is the state of being "safe" (from French sauf), the condition of

being protected against physical, social, spiritual, financial, political,

emotional, occupational, psychological, educational or other types or

consequences of failure, damage, error, accidents, harm or any other

event which could be considered non-desirable

TYPES OF SAFETY

• Normative safety

• Normative safety is a term used to describe products or designs that meet

applicable design standards.

• Substantive safety

• Substantive or objective safety means that the real-world safety history is

favorable, whether or not standards are met.

• Perceived safety

• Perceived or subjective safety refers to the level of comfort of users. For

example, traffic signals are perceived as safe, yet under some circumstances,

they can increase traffic crashes at an intersection.

SAFETY MEASURES

Safety measures are activities and precautions taken to improve safety, i.e. reduce

risk related to human health. Common safety measures include:

1. Root cause analysis

2. Visual examination for dangerous situations

3. Visual examination for flaws such as cracks, peeling, loose connections.

4. Safety margins/Safety factors

5. Implementation of standard protocols and procedures

6. Training of employees, vendors, product users

7. Instruction manuals

8. Instructional videos

9. Examination of activities by specialists

10.Government regulation

11.Industry regulation.

12.Self-imposed regulation of various types.

13.Statements of Ethics

14.Periodic evaluations of employees, departments, etc.

STANDARD SAFETY MEASURES IN HOSPITAL

• Physical health

• Bio medical waste management

• Standard precautions

PHYSICAL ENVIRONMENT

Aim: to provide an environment favourable to recovery

1. Promote comfort

2. Extermination and control of vermin and animal pets

3. Dangers

– Preventing mechanical injury

– Preventing shocks and burns from electrical fixtures

– Prevention of fire

– Protection from chemical injury

BIO MEDICAL WASTE MANAGEMENT

“any solid, fluid or liquid waste, including its container and any intermediate

product, which is generated during the diagnosis, treatment or immunization of

human beings or animals, in research pertaining thereto,

or in the production or testing of biological and the animal waste from slaughter

houses or any other like establishments”.

Classification of waste

General waste

– General sweeping

– Kitchen waste

– Packaging material

– Paper pieces

– Waste water from laundry, kitchen

Infectious waste

– Human anatomical waste

– Micro biology & micro technology waste

– Solid waste

Sharps:

– Hypodermic needles, stitching needles, needles attached with tubings

– Scalpel blades, razors, etc

CLASSIFICATION OF WASTE CATEGORY

Cat- 1 Human Anatomical Wastes

Cat- 2 Animal Anatomical Wastes

Cat- 3 Microbiology and Biotechnology wastes

Cat- 4 Waste Sharps

Cat- 5 Discarded medicines and Cytotoxic drugs

Cat- 6 Soiled wastes include items contaminated with blood, body fluids such as

cotton, dressings, linen, beddings etc.

Cat- 7 Solid wastes i.e. waste generated from disposable items other than sharps

such as tubing, catheters, IV sets.

Cat- 8 Liquid wastes ( washing, cleaning )

Cat- 9 Incineration ash

Cat- 10 Chemical wastes ( disinfectants, insecticides )

COLOR CODING FOR SEGGREGATION OF BMW

YELLOW

Human & Animal anatomical waste / Micro-biology

waste and

soiled cotton/dressings/linen/beddings etc.

Incineration /

Deep burial

RED Tubing’s, Catheters, IV sets. Autoclaving /

Microwaving /

Chemical

treatment

BLUE

Waste sharps ( Needles, Syringes, Scalpels, blades etc. ) Autolaving /

Microwaving /

Chemical

treatment &

Destruction /

Shredding

BLACK

Discarded medicines/cytotoxic drugs, Incineration ash,

Chemical waste.

Disposal in

secured landfill

Principles of Control of Hazards of Biomedical Waste in Health

Care Establishment

Each institution should develop its own bio waste management

policy and ensure that the health care workers are adequately

trained to handle biological waste.

Measures such as universal safety precautions, hand washing and

proper segregation of waste material should be encouraged.

Rationale patient management policy should be followed and admissions

restricted to those for whom it is felt absolutely necessary.

Proper house-keeping is essential and the hospital premises should be kept

clean and well-ventilated.

Use of disinfectants should be rationalised.

Steps in the Management of Biomedical Waste

1. Survey of waste generated.

2. Segregation of hospital waste

3. Collection & Categorization of waste.

4. Storage of waste.( Not beyond 48 hrs. )

5. Transportation of waste.

6. Treatment of waste.

STANDARD PRECAUTIONS

Standard precautions are meant to reduce the risk of transmission of blood borne

and other pathogens from both recognized and unrecognized sources. They are the

basic level of infection control precautions which are to be used, as a minimum, in

the care of all patients.

Health policy

• Promote a safety climate.

• Develop policies which facilitate the imple-mentation of infection control

measures.

Hand hygiene

• Perform hand hygiene by means of hand rubbing or hand washing (see

detailed indications in table).

