Transcript Infectious Waste Handlers Training Course

Sharps Training
Course
Table of Contents
Course Objective
Pre-Test
1.0 Overview of Occupational Hazards
2.0 Microorganisms & Infectious Agents
3.0 Infectious Waste
4.0 Cleaning for Health
5.0 Hazardous Material Safety
6.0 Needlestick and Injury Prevention
7.0 Spill Response
8.0 Regulated Medical Waste Transportation Requirements
Post-Test
Course Objective
This study program will provide environmental services
professionals and other infectious waste handlers with the
information they need to do their jobs safely. Successful
completion of the post-test will demonstrate knowledge in
the following areas:
• 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
• Requirements for packaging and transporting infectious or
regulated medical waste
Participants who successfully complete the course receive a
Certificate of Training.
Pre-Test
This test is to help the participant know where he/she stands at the
beginning of the course.
1. A hazard is anything that has the potential to cause injury or
harm. Circle one:
True
False
2. An employee with a fever should always come to work. Circle
one:
True
False
Only if the fever < 100 degrees
3. Diarrhea is often a sign of infection.
Circle one:
True
False
4. Infections are caused by tiny organisms called germs.
Circle one:
True
False
5. Can disinfectants be used on surfaces to kill germs?
Circle one:
Yes
No
Sometimes, depends on the germ.
6. Handwashing is the single most important thing one can do
to prevent the spread of infection.
Circle one:
True
False
7. If you get stuck by a needle, all you have to do to prevent
yourself from getting sick is to wash your hands.
Circle one:
True
False
8. The law requires your employer to provide you with
information about the chemical hazards in your workplace.
Circle one:
True
False
9. It doesn’t matter what dumpster you put medical waste in as
long as it is kept in a red bag.
Circle one:
True
False
10. You can’t get sick from a needlestick.
Circle one:
True
False
Occupational Hazards
1.0 Overview of Occupational Hazards
Environmental services professionals at hospitals and other
health care facilities face many hazards in the workplace
every day. Listed below are some of these 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.
All of the hazards listed above can be controlled by
establishing warning systems, engineering and administrative
controls, and safe work practices,. To ensure hazard control
in the workplace, the Hospitals should establish the
appropiate procedures.
Microorganisms &
Infectious Agents
2.0 Microorganisms & Infectious Agents
Webster’s dictionary defines the word “microorganism” as an
animal or plant of microscopic size. An animal or plant of this
size is too small to be seen by the naked eye and can only be
seen with a special instrument called a microscope. There are
many different kinds of microorganisms. Some of them are
able to make people sick and are often called germs. A
hospital laboratory has many microscopes on hand for
technicians to use so that they can identify the germs that
make people sick. Germs come in many shapes and sizes and
are sometimes called infectious agents. There are six different
types of infectious agents recognized by the Centers for Disease
Control (CDC) and they are listed below:
1. Bacterial agents - examples include Tuberculosis (TB),
Staphylococcus (staph), or Legionella (Legionnaires’ disease)
2. Fungal agents - examples include Aspergillus (mold) and
Tinea (ringworm)
3. Viral agents - examples include Hepatitis B Virus, Hepatitis C
Virus, HIV (AIDS),
4. Parasitic agents - examples include Giardia and
Trichomoniasis
5. Prions - examples include Kuru and Creutzfeldt-Jakob
Disease (CJD or mad cow disease)
6. Rickettsial agents - examples include Rocky Mountain
spotted fever and Lyme Disease
Although only a few examples have been provided for each of
the infectious agents listed above, there are many more that
make people sick.
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. Following are examples of exposures that can
occur in a health care facility:
EXAMPLE 1
Infectious bacteria would be found in the spit of a patient with
Tuberculosis (TB). If such a patient coughs, the TB bacteria
get into the air with the spit and can infect anyone in the
room who is not wearing a mask. Coming into contact with
the TB bacteria is an example of how a person could be
exposed to TB and become sick with Tuberculosis.
Tuberculosis is a disease that doctors are having a hard time
treating and many people who get this disease die.
Environmental services professionals in the health care
setting must protect themselves by wearing masks when
they enter TB isolation rooms. 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
Infectious virus would be found in the blood of a patient with
Hepatitis B (HBV) liver disease. If a environmental services
professional is stuck by a needle that was used to draw blood
from a patient with HBV liver disease, the environmental
services professional becomes exposed to the Hepatitis B virus.
