Morning Schedule (15 min.) Introductions (15 min.) Course Development and Objective, Pre-test, Overview of Occupational Hazards, Definitions (60 min.) Microorganisms & Infectious Agents (show 27 min. video before lecture/discussion) (15 min.) Break (75 min.) Infectious Waste (includes 22 min. video)
Morning Schedule (40 min.) Cleaning for Health (50 min.) Lunch
Afternoon Schedule (40 min.) Hazardous Material Safety (40 min.) Needlestick and Injury Prevention (15 min.) Break (30 min.) Spill Response (60 min.) Regulated Medical Waste Transportation Requirements (45 min.) Post Test and Course Evaluations
Course Objective - to provide environmental services professionals with the information they need to do their jobs safely. • Occupational hazards associated with handling infectious waste, disinfecting contaminated surfaces, and responding to infectious materials incidents • Infection control on the job • Material Safety Data Sheets and hazards associated with the use of chemical disinfectants
Selection of proper personal protective equipment • Housekeeping and spill response procedures • The American Hospital Association’s infectious waste reduction initiative sponsored by the EPA • Requirements for packaging and transporting infectious or regulated medical waste
1.0 Overview of Occupational Hazards When they enter patient rooms, they may become exposed to infectious diseases. They risk exposure to bloodborne pathogens from dirty needles that are occasionally thrown away in the biohazard and general waste streams.
They work with chemicals that are often corrosive and dangerous if not handled properly. They are a category of worker at risk of latex allergy from ongoing latex exposure. They may become injured from slips, trips, and falls, or heavy lifting.
2.0 Microorganisms & Infectious Agents 1. Bacterial agents - Tuberculosis (TB), Staphylococcus (staph), or Legionella 2. Fungal agents - Aspergillus (mold), Tinea (ringworm) 3. Viruses - Hepatitis B, Hepatitis C, HIV 4. Parasitic agents - Giardia and Trichomoniasis 5. Prions - Kuru and Creutzfeldt-Jakob Disease 6. Rickettsial agents - Rocky Mountain spotted fever and Lyme Disease
In order for an infectious agent to make a person sick, it must first come into contact with that person. This contact is called an exposure. EXAMPLE 1 - Tuberculosis
In a 1995 publication, CDC researchers reported the results of a study that found the annual risk of contracting TB was higher for hospital housekeepers than nurses. EXAMPLE 2 - Hepatitis B
There are two ways to reduce the rate of HBV transmission from needlestick injuries and they are: 1) To get a Hepatitis B vaccination 2) To report all needlestick injuries to the infection control nurse and accept post-exposure treatment.
Environmental services professionals can prevent the spread of infectious agents among patients and healthcare workers by protecting themselves in the following ways: • Wearing puncture resistant gloves while handling any form of hospital waste to include biohazard bags, infectious waste containers, and trash bags of any color
If puncture resistant gloves are worn, wash gloves between patient rooms to avoid transfer of microorganisms from one patient to another • Wear proper personal protective equipment when cleaning up spills of potentially infectious material • Use an antibacterial soap to wash gloves immediately after contact with blood and/or body fluids, soiled linen, or contaminated equipment
Immediately report needlestick and other sharps-related injuries to the infection control staff • Follow any recommendations made by the infection control staff after a potential exposure to prevent infection • Follow recommended infection prevention practices to include receiving the hepatitis B vaccination
Participate in OSHA bloodborne pathogen training • Wash hands immediately after removing gloves • Wash hands before and after eating, smoking, applying cosmetics, or preparing food • Stay home to rest when feverish and sick with a cold, flu, or other infection
3.0 Infectious Waste • Isolation wastes are those made in isolation rooms where patients with infectious diseases are cared for. • Cultures and stocks are wastes generally made in the laboratory and may include specimen cultures, discarded vaccines, culture dishes, and devices used to transfer, inoculate, and mix cultures.
