Infection prevention and a control a case of Kiswa HC III, Kampala Capital City Uganda

1. INFECTION PREVENTION AND
CONTROL
BIOSAFETY & BIOSECURITY
PRESENTED BY
KATO AND TYNDALE

2. Infection Control and
Prevention
 An infection is the invasion of an organism's body tissues by
disease-causing agents, their multiplication, and the
reaction of host tissues to the infectious agents and the
toxins they produce.
 Infection Control and Prevention;
 Refers to policies and procedures used to minimize the risk
of spreading infections, especially in hospitals and human or
animal health care facilities.

3. BIOSAFETY VS BIOSECURITY
Biosafety adapted from: (WHO/CDS/EPR/2006.6)
Biosafety describes the containment principles, technologies and
practices that are implemented to prevent the unintentional exposure to
Biological agents and toxins or their accidental release
BIOSECURITY: (WHO/CDS/EPR/2006.6)
Describes protection, control and accountability for valuable biological
materials within laboratories, in order to prevent their loss, theft, misuse,
diversion of, unauthorized access or intentional release wether or not the
biorisk(s) is acceptable

4. WHY BIOSAFETY/BIOSECURITY
Goals
Safety for people
and the
environment
Design &
implement
biorisk
management
program
Review & revise
risk assessment
safety practices
and equipment
Report
on problems
and successes
in
implementation
Evaluate
reports,
reviews and
revisions
Policy
High standard in
environmental
health and safety

5. Role of facility in charge in
infection control
 Actively participate in the design and planning stages of infection control
activities
 Assess all potential risks
 Ensure proper and safe environment for health facility users
 Lobby for supplies especially the PPE from the different stakeholders

6. Role of Quality Manager or
Safety Officer
 Develop basic facility safety rules and organization
 Ensure personnel are trained in their specific duties
 Know the basics of chemical safety and risk pathogens
 Know how to perform extensive risk assessment
 Conduct safety audits.

7. Roles of staff
 Be aware of basic safety rules and processes;
 Understand the basics of safety and biosafety
management issues when working with toxic chemicals,
biological samples and physical hazards, and when
interacting with patients.

8. Roles of infection control
focal person
 Ensure adherence to the safety procedure and standards
 Protect the safety and health of the learners , staff and
visitors
 Ensure that staff practice the PPE
 Establish the budget proposals for the operation of the
OSH
 Increase the health and safety awareness at all levels
within the facility
 Investigate and report all the accidents within the
facility
 Ensure staff are trained in all safety programs

9. Roles of infection control
focal person
 Ensure that accidents are properly managed
 Reports to the quality manager who forwards them to
facility supervisor
 Conduct safety audits in the facility
 Respond to the fire and other emergencies on the
facility property.
 Etc

10. Factors that contribute to general
risks
• Improper training
• Lack of supervision while at work (conversation, reading newspapers,
etc)
• Faulty equipment
• Untidy or cluttered work environment

11. Factors that contribute to
general facility risks …..
 Excessive work load, fatigue and hurrying to finish work
 Carelessness and negligence
 Failure to use or appropriately use protective wear
 Ignorance of the infection risks of materials being handled.

12. General health hazards
These are categorised into:
 Biological hazards
 Chemical hazards
 Fire hazards
 Physical structure
 Mechanical hazards
 Electrical hazard
 Ergonomic
 Noise
Contamination Routes
Ocular invasion
Inhalation
Ingestion
Skin penetration

13. General hazards:
Biological
Biological hazards: Infections
Infections in the laboratory can be acquired by:
 Inhaling pathogens in aerosols (microscopic droplets) created in the
laboratory by snap closing/opening specimen containers, centrifuging
infectious materials in open buckets, or breakage of specimen containers.

14. General hazards:
Chemical hazards
 All laboratories use dangerous chemicals either directly or incorporated
into stains and reagents.
 Material safety data sheets or other chemical hazard information are
available from chemical manufacturers and/or suppliers.
 Follow chemical hazard mitigation plans.