Hepatitis is a disease that attacks the liver and eventually kills
the patient. Environmental services professionals in the health
care setting must protect themselves from needlestick injuries
by wearing puncture resistant gloves when they handle red
bags or sharps containers. In a 1999 alert published by the
CDC, the government reported that six to thirty percent of
unvaccinated workers can get HBV after a single needlestick
exposure. This means that if 100 environmental services
professionals are each stuck with a needle contaminated with
blood containing Hepatitis B virus, then six to thirty of those
professionals will get sick with Hepatitis. There are two ways
to reduce the rate of HBV transmission from needlestick
injuries and they are:
1) To get a Hepatitis B vaccination, and
2) To report all needlestick injuries to the infection control
nurse and accept post-exposure treatment.
The primary goal of a health care facility cleaning program is
to prevent the spread of infectious agents among patients
and healthcare workers. Environmental services
professionals play an important role in achieving this goal 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
• Participate in OSHA bloodborne pathogen training
• Follow recommended infection prevention practices to
include receiving the hepatitis B vaccination
• 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
Infectious Waste
According to Health Care Without Harm, a non-profit
organization, “hospitals produce approximately 2 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.
Neither method of disposal is ideal. Landfills threaten our
local drinking water supplies by leaking toxic liquids and
incinerators threaten global air supplies by emitting toxic
contaminants. The problem with incinerators is worse than
the problem with landfills because contaminants from
incinerators travel all over the world and can never be
collected and contained once they are released whereas toxic
liquids leaking from landfills can be collected and treated
locally to remove the harmful properties.
About Healthcare Waste -----------------------
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 special
burial
Needlestick and Injury
Prevention
Needlestick and Injury Prevention
The National Institute of Occupational Safety and Health (NIOSH)
published an alert in November 1999 to provide current scientific
information about the risk of needlestick injury and the
transmission of bloodborne pathogens to health care workers.
According to this alert, it is estimated that 600,000 to 800,000
needlestick and other percutaneous injuries occur annually among
health care workers in the United States. About half of these
injuries go unreported. Data suggests than at an average hospital,
approximately 30 needlestick injuries occur per year for every 100
beds. Of the reported needlestick injuries, approximately 41%
occur for the following reasons:
• Improperly disposed sharp;
• Disposal-related causes;
• Collision with health care worker or sharp; and
• Cleanup.
In an article published in the Journal of Occupational Medicine in
January of 1991, researchers provided data from a study of
housekeepers’ injury experiences in medical laboratories at a major
university. They reported an incidence rate of forty six injuries per
100 housekeepers per year. 37% percent of the injuries were cuts
and punctures and seventy percent of these were attributable to
glass, needles, or cutting instruments. 65% of the housekeepers
surveyed indicated that they did not always report their injuries.
To reduce the risk of needlestick and other injuries, the following
control measures are recommended to protect the environmental
services professional:
• Always wear whatever personal protective equipment is
necessary to do the task safely to protect your skin, work clothes,
and mucous membranes from contact with potentially infectious
materials (e.g. gloves, masks, face shields, gowns, and aprons).
• A gown or apron should be worn if there is a possibility of
contact with infectious materials on your work clothes.
• A mask and goggles or eye protection should be worn if there is
a possibility of contact with infectious materials in your eyes,
nose, or mouth.
• Gloves should be worn to protect your hands from contact with
chemicals and potentially infectious materials.
• Wear puncture resistant gloves when performing high risk tasks
(e.g., changing out needle boxes, cleaning up broken glass,
handling infectious waste containers).
• Locate puncture resistant leak-proof containers for sharps and
needle disposal in areas where they are convenient and likely to
be used by health care providers.
• Ensure that sharps and needle disposal containers are emptied
before they become full.
• Report to management any sharps containers that are mounted
too high or are not easily accessible to health care providers.
• Report to management any needles or other sharp items not
properly disposed of by the health care providers.
• Use a brush and dust pan to pick up broken glass which may be
contaminated with blood or other body fluids.
• Handle contaminated laundry including sheets as little as
possible. Do not shake out these items. Hold them away from
your body and place in the linen hamper without pressing down
on them.
• Carry red bags or other containers of medical waste away from
your body.
• When cleaning up contaminated areas, minimize splashing,
spraying, and spattering.
• Bandage any cuts on your hands before putting on gloves.
• If latex gloves are worn, always wash and remove them after
cleaning a patient’s room or any other potentially contaminated area.
• Dirty gloves should never be worn after the cleaning job is done wearing them around the hospital contaminates surfaces and
spreads disease among the patients.
• Always wash hands after removing gloves and whenever they are
dirty.
• Always wash hands in between patient rooms.
• Follow safe work practices (e.g., do not eat, drink, smoke, apply
lip balm, or handle contact lenses where there might be exposure to
blood or other potentially infectious materials).