• Perform hand washing with soap and water if hands are visibly soiled, or

exposure to spore-forming organisms is proven or strongly suspected, or

after using the restroom. Otherwise, if resources permit, perform hand

rubbing with an alcohol-based preparation.

• Ensure availability of hand-washing facilities with clean running water.

• Ensure availability of hand hygiene products (clean water, soap, single use

clean towels, alcohol-based hand rub). Alcohol-based hand rubs should

ideally be available at the point of care.

Hand Hygiene Techniques

1. Alcohol hand rub

2. Routine hand wash 10-15 seconds

3. Aseptic procedures 1 minute

4. Surgical wash 3-5 minutes

ROUTINE HAND WASH

Repeat procedures until hands are clean

Hand Care

• Nails

• Rings

• Hand creams

• Cuts & abrasions

• “Chapping”

• Skin Problems

Personal protective equipment (PPE)

ASSESS THE RISK of exposure to body substances or contaminated

surfaces BEFORE any health-care activity. Make this a routine!

• Select PPE based on the assessment of risk:

– clean non-sterile gloves

– clean, non-sterile fluid-resistant gown

– mask and eye protection or a face shield.

Respiratory hygiene and cough etiquette

• Education of health workers, patients and visitors.

• Covering mouth and nose when coughing or sneezing.

• Hand hygiene after contact with respiratory secretions.

• Spatial separation of persons with acute febrile respiratory symptoms.

Guidance for the Selection and Use of Personal Protective Equipment (PPE)

in Healthcare Settings

PPE Use in Healthcare Settings: Program Goal

Improve personnel safety in the healthcare environment through appropriate use of

PPE.

Personal Protective Equipment Definition

“Specialized clothing or equipment worn by an employee for protection against

infectious materials” (OSHA)

Types of PPE Used in Healthcare Settings

1. Gloves – protect hands

2. Gowns/aprons – protect skin and/or clothing

3. Masks and respirators– protect mouth/nose

1. Respirators – protect respiratory tract from airborne infectious agents

4. Goggles – protect eyes

5. Face shields – protect face, mouth, nose, and eyes

Factors Influencing PPE Selection

• Type of exposure anticipated

– Splash/spray versus touch

– Category of isolation precautions

• Durability and appropriateness for the task

• Fit

Gloves

• Purpose – patient care, environmental services, other

• Glove material – vinyl, latex, nitrile, other

• Sterile or nonsterile

• One or two pair

• Single use or reusable

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

Do’s and Don’ts of Glove Use (cont’d)

• 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

Gowns or Aprons

• Purpose of use

• Material –

– Natural or man-made

– Reusable or disposable

– Resistance to fluid penetration

• Clean or sterile

Face Protection

• Masks – protect nose and mouth

– 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

– Antifog feature improves clarity

Face Protection

• Face shields – protect face, nose, mouth, and eyes

– Should cover forehead, extend below chin and wrap around side of

face

Respiratory Protection

• Purpose – protect from inhalation of infectious aerosols (e.g.,

Mycobacterium tuberculosis)

• PPE types for respiratory protection

– Particulate respirators

– Half- or full-face elastomeric respirators

– Powered air purifying respirators (PAPR)

PPE Use in Healthcare Settings:

How to Safely Don, Use, and Remove PPE

Key Points about PPE

• Don before contact with the patient, generally before entering the room

• Use carefully – don’t spread contamination

• Remove and discard carefully, either at the doorway or immediately outside

patient room; remove respirator outside room

• Immediately perform hand hygiene

Sequence for Donning PPE

• Gown first

• Mask or respirator

• Goggles or face shield

• Gloves

How to Don a Gown

• Select appropriate type and size

• Opening is in the back

• Secure at neck and waist

• If gown is too small, use two gowns

– Gown #1 ties in front

– Gown #2 ties in back

How to Don a Mask

• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with ties or elastic

• Adjust to fit

How to Don a Particulate Respirator

• Select a fit tested respirator

• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with elastic

• Adjust to fit

• Perform a fit check –

– Inhale – respirator should collapse

– Exhale – check for leakage around face

How to Don Eye and Face Protection

• Position goggles over eyes and secure to the head using the ear pieces or

headband

• Position face shield over face and secure on brow with headband

• Adjust to fit comfortably

How to Don Gloves

• Don gloves last

• Select correct type and size

• Insert hands into gloves

• Extend gloves over isolation gown cuffs

How to Safely Use PPE

• Keep gloved hands away from face

• Avoid touching or adjusting other PPE

• Remove gloves if they become torn; perform hand hygiene before donning

new gloves

• Limit surfaces and items touched

PPE Use in Healthcare Settings: How to Safely Remove PPE

“Contaminated” and “Clean” Areas of PPE

• Contaminated – outside front

• Areas of PPE that have or are likely to have been in contact

with body sites, materials, or environmental surfaces where the

infectious organism may reside

• Clean – inside, outside back, ties on head and back

• Areas of PPE that are not likely to have been in contact with the

infectious organism

Sequence for Removing PPE

• Gloves

• Face shield or goggles

• Gown

• Mask or respirator

Where to Remove PPE

• At doorway, before leaving patient room or in anteroom*

• Remove respirator outside room, after door has been closed*

• Ensure that hand hygiene facilities are available at the point needed, e.g.,

sink or alcohol-based hand rub

How to Remove Gloves (1)