Human blood and blood products are wastes that can be found anywhere in the health care facility but most often they are found in the laboratory, operating rooms, and labor and delivery areas - these wastes include blood, serum, plasma, and other blood products. • Pathological wastesare wastes generally found in the pathology labs and autopsy suites - these wastes include tissues, organs, body parts, and body fluids that are removed during surgery and autopsy.
Contaminated sharpsare wastes that can be found in areas where patients are treated and the laboratory - these wastes include hypodermic needles, syringes, glass pipettes, broken glass, and scalpel blades. • Contaminated carcasses, body parts, and bedding are wastes that can be found in a medical research laboratory where animals are exposed to infectious microorganisms.
Miscellaneous wastes are those items that are probably contaminated with infectious microorganisms - they include contaminated materials found in the dialysis units, surgery and autopsy suites, and laboratory areas. • If an item has come in to contact with blood or body fluids, it is considered contaminated and probably infectious, therefore, it should be treated as infectious waste.
All infectious waste must be disposed of properly in accordance with a federal law known as the OSHA Bloodborne Pathogens Standard. Proper disposal means the following: • All needles and other contaminated sharps must be placed in a closable, puncture-resistant, leakproof, red or biohazard-labeled container. • All other infectious wastes must be placed in closable, leakproof, red or biohazard-labeled bags or containers.
Red Bag Biohazard Label Biohazard Labeled Bag or Container
Hospitals produce approximately two million tons of solid waste per year. Of this amount, ten to fifteen percent is categorized as infectious and the rest is general waste made up of paper and paper board, plastics, food waste, metal, glass, wood and other materials. All of the solid waste is sent to landfills or incinerators for disposal.
If 100% of hospital solid waste is disposed of in red bags... Only about 10% of the waste is actually infectious ... And 2% of the waste is pathological, requiring incineration.
According to the EPA, medical waste incinerators are the fourth largest known releasers of mercury to the environment. • Mercury waste is being improperly disposed of in biohazard bags along with other solid wastes that are not considered infectious. • Mercury cannot be destroyed by incineration. • Thirty nine states have issued over 1,600 warnings against eating mercury contaminated fish found in their waterways.
Because of all of the environmental health problems caused by medical waste incinerators, the American Hospital Association and the EPA have reached an agreement to work together to reduce the amount of waste within the hospital system by half by the year 2010. A number of actions can be taken to reduce the amount of solid waste within the hospital system that is sent in biohazard bags to medical waste incinerators for disposal.
Work with hospital administrators to develop policies that support biohazard bag reduction efforts. • Provide information to all hospital staff about the toxic contaminants created by medical waste incineration. • Educate staff about different categories of infectious waste and teach them to place only infectious wastes in biohazard bag containers.
Place and maintain biohazard bag containers only in those areas where infectious wastes are likely to be made. • Place and maintain special biohazard-labeled containers in areas where pathological wastes are likely to be made and teach staff to only place pathological wastes in them.
Keep pathological wastes separate from the other infectious wastes. • Send only pathological wastes to a medical waste incinerator for disposal. • Make alternative arrangements to properly treat and dispose of all other infectious waste (e.g. autoclaves, microwaves, chemical treatment).
4.0 Cleaning for Health • The goal of a health care facility cleaning program is to prevent the spread of infectious agents among patients and healthcare workers and to maintain a healthy indoor environment. A healthy indoor environment is one that is free of hazardous pollutants. • Organic Pollutants - chemical compounds such as formaldehyde, pesticides, and disinfectants • Inorganic Pollutants - particles such as asbestos and lead
Radiation - pollutants include both ionizing (e.g. radon) and non-ionizing (e.g. electromagnetic fields) types. • Complex Mixtures - examples include soot and tobacco, both of which contain organic and inorganic matter. • Biological Contaminants - referred to as bio-pollutants. Examples include bacteria, viruses, algae, fungi, ragweed, mites. • Biological contaminants are the most hazardous pollutants found in the indoor healthcare facility environment.