• Keep food and drinks away from areas where blood or other
potentially infectious materials are present.
• Report needlestick injuries and other potential bloodborne
pathogen exposures to the infection control staff at your health care
facility.
• Follow any recommendations made by the infection control staff
after a potential exposure.
• Ask the infection control staff at your health care facility about the
free Hepatitis B vaccine that is provided to environmental services
professionals.
IMPORTANT
POINTS……………………..
**Contaminated sharps and
concentrated micro biologic cultures
are the hazardous waste items that
represent the most acute potential risk
to health.
***Sharps are considered as the most
risky health care waste, because of
the double risk of sharps; injury and
disease transmission.
Through the world every year an
estimated 12,000 million injects
are administered
COMPARING HBV, HCV, & HIV
INFECTIONS
- The risk of viral hepatitis B and C infection
from contact with health-care waste is
significant. YOUR FIRST CONTACT COULD
BE THE LAST
- Hepatitis B virus is resistant to dry heat and
can survive for several weeks on a surface; it
is resistant to brief exposure to boiling, it can
survive exposure to 70% ethanol.
- The Japanese Association for research on
Medical Waste found that an infective dose
of hepatitis B or C virus could survive for up
to a week in a blood droplet inside a
hypodermic needle.
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Items causing sharp-object
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3000
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1081
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64 59 49 35 28 18 16 16 12
EPINETAC –
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Jan 1998 - Dec
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N=10472
Sharps and nosocomial
infections
Facts about sharps:
-Accidents by sharps are
the number one of all
reported accidents (16%
in the US)
- In two years in the UK,
477 cases of accidents by
sharps, contaminated with
HIV, HBV, HCV – 12
worker got infected
- 600,000 – 800,000 cases
of needle accidents in the
US per year.
- 66 documented cases of
occupationally acquired
HIV till 1995 in Europe.
- In 1990, 6500-9000
HBV cases by sharp in
the US (125 –190 death)
Handout and Turn
to BBC News Site
The Problem of Hepatitis B
(HBV)
Turkish News – 17th October 2001
 Hepatitis B causes the death of 2
million people in the world each year
 There are same 500 million Hepatitis
B carriers in the world today
 Alone in Turkey, the number of
carriers is 5 million
 Hepatitis B virus is the ninth biggest
killer worldwide
 HBV can result in cirrhosis and liver
cancer
 Mainly contracted through blood
exchange
General hazards from healthcare waste
Sample of risks to the health of
humans:
 Sharps:
 (Cape Town, South Africa: 30 Children were
found playing with medical waste, dumped on
a football field)
 Radioactive Waste
 (Goina, Brazil: 4 People died and 28 suffered
serious radiation burns after an accident with
radioactive hospital waste)
 Infectious Waste
 (US: Three waste workers of a disposal
company got infected by mycobacterium
tuberculosis)
 Pharmaceuticals/Vaccine
 (Vladivostok, Russia: 8 children got infected
with the live vaccine strain of discarded
smallpox vaccine ampoules)
Emergency and Spill
Response
End of Lecture
What is your procedure ? –Example of procedures
Checklist exercise
Spill Response
Environmental services professionals routinely respond to calls for
assistance in cleaning up spilled materials on the patient wards
and other areas of the hospital. The spilled materials often
consist of human body fluids such as urine, blood, and feces that
may or may not be infectious. Regardless of whether or not the
material is actually infectious, any human body fluid must be
considered potentially infectious and the environmental services
professional should receive training on the following topics:
• The health care facility emergency response plan for hazardous
materials spills (e.g. notification, personal protective equipment
(PPE), spill response and equipment maintenance procedures,
etc…);
• The different types of micro-organisms potentially found in their
workplace to which they are susceptible (e.g. E. coli, MRSA, VRE)
along with definitions and symptoms of exposure;
• Spill site security and control;
• The measures that environmental services professionals can
take to protect themselves to minimize their risks of exposure
during cleanup operations to include wearing proper PPE;
• Contaminated surface cleaning procedures;
• Disinfectant selection and effective decontamination
procedures;
• Proper disposal procedures for potentially infectious waste
materials;
• Removing PPE, decontamination and/or disposal procedures;
and
• The health care facility exposure control plan for bloodborne
pathogens and employee health and medical surveillance
program.
Do environmental services professionals require special
training to clean up hazardous material spills in the
hospital environment?
The MoH standard requires that workers be trained to perform
their anticipated job duties without endangering themselves or
others. A hazardous material spill that poses a significant
safety or health hazard to individuals in the immediate area
requires clean up by employees who have received some
degree of HAZWOPER training.