• Grasp outside edge near wrist

• Peel away from hand, turning glove inside-out

• Hold in opposite gloved hand

How to Remove Gloves (2)

• Slide ungloved finger under the wrist of the remaining glove

• Peel off from inside, creating a bag for both gloves

• Discard

Remove Goggles or Face Shield

• Grasp ear or head pieces with ungloved hands

• Lift away from face

• Place in designated receptacle for reprocessing or disposal

Removing Isolation Gown

• Unfasten ties

• Peel gown away from neck and shoulder

• Turn contaminated outside toward the inside

• Fold or roll into a bundle

• Discard

Removing a Mask

• Untie the bottom, then top, tie

• Remove from face

• Discard

Removing a Particulate Respirator

• Lift the bottom elastic over your head first

• Then lift off the top elastic

• Discard

PPE for Expanded Precautions

• Expanded Precautions include

– Contact Precautions

– Droplet Precautions

– Airborne Infection Isolation

Use of PPE for Expanded Precautions

• Contact Precautions – Gown and gloves for contact with patient or

environment of care (e.g., medical equipment, environmental surfaces)

• In some instances these are required for entering patient’s

environment

• Droplet Precautions – Surgical masks within 3 feet of patient

• Airborne Infection Isolation – Particulate respirator*

Hand Hygiene

• Required for Standard and Expanded Precautions

• Perform…

– Immediately after removing PPE

– Between patient contacts

• Wash hands thoroughly with soap and water or use alcohol-based hand rub

Standard precautions –key components

1. Hand hygiene

Summary technique:

Hand washing (40–60 sec): wet hands and apply soap; rub all surfaces; rinse

hands and dry thoroughly with a single use towel; use towel to turn off

faucet.

Hand rubbing (20–30 sec): apply enough product to cover all areas of the

hands; rub hands until dry.

Summary indications:

Before and after any direct patient contact and between patients, whether or

not gloves are worn.

Immediately after gloves are removed.

Before handling an invasive device.

After touching blood, body fluids, secretions, excretions, non-intact skin,

and contaminated items, even if gloves are worn.

During patient care, when moving from a contaminated to a clean body site

of the patient.

After contact with inanimate objects in the immediate vicinity of the patient.

2. Gloves

Wear when touching blood, body fluids, secretions, excretions, mucous

membranes, nonintact skin.

Change between tasks and procedures on the same patient after contact with

potentially infectious material.

Remove after use, before touching non-contaminated items and surfaces, and

before going to another patient. Perform hand hygiene immediately after

removal

3. Facial protection (eyes, nose, and mouth)

Wear

(1) a surgical or procedure mask and eye protection (eye visor, goggles) or

(2) a face shield to protect mucous membranes of the eyes, nose, and mouth

during activities that are likely to generate splashes or sprays of blood, body fluids,

secretions, and excretions.

4. Gown

Wear to protect skin and prevent soiling of clothing during activities that

are likely to generate splashes or sprays of blood, body fluids, secretions, or

excretions.

Remove soiled gown as soon as possible, and perform hand hygiene.

5. Prevention of needle stick and injuries from other sharp instruments

Use care when:

Handling needles, scalpels, and other sharp instruments or devices.

Cleaning used instruments.

Disposing of used needles and other sharp instruments.

6. Respiratory hygiene and cough etiquette

Persons with respiratory symptoms should apply source control measures:

Cover their nose and mouth when coughing/sneezing with tissue or mask,

dispose of used tissues and masks, and perform hand hygiene after contact

with respiratory secretions.

Health-care facilities should:

Place acute febrile respiratory symptomatic patients at least 1 metre (3 feet)

away from others in common waiting areas, if possible.

Post visual alerts at the entrance to health-care facilities instructing persons

with respiratory symptoms to practise respiratory hygiene/cough etiquette.

Consider making hand hygiene resources, tissues and masks available in

common areas and areas used for the evaluation of patients with respiratory

illnesses.

7. Environmental cleaning

Use adequate procedures for the routine cleaning and disinfection of

environmental and other frequently touched surfaces.

8. Linens

Handle, transport, and process used linen in a manner which:

Prevents skin and mucous membrane exposures and contamination of

clothing.

Avoids transfer of pathogens to other patients and or the environment.

9. Waste disposal

Ensure safe waste management.

Treat waste contaminated with blood, body fluids, secretions and excretions

as clinical waste, in accordance with local regulations.

Human tissues and laboratory waste that is directly associated with specimen

processing should also be treated as clinical waste.

Discard single use items properly.

10. Patient care equipment

Handle equipment soiled with blood, body fluids, secretions, and excretions

in a manner that prevents skin and mucous membrane exposures,

contamination of clothing, and transfer of pathogens to other patients or the

environment.

Clean, disinfect, and reprocess reusable equipment appropriately before use

with another patient.