Safety measures and infection control is a good topic for safe practice in health sector and therefore to medical laboratory too.

1. 9/18/2014
Safety Measures
and
Infection Control
Ajay Kumar Chaurasiya

2. History
 Single cell microorganisms were the first forms of life to develop on
earth, approximately 3-4 billion years ago.
 The existence of unseen microbiological life was postulated by
Jainism, which based on Mahavira’s teaching as early as 6th century
BCE (Nigods).
 Roman scholar ‘Marus Terentius Varro’ in a 1st century BC book titled
on ‘Agriculture in which warns against locating a homes lead near
swamps‘ ‘…and because there are bred certain minute creature s that
can’t be seen be the eyes which float in the air and enter the body
through mouth and nose and they cause serious diseases .’
 In the canon of medicine (1020), Abu Ali Ibh Sina (avicenna)
hypothesized that tuberculosis and other disease might be contagious.
 In 1546 ,Girolamo Francostoro proposed that epidemic diseases were
caused by transferable seed like entities that could transmit infection
by direct or …

3. Contd…
Indirect contact or even without contact over long distances. All
these early claims about the existence of the micro-organisms
were not based on any data or science.
 Antony van Leeuwenhoek , the first microbiologist and the
first to observe microorganisms using his own microscope.
Lazaro Spallanzani showed that boiling a broth stopped it
from decaying .
Oliver Wendell Holmes ,USA: story on Puerperal fever:
contagious.
Ignaz Philipp Semmelweis ,Hungarian physician; pioneer of
antisepsis policy and savour of mothers.
Joseph Lister , father of antiseptic surgery.

4. Contd...
Louis Pasteur showed that Spallanzani’s
finding held even if air could enter through a
filter that kept particles out .
Robert Koch showed that microorganisms
caused disease .
9/18/2014

6. 9/18/2014
Joseph Lister, a British surgeon and a pioneer of antiseptic surgery.
Lister promoted the idea of sterile surgery while working at the
Glasgow Royal Infirmary
Carbolic steam spray used by
Joseph Lister

7. Problem statement
 In May 1847 Jakob Kolletschka, a Viennese doctor, cut his
finger while doing an autopsy on a woman who had died of
puerperal fever in the hospital. A few days later Kolletschka
was died.
 In the US Sulkin and Pike reported that 34 of 1342
laboratory infections occurring between 1930 and 1950
were due to mouth pipetting.
 Ricketts and Karls Urbani died of rockey mountain fever
and SARS respectively while doing research on finding the
cause.
 Cholera lab workers often died of the disease,
 CDC annual data approxmately 12,000 HCWs become
accidently infected with Hepatitis B virus.

8. Common causes of death from lab acquired
infections Worldwide (except UK) 1969-89
Brucellosis-423
Q-fever-278
Typhoid fever-256
Hepatitis-234
Tularemia-225
TB-176
Dermatomycosis-161
 Salmonellosis-48
 Streptococcal infection-78
 Leptospira-77
 Shigellosis-58
 Typhus-124

9. Occupationally acquired HIV;
CDC by 1992
 Lab technician-25
 Nurse-26
 Physician-15
 Paramedics-7
 Dentist/technician-6
 Health attendant-6
 House keeper-6

10. “It may seem a strange principle to enunciate as the
very first requirement in a hospital that it should do
the sick no harm”
…”the acquired mortality in a hospital especially in
those of large crowded cities is very much higher
than any calculation founded on the mortality of the
same class of disease among patients treated out of
hospital would lead us to expect”…
-Florence Nightingale

11. Principles of bio safety
TO protect:
The patient
Health care workers
The environment

12. In 1996
• National Health and Medical Research Council
(NHMRC) and Australian National Council on
AIDS (ANCA) recommended adoption of the
terms
• “Standard Precautions” as an alternative to
Universal Precautions
• And “Additional Precautions”

13. Universal/standard precautions: these are the
measures that must be applied during
Patient care: mucosa, breached skin
Handling any potentially infected material: Blood
and body fluids or any other secretion
contaminated with blood
Components:
A. Hand washing.
B. Barrier precautions.
C. Sharp disposal.
D. Handling of contaminated material.