A spill that presents a minor safety or health hazard to
individuals in the immediate area is considered “incidental” and
may be safely cleaned up by employees who have not received
HAZWOPER training. An incidental spill is a release of
hazardous material which does not have the potential to
become an emergency within a short time frame. Incidental
releases are limited in quantity, exposure potential, or toxicity
and present minor safety or health hazards to employees in the
immediate work area or those assigned to clean them up. An
incidental spill may be safely cleaned up by an employee who is
familiar with the hazards of the material.
It is up to management personnel to decide whether or not a
spill is incidental.
The properties of the hazardous material (e.g. toxic, flammable,
corrosive, radioactive, etc…) and the particular circumstances of
the spill itself, such as amount of material, location of spill,
ventilation, etc., will determine whether or not employees can
safely clean up the spill. Additionally, there are factors that may
lessen the hazards associated with the spill and its clean up,
such as the knowledge of the employee in the immediate work
area, the response and personal protective equipment (PPE) at
hand, and the pre-established standard operating procedures for
responding to spills of the hazardous material. In some cases,
there may be some engineering control measures that
employees can activate to assist them in controlling and
stopping the hazardous material release (e.g. turning off a valve,
turning on a fan).
These considerations (properties of the hazardous material, the
circumstances of the spill, and the mitigating factors in the work
area) combine to define the spill as incidental or one that would
require an emergency response. The definition is facility-specific,
a matter of policy, and is a function of the health care facility
emergency response or contingency plan.
Potential spills of hazardous materials in the health care facility
can be defined as follows:
1. Spills that are clearly incidental regardless of the
circumstances,
2. Spills that may be incidental or may require an emergency
response depending on the circumstances, and
3. Spills that clearly require an emergency response regardless
of the circumstances.
Spills that are Clearly Incidental
Example: If a hazardous material in a laboratory is always stored
in very small amounts, such as pint sizes down to test tubes, and
the hazardous material does not pose a significant safety and
health threat if spilled in the immediate vicinity at these amounts,
then the risks of having a release that escalates into an
emergency are minimal. In this example, incidental spills may
occur and employees will be able to clean up the spills safely if
they have been trained in accordance with the Hazard
Communication Standard.
Spills That May Be Incidental or Require an Emergency
Response Depending on the Circumstances
Example: A release of mercury in a plant that manufactures
mercury thermometers may not require an emergency response
because of the advanced knowledge of the personnel in the
immediate vicinity and the equipment available to handle the
release. However, the same size spill inside a patient exam room
may require an emergency response by specially trained
personnel. The health care facility’s emergency response plan in
this case would call for evacuation of all individuals from the
exam room and notification of the spill response team or the
hazardous material contractor.
Spills that Require an Emergency Response
Regardless of the Circumstances
There are spills of hazardous materials that pose a significant
threat to health and safety that, by their very nature, require an
emergency response regardless of the circumstances surrounding
the release or the mitigating factors. An employer must
determine the potential for such an emergency and plan response
procedures accordingly. Response procedures should be provided
in the health care facility’s emergency response plan.
An emergency response includes, but is not limited to, the
following situations:
1. The response comes from outside the health care facility (e.g.
local fire department);
2. The release requires evacuation of all employees in the area;
3. The release poses, or has the potential to pose, conditions that
are immediately dangerous to life and health (IDLH);
4. The release poses a serious threat of fire or explosion;
5. The release requires immediate attention because of imminent
danger;
6. The release may cause high levels of exposure to toxic
substances;
7. There is uncertainty that the employee in the work area can
handle the severity of the hazard with the PPE and equipment
that has been provided and the exposure limit could easily be
exceeded; and
8. The situation is unclear, or data are lacking on important
factors.
Can you think of an example of a spill or release
requiring an emergency response?
Medical Waste
Transportation
Regulated Medical Waste Management,
Disposal, and Transportation Requirements
There is a great deal of concern about the proper management of
health care facility wastes. Environmental services professionals are
responsible for picking up the waste at each point of generation and
transporting it to the designated place of disposal or storage at the
facility. If certain wastes are mishandled or improperly disposed of,
health care facilities may be subject to fines. Some of the waste
generated in the health care setting could be infectious and transmit
disease if improperly handled or disposed of. It is important that
environmental services professionals receive training on the following
topics:
• The health care facility waste management plan
• The different types of waste streams at the facility for which they
will be responsible
• The definition and/or designation of infectious waste including
where it is likely to be generated and how it is to be segregated from
the other waste streams
• Proper segregation, containment, and labeling of wastes in the
health care facility
• MoH transporation regulations for infectious and/or regulated
medical waste transported off-site for treatment/incineration; and
• State or local regulations for medical and/or infectious waste
disposal