They are living organisms, or come from living organisms, and can be found under certain environmental conditions: 1. There must be a comfortable home or reservoir in which to hang out which is just about anyplace, and 2. They need nourishment just like us in the form of food and water. What kind of food do these organisms “eat?”
Aspergillus is a fungus found in dust and is an example of a common biological contaminant that lives well in soil, water and decaying material. In health care facilities, it may be found in the building ventilation system in areas where organic matter (dust) and water are present. Where would you expect to find this organism in a health care facility?Can this organism kill a patient?
Another deadly biological contaminant found in the healthcare facility is a bacteria named Vancomycin-resistant enterococci. (VRE). The reason why this bacteria is deadly is because it cannot easily be killed by antibiotics and many patients die once they become infected with it. How do you think patients become infected with this bacteria?
If someone comes into the hospital carrying the VRE bacteria, then whatever that person touches may become contaminated with VRE. Deadly VRE can survive for weeks on environmental surfaces. Patients may become infected with VRE by touching contaminated surfaces such as bedrails, sinks, faucets, and doorknobs, or coming into contact with health-care workers who do not wash their hands.
Environmental services professionals play a key role in controlling the spread of VRE throughout the healthcare facility by washing hands and wearing gloves properly, and diligently cleaning and disinfecting all environmental surfaces.
Surfaces with regular hand-contact are called high touch surfaces. High touch surfaces in patient care areas include items such as telephones, doorknobs, bedrails, light switches, faucets, and wall areas around the toilet. These surfaces must be cleaned and disinfected daily to protect the patient and reduce the spread of nosocomial diseases such as VRE. Nosocomial diseases are illnesses that patients acquire during their stay in the hospital.
The primary goal of a health care facility cleaning program is to prevent the spread of nosocomial disease among patients and healthcare workers. Environmental services professionals play an important role in achieving this goal. Daily cleaning reduces the amount of microorganisms in the patient care environment.
Suggestions for improving the general cleaning and disinfecting process: • When selecting a disinfectant for use, choose the least toxic and most effective cleaning product you can find. • Always clean from least soiled to more soiled areas and from top to bottom in the patient rooms. • Always change the disinfecting solution when it appears dirty (usually after every 3-4 patient rooms).
Use a clean cloth or mop head each time a bucket of detergent/disinfectant is emptied and replaced with fresh, clean solution. • Dusting reduces potential food for Aspergillus and prevents infection in hospitalized patients and allergies in employees. • Dust can be removed without making patients sick by using a chemically treated cloth/mop or a cloth dampened with approved disinfectant.
When dusting, it is important NOT to shake the cloth/mop because dust and fungal spores will then get in the air. If patients breathe in these spores, they may get sick and die. • While dusting ceilings and vents, report any stains and/or wet areas immediately for repair. Fungus will start to grow on wet ceiling tiles within 72 hours. • Special care areas need additional attention. • What are special care areas?
Process improvement for special care areas : • Use a bucket method for cleaning each special care area, where a clean cloth is dipped into a bucket filled with approved disinfectant and items are cleaned and left wet for ten minutes. • Daily cleaning should include the washing and disinfecting of walls around light switches, doorknobs, and other high touch surfaces. • Use CLEAN mops and CLEAN mop water for cleaning and disinfecting the floor in each special care or isolation room.
When a patient is discharged from a special care area, throw away all disposable items, change any cubicle curtains, and disinfect all surfaces including chairs, tables, ledges, call lights, telephones, sinks, showers, and toilets. • Avoid the use of cleaning equipment that produces mists. • If a vacuum is needed to clean the floor in a special care area, use one with a clean HEPA filter on the exhaust. Keep the door to the special care area closed when vacuuming.
It can not be emphasized enough. Environmental services professionals play a key role in preventing the spread of infectious agents among patients and healthcare workers. Diligent housekeeping keeps microorganisms and other bio-pollutants under control and reduces the spread of nosocomial disease. What is nosocomial disease?