14. Additional Precautions
Used for patients with known or suspected of infection in which
standard precautions are not enough and which may be
transmitted by
• Respiratory secretions; TB, Measles, influenza
• By contact: MRSA, VRE
• Other diseases : Creutzfeldt-Jakob disease (CJD)
They may include:
• Isolation in single room (MRSA)
• separate toilet (VRE)
• Additional personal protective equipment
(e.g. particulate filter mask (N95) /powered air purifying
respirator for Influenza, TB)

15. N95, N99masks

16. Laboratory Bio safety
WHO describes this is as:
 practices
 containment principles
 technologies
• Implemented to prevent unintentional exposure to
pathogens and toxins, or their accidental release

17. Good Microbiological Techniques(GMT)
GMT involves the use of aseptic techniques and other good
microbiological practices to achieve two objectives:
• Prevent handled organisms from contaminating the
laboratory, and
• Prevent organisms in a laboratory environment from
contaminating the work.
The principles of GMT should generally be applied
to all types of work involving microorganisms and
tissue cultures, regardless of containment level.

19. Only authorized persons should be
allowed to enter the laboratory working
areas.
Lab doors should be kept closed.
Children should not be allowed to enter
working areas.
Access to animal houses should be
specially authorized.
No animals should be admitted other
than those involved in the work of the
Lab.

23. Recommended vaccines for HCWS
Vaccines Recommendations in brief
1) Hep-B Not vaccinated/not immune to Hep-B i.e.no
serological evidence of immunity or prior to
vaccination then you should get 3 dose series.
2)Flu(Influenza) Get 1 dose of influenza vaccine annually
3)Measles, Mump
and Rubella(MMR)
If you are born in 1957 or later/not vaccinated/no
up to date serological evidence of Measles and
Mumps immunity/prior vaccination ;get 2 doses of
MMR.
4)Varicella(Chicken
pox)
Not Vaccinated/no serological evidence then you
should get 2 doses.
5)Tetanus
,Diphtheria
,Pertussis(Tdap)
Not received previously, get one time dose of
Tdap as soon as possible and then get booster
dose every 10 years. Pregnant HCWs need to a
dose during each pregnancy.
6)Meningococcal Those who are routinely exposed to isolate of N.
meningitidis should get one dose.

24. Categorization of biological agents and
containment(according to WHO)
Disease
Facility
 Risk group 1 (no low individual and community risk) A microorganism that is
microorganism that is unlikely to cause human or animal disease.eg. Food
Food spoilage bacteria, common Mold , Yeast, Bacillus spp., non
diarrhoeagenic E. coli.
 Basic
Biosafety
Level 1
 Risk group 2(moderate individual risk, low community risk) A pathogen that
pathogen that can cause human or animal disease but unlikely to be a serious
a serious hazard to laboratory workers ,community, livestock or the
environment. E.g.Staphylococci,streptococci,Enterobacter except Salmonella
Salmonella Typhi, Clostridium ,Vibrios, Adenovirus ,Polio virus, Coxsackie
Coxsackie virus, Hepatitis virus, Blastomyces, Toxoplasma and Leishmania.
 Basic
Biosafety
Level 2
 Risk group 3(high individual risk and low community risk) It Causes serious
Causes serious disease and can be readily transmitted from one individual to
individual to another, directly or indirectly.eg. Brucella, Mycobaterium
 Containment

25. Cond…
 Risk group 4 (high individual and community
community risk) A pathogen that usually causes
causes serious disease and that can be readily
readily transmitted from one individual to
another, directly or indirectly. Effective
treatment and preventive measures are not
usually available.eg.Marburg , Ebola, Lyssa,
CFD, Equine encephalitis viruses, SARS virus
virus and certain Arboviruses.
 Maximum
Containment
Biosafety Level 4

36. Basics of Infection Control
 Prevention of nosocomial infection is the
responsibility of all individuals and services
provided by healthcare setting.
 A comprehensive, effective and supported
program is essential for reducing infection risk
and increasing hospital safety.
 It should include surveillance, preventive
activities and staff training.