15. General hazards:
Improper Hazardous Chemical
Storage
 Discard old chemicals
according to MSDS
sheets

16. General hazards:
Fire hazards
 Close cooperation between safety officers
and local fire prevention officers is essential.
 Fire warnings, instructions and escape routes
should be displayed prominently in each
room, corridors and hallways.
 Fire-fighting equipment should be placed
near room doors and at strategic points in
corridors and hallways.

17. General hazards:
Fire hazards
Examples of fire fighting equipment:
 Horses
 buckets (of water or sand)
 Fire extinguisher.

18. General hazards:
Fire hazards
Common causes of fires in laboratories are:
 Electrical circuit overloading
 Poor electrical maintenance, e.g. poor and perished insulation on
cables
 Excessively long gas tubing or long electrical leads
 Equipment unnecessarily left switched on
 Equipment that was not designed for a laboratory environment
 Open flames
 Deteriorated gas tubing
 Improper handling and storage of flammable or explosive materials
 Improper segregation of incompatible chemicals
 Sparking equipment near flammable substances and vapours
 Improper or inadequate ventilation.

19. General hazards:
Fire Hazard
Everything near open flame
 Keep open flame away
from potentially
flammable material;

20. General hazards:
Electrical hazards
 All electrical installations and equipment inspected and tested
regularly, including earthing /grounding systems.
 Circuit breakers and earth-fault-interrupters should be installed in
appropriate electrical circuits.
 All electrical equipment and wiring should conform to national
electrical safety standards and codes.

21. General hazards:
Electrical cords in traffic flow
 # 12.4
 Re-rout plug out of
traffic flow

22. General hazards:
Ergonomic hazards
 Ergonomic hazards refer to workplace
conditions that pose the risk of injury to the
musculoskeletal system of the worker:
o Repetitive and forceful movements,
o Vibration,
o Extreme temperatures and
o Awkward postures that arise from improper work methods and improperly
designed workstations tools and equipment.

23. General hazards:
Ergonomic hazards
General recommendations to improve Ergonomics
1. Store heavy objects on shelves below shoulder height
whenever possible .
2. Use a stable footstool or stepladder to reach objects stored
on high shelves .
3. Avoid twisting while carrying an object. The load should be
directly in front of the worker .
4. Store frequently used materials on shelving units which are
located between knuckle and chest height .
5. Utilize rotating platforms/shelves to store material close to
the worker, reducing unnecessary reaching.
6. Increase the diameter or span of the tweezers to reduce
grip force

24. General hazards:
Ergonomic hazards
7. Use anti-fatigue mats or foot rests for areas requiring prolonged
standing
8. Use thin flexible gloves that fit properly
9. Use tools with padded handles or large-diameter handles to reduce
required grip force.
10. Shift weight frequently when standing for a prolonged time; use a
footrest to prop up one foot at a time.
11. Vary activities. Change your position and take breaks every 20
minutes to rest muscles and increase blood flow and circulation.
12. Report early signs and symptoms of repetitive motion injuries.

25. General hazards:
Chemical hazards
Storage of chemicals
 Only amounts of chemicals necessary for daily use should be stored in
the laboratory.
 Bulk stocks should be kept in specially designated rooms or buildings.
 Chemicals should not be stored in alphabetical order.

26. General hazards:
Chemical hazards
Exposure to hazardous chemicals may occur
by:
 Inhalation
 Contact
 Ingestion
 Needle-sticks
 Through broken skin.

