Manoj Mahato

1. UNIVERSAL PRECAUTION
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

2. Universal precautions refer to safety procedures established by
the Centers for Disease Control and Prevention (CDC) designed
to reduce the risk of transmission of bloodborne infections
Purpose:
Universal precautions are used to avoid contact with patients’
bodily fluids. This involves wearing nonporous articles such
as medical gloves, goggles, and face shields.
Who Is Affected:
Universal precautions apply to doctors, nurses, patients, and all
health care workers who come into contact with patients and
their bodily fluids.
UNIVERSAL PRECAUTIONS

3. Universal precautions typically apply in environments where workers are
exposed to bodily fluids such as blood, semen, vaginal secretions, synovial
fluid, amniotic fluid, cerebrospinal fluid, pleural fluid, peritoneal fluid,
and pericardial fluid.
Personal Protective Equipment (PPE):
•PPE includes items like barrier gowns, gloves, masks, eyewear (goggles or
glasses), and face shields.
•These protect against both bloodborne and airborne pathogens
In summary, universal precautions focus on bloodborne pathogens, while
standard precautions encompass fighting the spread of both bloodborne and
airborne pathogens in healthcare settings
Healthcare professionals need to be aware of both sets of precautions to
maintain a safe environment for patients and staff.
UNIVERSAL PRECAUTIONS

4. Standard Precautions define all the steps that should be taken to prevent
spread of infection from person to person or from contaminated
environmental surfaces/healthcare items, when there is an anticipated
contact with:
Blood
Body fluids Secretions
Excretions, such as urine and faeces
Non-intact skin, such as an open wound
Mucous membranes, such as the mouth cavity
Standard Precautions are designed to reduce the risk of transmission of
blood borne pathogens and pathogens from moist body substances.
STANDARD PRECAUTIONS
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

5. SAFETY PRECAUTION IN THE LABORATORY
Wearing of gowns, aprons, gloves, shoes, lab coats when collecting
and handling specimens that can help protect from accidental
contamination by microorganisms.
Wear mask, face shields and goggles that protect from accidental
contamination of eye, nose or mouth from fluid by microorganisms.
Take precautions to prevent injuries caused by needles, lancets,
scalpels, and other sharp instruments and devices during and after
procedures
Dispose of all disposable sharp instruments in puncture-resistant
containers
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

6.  Clean the lab bench with disinfectant before and after lab. This helps to
prevent Contamination of cultures, books, clothing etc.
No eating or drinking during lab. Many pathogens spread by ingested
food and drink.
Thoroughly wash your hands with soap and water before and after lab.
Keep long tied up and out of the way. Hair can contaminate and be
contaminated by microbial cultures.
Place, transport, and store specimens in leak-proof receptacles with solid,
tightly sealed bag marked with a “biohazard” tag ports of containers.
SAFETY PRECAUTION IN THE LABORATORY
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

7. Decontaminated of all contaminated materials in autoclave.
Report accidents and dangerous incidents (“near-misses”) promptly
to your Supervisor.
Restrict laboratory access to authorized persons only.
Children are not Permitted in labs
Never pipette by mouth; use mechanical transfer devices
Turn off gas, water, electricity, vacuum and compression lines and
heating
SAFETY PRECAUTION IN THE LABORATORY
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

8. 1. Lab Access and Personal Protective Equipment (PPE):
Only authorized personnel should have access to the
microbiology lab.
Wear appropriate PPE, including lab coats, gloves, safety
glasses, and closed-toe shoes.
2. Hand Hygiene:
Wash hands frequently with soap and water, especially
before and after handling microorganisms or lab equipment.
Guidelines of safety precautions in Microbiology Lab

9. 3. Containment and Work Practices:
Work with microorganisms in designated areas, preferably within
biosafety cabinets.
Use proper techniques to minimize the creation of aerosols and splashes.
Avoid touching your face or eyes while working in the lab.
4. Decontamination and Waste Disposal:
Decontaminate work surfaces and equipment regularly with appropriate
disinfectants.
Properly dispose of contaminated materials, including cultures,
disposable PPE, and sharps, in designated containers
Guidelines of safety precautions in Microbiology Lab

10. 5. Incident Response:
In case of spills or accidents, immediately notify the lab supervisor and
follow established protocols for containment and cleanup.
6. Training and Supervision:
All lab personnel must receive proper training on safety procedures and
emergency protocols.
Supervisors should ensure that safety guidelines are strictly followed.
7. Documentation and Risk Assessment:
Maintain accurate records of all safety-related incidents and actions taken.
Regularly conduct risk assessments to identify potential hazards and
implement control measures.
Guidelines of safety precautions in Microbiology Lab

11. When working in a microbiology lab, understanding the routes of laboratory-
acquired infections (LAIs) is crucial for maintaining safety.
Here are the primary routes through which infections can occur:
1.Mucous Membranes: Infections can be transmitted through direct contact with
contaminated surfaces, laboratory workers, or items such as vials, devices, and
equipment. Microbes, viruses, and parasites can enter the host’s body via mucous
membranes (e.g., eyes, nose, mouth).
2.Respiratory Tract:
Airborne transmission occurs when microorganisms or viruses are disseminated as
droplet nuclei or dust particles.
These infectious agents can be inhaled by the host within the same room or over
longer distances, depending on environmental factors.
Routes of lab associated infection

12. POST EXPOSURE PROPHYLAXIS
Post Exposure Prophylaxis refers to the preventive medical treatment
started immediately after exposure to diseases causing virus such as HIV,
Hepatitis B, Hepatitis C to prevent infection by these virus and
development of diseases.
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