37. I. National program developed by Ministry of Health: to support
hospital programs. It sets national objectives, develops and
updates guidelines recommended for health care.
II. Hospital programs including:
1) major preventive efforts; keeping in mind
patients and staff.
2) It must be supported by senior management
And provided with sufficient resources.
3) It must develop a yearly work plan to
assess and promote all good health care
activities.

39. Infection Control Committee
 It is a multidisciplinary committee responsible for
monitoring program policies implementation and
recommend corrective actions.
 It includes representatives from different concerned
hospital departments & management. They meet
bimonthly.
 It establishes standards for patient care, it reviews
and assesses IC reports and identifies areas of
intervention.

40. Infection Control Team
 The optimal structure varies with hospitals types,
needs and resources.
 Hospital can appoint epidemiologist or infectious
disease specialist, microbiologist to work as infection
control physician.
 Infection control nurse who is interested and
has experience in infection control issues.

41.  Team should have authority to manage an effective
control program.
 Team should have a direct reporting with senior
administration.
 Infection control team members or are responsible for
day-to-day functions of IC and preparing they early
work plan.
 They should be expert and creative in their job.

42. Infection Control Manual
 Every Hospital should have a nosocomial infection
prevention manual compiling recommended instructions
and practices for patient care.
 This manual should be developed and updated in a timely
manner by the infection control team.
 It is to be reviewed and accepted by infection control
committee.

43. Infection Control Responsibility
 Role of every hospital department and service units
must be identified, documented as manuals kept in
accessible place.
 Job description of every hospital staff; defining details of
his duties must be discussed before employment.
Infection control precautions should be part of the routine
work and stressed for that.

44. Surveillance Preventive Activities Staff Training
Program Components

45. Nosocomial Infection Surveillance
 Nosocomial infection rate in a hospital is an indicator of
quality and safety of care.
 Surveillance to monitor this rate is essential to identify
problems and evaluate control activities
 The ultimate aim is the reduction of infection rate and
their costs.
 The term surveillance implies that observational data are
regularly analyzed.

46. Key points in Surveillance
 Active surveillance (Prevalence and incidence
studies)
 Targeted surveillance (site, unit, priority-oriented)
 Appropriately trained investigators
 Standardized methodology
 Risk- adjusted rates for comparisons

47. Organization for surveillance
Ward activity
devices or procedures
fever & inf. signs
antibiotics & charts
Laboratory reports
culture& sensitivity
resistance patterns
serologic tests
Data elements &analysis
patient data & infection
population & risks
computerization of data
Data collection and analysis

48. Organization for surveillance
prompt, relevent to target group Meetings & disscussions Dissemenation by committee
Feedback & dissemenation

49. Staff health promotion and
education
1. HCW are at risk of acquiring infection, they can also transmit
infection to patients and other employee.
2. Employee health history must be reviewed, immunizations
recommendations to be considered.
3. Release from work if sick, occupation injury must be notified.
4. Continuous education to improve practice,
better performance of new techniques.

50. UNCETDG ICAO IATA
TRANSPORT OF
INFECTIOUS SUBSTANCES
Scientific background to the 13th revised edition of the UN Model
Regulations regarding the requirements for transporting infectious
substances
2003
Air transport of infectious substances
International Air Transportation Association (IATA)
Infectious Substances Shipping Guidelines

53. "Soap and water and common sense are the best disinfectants”
-Sir William Osler

55. References
 Topley and Wilson ‘ microbiology and microbial infection ,vol-
2,4 9th edition
 Microbiology and infection control for health processionals-
Gary Lee and Penny Bishop,3rd edition.
 Laboratory Biosafety Manual 3rd edition WHO 2004.
 www.CDC.gov/biosafety
 http//www.who.int/research/en/
 http//en.Wikipedia.org/wiki/Biosafety
 Handbook of bioterrorism and biodefense-Erik De Clercq and
Earl R Kern
 Bailey and Scoot's Diagnostic Microbiology-13 ed
 Monica Cheesbrough 2nd Updated part 1& 2.