27. General hazards:
Biological
Biological hazards: Infections
 Ingesting pathogens from
contaminated hands, food/drink
or licking pens, markers, labels,
etc.
 Broken skin due to needle pricks
cuts from broken glass and
scratching eyes, ear nose picking,
etc.
 Aerosols and splashes through
open mucous membranes (e.g.
unprotected eyes) and prolonged
contact with intact skin.
Contamination Routes
Ocular invasion
Inhalation
Ingestion
Skin penetration

28. Factors that contribute to
general health risks …..
 Work station
cluttered
 Sort,set,shine,standardise,
sustain and ensure Safety of
the workspace

29. Factors that contribute to general
health risks
• Improper training
• Lack of supervision while at work
(conversation, reading newspapers,
etc)
• Faulty equipment
• Untidy or cluttered work environment

30. AMP model
AMP Model
Assessment
Mitigation
Performance

31. Waste management
Category of waste Examples
Class 2: INFECTIOUS WASTE
Generated by both inpatients/out-
patients or animals,
likely to contain pathogenic micro-
organisms and can be dangerous or
infectious to both patients,
healthcare workers and the public.
requires special management both
inside and outside the hospital.
Laboratory waste, materials
potentially infected blood, swabs,
materials that have been in used in
surgery or been in contact with
patients.
PATHOLOGICAL / ANATOMICAL
Includes amputations and other body
tissues resulting from surgical
operations, autopsy (post-mortem),
or delivery. Requires special
treatment for ethical and aesthetic
reasons.
Internal body organs, amputated
limbs, placentas, foetus. Also
includes urine and blood products.
CHEMICAL, PHARMACEUTICAL,
GENOTOXIC WASTE
generated from the pharmacy,
radiology and from chemotherapy
Vials, connecting tubing, drugs,
vaccines, pharmaceutical products,
disinfection solutions.

32. WASTE MANAGEMENT continued
Waste category Examples
Class 3: SHARPS
sharp-edged wastes that can cause
cuts or puncture wounds (e.g. needle
stick injuries).
hazardous whether or not they are
contaminated with blood.
handled with specific procedures
within the health facility.
Needles, syringes, surgical blades,
scalpels, test tubes, ampoules, glass
instruments, pipettes.
HIGHLY INFECTIOUS
immediate treatment by chemical
disinfectants or autoclaving before
joining the hazardous HCW stream.
Sputum
Sputum cultures of TB laboratories,
contaminated blood clots and
glassware, highly concentrated
microbiological cultures
Class 7: RADIOACTIVE WASTE
Any solid, liquid, or pathological
waste contaminated with radioactive
isotopes of any kind
Radioactive papers, gloves, cotton
swabs, needles (sharps), liquid-
patient excretion, spent radiation
sources radium needles.

33. WASTE MANAGEMENT……
Figure 2: Figure 3
Daily waste generation in SRRH Weekly waste generation in SRRH
International Journal of Waste Management and Technology
Vol. 2, No. 2, April 2014, PP: 1 - 12, ISSN: 2327 - 8757
45.79
30
19 .
5
7
12 .43
0
20
40
60
Red Yellow Black Sharps
Waste categories
320.5
10
2
37
1
87
0
200
400
Red Yellow Black Sharps
Waste categories

34. Situation at Kiswa health
AVILABLE WASTE BINS
NUMBER OF NEEDED % availability of waste bins
BLACK YELLOW RED Black yellow red black yellow red
13 8 8 30 23 23 43% 35% 35%

35. Situation at Kiswa health
continued
 From the above results it has been observed that only
43% of the non-infectious waste bins are available at
the facility.
 Only 35% is available for both the infectious and highly
infectious waste bins.

36. Recommendations
 More waste bins should be purchased to ensure proper
waste segregation
 Conduct a continuous improvement project on the
proper waste management
 Conduct staff training on the waste management.
 Be more responsible for the waste that we generate
 Safe hand washing hygiene
 9/16 with hand washing services such as sanitizers and
the water available,
 The general patient’s washrooms without the soap and
even the water container most times empty and dry
 The main gate without the washing tap and the access
is unrestricted

37. What have we learned?

38. THE CHALLENGE ISN'T A
CHALLENGE,
THE CHALLENGE IS THE
ATTITUDE TOWARDS THE
CHALLENGE