13. Exposed person is the person who is at risk of acquiring HIV/HBV/HCV
infection through exposure to blood or body fluids .
Who is at Risk ?
- Dentists
- Surgeons and operation theater staff
- Nursing Staff
- Emergency Care Providers
- Labor & delivery room personnel
- Lab Technicians
- Health cleaning/ mortuary staff / Waste Handlers
HIGH RISK POPULATION
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

14. MANAGEMENT OF EXPOSED PERSON OF HIV
1ST STEP:
Skin: Do not squeeze the wound to bleed it, do not put the pricked finger in
mouth. Wash with soap & water, don’t scrub, no antiseptics or skin washes
(bleach, chlorine, alcohol, betadine).
Eye: wash with water/ normal saline/ don’t remove contact lens immediately if
wearing, no soap or disinfectant.
Mouth: spit fluid immediately, repeatedly rinse the mouth with water and spit /
no soap/ disinfectant
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

15. Evaluation must be made rapidly so as to start treatment as soon as possible-
ideally within 2hours but certainly within 72 hours of exposure.
However all exposed cases don’t require prophylactic treatment
Factors determining the requirement of PEP-
Nature/Severity of exposure and risk of transmission.
HIV status of the source of exposure.
HIV status of the exposed individual.
MANAGEMENT OF EXPOSED PERSON OF HIV
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

16. Prescribe PEP:
There are 2 types of regimen:
Basic - 2 drug combination
Expanded regimen - 3 drug combination
MANAGEMENT OF EXPOSED PERSON OF HIV
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

17. Drug 2 drug regimen 3 drug
regimen
Zidovudine(AZT) Or 300 mg twice a day or 300 mg twice a day or
Stavudine (d4T) + 30 mg twice a day + 30 mg twice a day +
Lamivudine(3TC) 150 mg twice a day 150 mg twice a day
Protease inhibitors Nil 1st choice: Lopinavir/ritonavir
400mg/100mg twice a day or
2nd choice: Nelfinavi
1250 mg twice a day
MANAGEMENT OF EXPOSED PERSON OF HIV
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

18. Drug Stock at the Healthcare facility:
PEP kit comprises of 2 drug regimen:
Zidovudine(AZT) 300mg + Lamivudine (3TC) 150 mg as a fixed dose
combination.
MANAGEMENT OF EXPOSED PERSON OF HIV
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

19. LAB FOLLOW UP FOR HIV:
Timing In persons taking PEP
Weeks 2 & 4 Complete blood counts
Week 6 HIV-Ab
Month 3 HIV-Ab, anti - HCV,
Month 6 HIV-Ab, anti –HCV,
Exposed persons should have post PEP HIV test. Testing at end of PEP may
give indication of zero conversion. To diagnose all persons who zero convert
testing at 3 and 6 months is recommended.
MANAGEMENT OF EXPOSED PERSON OF HIV
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

20. Clinical –
Monitoring for appearance of signs of HIV zero conversion
Use precautions to prevent secondary transmission (Blood donation, Breast
feeding, Pregnancy, Unprotected Sexual relations especially during 6-12 wks.
Following exposure. Condom use is essential.
 Drug adherence
Psychological support
MANAGEMENT OF EXPOSED PERSON OF HIV
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

21. RABIES
• PEP is commonly and very effectively used to prevent the outbreak of
rabies after a bite by a rabid animal.
• The treatment consists of repeated injections of rabies vaccine and
immunoglobulin.
TETANUS
• Tetanus post-exposure consists of 2 to 3 injections of tetanus vaccine
and tetanus Immunoglobulin.
COMMON POST EXPOSURE PROPHYLAXIS
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

22. HEPATITIS B:
Immediate care to the exposure site:
Wash wounds and skin with soap and water.
Flush mucous membranes with water.
Determine the risk of Exposure:
 Type of fluid – Body fluids saliva potentially infectious fluids or tissue.
Type of exposure – Percutaneous injury, mucous membrane or non intact skin
exposure
COMMON POST EXPOSURE PROPHYLAXIS
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

23. HEPATITIS B
• If the person exposed is an HBsAg positive source(a known responder to HBV
vaccine) then if exposed to hepatitis B a booster dose should be given
• If they are in the process of being vaccinated or are a non-responder they need to
have hepatitis B immune globulin (HBIG) and the vaccine
COMMON POST EXPOSURE PROPHYLAXIS
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

24. HEPATITIS B VACCINE:
Initiation of the hepatitis B vaccine within 12 to 24 hours of an exposure.
The vaccine should not be given later than 14 days post exposure.
The 3 doses of hepatitis B vaccine is given at 0,1 to 2 months, and 6 months.
Hepatitis B antibodies should be obtained 1 to 2 month after completion of the third
dose of the vaccine
COMMON POST EXPOSURE PROPHYLAXIS
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

25. LAB FOLLOW UP
Perform follow up anti HBs testing in persons who receive hepatitis B vaccine.
Test for protective surface antibodies for 1 to 2 months after last dose of vaccine.
HBsAb responses to vaccine cannot be ascertained if HBIG was received in the
previous 3 to 4 months.
COMMON POST EXPOSURE PROPHYLAXIS
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

26. HEPATITIS C
• Neither immunoglobulin nor antiviral agents are recommended for HCV
post-exposure prophylaxis
-Early infection effectively treated with Peg-interferon +/- ribavirin
COMMON POST EXPOSURE PROPHYLAXIS
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal

27. THANK
YOU
Clinical Microbiologist Mr. Manoj Mehta, Civil Service Hospital Of Nepal