Quality & Safety Issues in BMW

1. Quality & Safety Issues in BMW Dr. Mudit Saxena Head Admin Services Wockhardt Hospital Bangalore

2. Quality & Accreditation Standards • Bio Medical Waste Handlers Safety

3. Quality & Accreditation Standards • Focus on • Prevention and Control of Infection – among patients, staff, healthcare professionals, volunteers and visitors • Proactive Surveillance, appropriate Policy – addressing the need of organization (location, service, patients)

4. Qualified Individual or Group designated for above purpose – Committee that has educated, trained, experienced and certified members • Across the organization, multiple stakeholders – physicians, nurses, managers

5. Design Programs targeting Prevention and Reduction of Healthcare Associated Infections: • based on scientific guidelines, • as per local laws and regulations • e.g. UTI, BSI, SSI

6. Identify Procedure and Programs assoc with Risk of Infection and implement Strategies to reduce risk: • Equipment : Sterilization Tech, Reuse • Waste disposal : • Disposal of sharps • F&B, Engg., Civil Work: Sanitation

7. Isolation Procedures – for patients, visitors, staff and immunosuppressed, strategy to deal with large influx of contagious disease • Barrier Techniques: Gloves, Mask, Eye Protection, Disinfectant • Hand Hygiene: Monitoring infection rates and trends

8. Bio Medical Waste Handlers Safety

9. The activity is a part of organization’s overall program on Quality Improvement and Patient Safety • Track healthcare assoc Infections • Rework strategies based on above • Results of monitoring informed to key stakeholders • Educate and Inform all concerned

10. Bio Medical Waste Handlers Safety • Waste Handlers: Nurses, Physicians, Housekeeping, Linen, Maintenance • Exposed to: Blood, Body Fluids, Infected Linen, Spills and Splash • Identified Qualified Individual or Group – Infection Control Committee / Nursing Supervisor • Each individual is responsible for reporting his / her own accidents

11. …Following Blood Borne Injury / Exposure • Action By Staff or Health Worker • Report all blood borne exposure events immediately - urgent medical concern. • employee must report the incident immediately to his/her supervisor, • be excused from work and directed to the infection control nurse/ Doctor. They will advise on the appropriate action to follow as identified in this procedure.

12. Infection Control staff are responsible for • Providing advice to staff • Coordinating exposure action identified and related documentation. • assess all reported accidents/incidents using the incident /accident form • Ensuring the infection control policies are available at all nursing stations – with desired information, instructions and forms needed by clinicians to document and medically manage

13. …………Blood Borne Injury / Exposure • Prevention – SAFETY FIRST • Hand washing • Plastic aprons, gowns, goggles, latex gloves and masks to be worn as required for protection • Blood related accidents to be reported immediately • Sharps to be disposed of safely into container provided • Hollow needles shall not be recapped

14. Action by Healthcare Worker following Blood Borne Injury / Exposure First Aid • Sharps Injury • If the skin is penetrated by a contaminated sharp object or if blood gets onto the skin - wash the area with soap and water: • Encourage bleeding by squeezing the injured site. • Wash liberally under cold running water. (Alcohol based hand rinses or foams 60% - 90% alcohol by weight, should be used when water is not available). • Apply iodine swab or Betadine to wound. • Cover cut injury with waterproof dressing.

15. In the case where the source is unknown, retain the device which caused the injury in a safe container to test if necessary for Hepatitis B or HIV. • Other Exposures (eg mouth, eyes, fresh abrasions) • Eye Contamination- Rinse the eyes gently but thoroughly with water or normal saline. • Mouth - Spit out the blood and then rinse the mouth with water several times Report • Incidents to be reported to an immediate supervisor and/or medical staff immediately after the incident. • After hours, report to person in charge of work area at time of injury and exposure. • Contact Nursing Supervisor immediately. • Complete Hospital Needle stick injury form

16. Action Following Reporting Of Blood Borne Injury / Exposure By Organization • Assessment - Assess level of risk from accident • Documentation of Injury Form • Obtain details on Accident/Incident/Hazard if necessary. Action Taken • Immediate • The opportunity should be taken to institute or complete Hepatitis B vaccination based on Hepatitis B Antibody titre

17. If the source patient can be identified, • he/she must be approached for testing and written consent. • Testing for HIV antibodies, HBsAg and anti HCV should be initiated. The patient or the Consultant may be contacted to provide this information. • Additional history and viral load testing may be indicated.

18. If source is known to be HIV positive or answers positively to the certain questions, he should be referred for interview, treatment and counseling. • Chemoprophylaxis for Occupational HIV Exposure - Zidovudine and Lamivudine / (expanded) Indinavir or Nelfinavir or Saquinavir. • Follow up visits may include mental health or counseling appointments as well as medical management and required lab tests. • If the status of infectivity of any blood borne pathogens unknown) then repeat HIV, HBsAg, anti-HCV, SGOT in 6 weeks, 3 and 6 months.

19. Risk to health care worker from a needlestick injury from a known infected patient source has been shown to be – • Hepatitis Bs Ag positive: 10-30% (depending on HB e antigen status of source; immune status of recipient) • Hepatitis C positive - estimated 3% (depending on source) • HIV - Overall 0.3% - 0.03% (depending on nature of exposure)

20. Risk factors for infection in health care worker are dependent on - • Infectivity status of source blood, eg, Hepatitis B e antigen positive, Hepatitis C PCR positive, terminal AIDS condition • Deep penetrating injury - Hollow bore needle ,Needle having been placed directly in vein/artery • Presence of visible blood on the device. • Skin/mucous membrane exposure - Volume of body fluid, Length of time of exposure, Skin/mucous membrane damage (e.g. eczema), Type of injury • Intact skin - Little or no risk.

21. Linen : All linen contaminated with blood or body fluids is considered potentially infectious. • Protective barrier apparel should be used as follows: Gloves, masks, should be worn for actual or potential contact with soiled linen • Handwashing should be performed after having contact with all soiled linen. • Using color–coded liners to segregate used and infected linen.. • Decontamination is carried out by soaking infected linen in 1% sodium hypochlorite solution for half an hour.

22. Linen once decontaminated is considered non-infectious and is handled similar to used, non-infected linen. • Handle soiled linen as little as possible and with a minimum of agitation to prevent gross microbial contamination of the air and of persons handling the linen. • Linen should not be sorted or rinsed in patient care areas. • Caution must be exercised to help prevent laundry bags from being OVERFILLED.

23. Water – Sewage Treatment • Radiation – • Infrastructure – Lead sheet Doors, Windows • Calibration –TLD Badges • Relocation to Non Radiation Exposing Areas

24. Safety First Thank You • Hand Hygiene