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Biohazards in Medical Practice

BIO-HAZARDS IN MEDICAL PRACTICE

Dr T.V. RAO MD.

INTRODUCTION

Bio-hazards remain a great challenge to the health care workers who come in contact with the patients. In a health care setting the problem of bio-hazards rarely spread from health care workers to patients. In each of these pathways transmission risk depends on the prevalence of infected individuals in the population. While blood is the important source of HBV, HIV and other blood borne pathogens in the health care setting, transmission can also occur through accidental exposure to contaminated tissues, semen, vaginal secretions, cerebrospinal fluid, pleural fluid, peritoneal fluid, pericardial fluid and amniotic fluid.

Important Blood Borne Infections.

The important diseases which are of great concern in Health care setting.

1) Hepatitis B infection: there being more than 400 million carriers in the world, there is a high risk of infection with contamination of the hands, mucus membrane of the eyes, nose and mouth by infectious blood and other body fluids. The risk of HBV infection following exposure to virus is 45-120 times.

2) The risk of HIV infection is low in health setting. The risk of HIV infection following percutaneous needle-stick exposure to HIV contaminated blood is estimated to be between 0.13% and 0.5%.There is no evidence that HIV or HBV is transmitted by the air borne route, In spite level of occupational risk is low, the consequences of infections with HIV are dire and should not be under rated by Medical personnel

To counter the bio-hazards the bio safety guidelines are to be followed for the protection of health care workers handling patients, samples arising out of Human Immunodeficiency Virus, Hepatitis B virus and other viral infections. It is to be impressed on the health workers to consider all patients are potentially infected with HIV/HBV or other blood borne pathogens, and follow infection control precautions.

The following guidelines as recommended by the Centre for disease control (Universal Precautions) should be appreciated and practiced to protect ourselves and our patients from the bio-hazards.

In Day To Day Medical Practice

1) Hand washing :

Regardless of frequency, the hand must always be washed thoroughly, with meticulous attention to all areas including the nails and interdigital space, with vigorous rubbing.

Indications for Hand washing.

a) In prolonged and intense contact with the patient

b) Before taking care of particularly susceptible patients (immuno compromised patients or new born children)

c) Before and after doing invasive procedures.

d) Before and after touching wounds.

e) In situations when Microbial contamination of hands is likely to occur (e.g. Contact with mucous membrane blood, body fluids secretions and excretions.)

2) Hand Washing Policies and procedures:

The use of nonmedicated soaps and detergents in solid or liquid form is efficacious in removing most transient contaminations from hands. In special circumstances the following chemical agents can be used.

a) Ethyl or isopropyl alcohol approximately diluted with sufficient water for maximum bactericidal action.

b) Detergent formulations containing chlorhexidine, povidone-iodine or hexachlorophene may be used for disinfection of the hands

3) Gloves should be worn for touching blood and body fluids, mucous membranes non intact skin, and handling of items or surfaces soiled with body fluids.

4) Guidelines for collection of blood and other body fluids.

a) Inspect your hands. If broken or any ulcer is present wear gloves.

b) Wash your hands with ordinary soap and water immediately after any blood contamination and after the work is completed.

c) If you wear gloves wash your hands with soap and water after removing it.

d) Place used needles and syringes in a puncture resistant container.

Do not recap needles.

Do not remove needles from syringes.

e) In the event of needle stick or other skin puncture or wound, wash the injured area thoroughly with soap and water. Never forget to encourage bleeding.

f) In the event of any injury while working in the hospital with HIV/HBV infected patients, inform the head of the unit for necessary safety measures, you may need antiviral prophylaxis.

g) Gowns or aprons should be worn during procedures that are likely to generate splashes of blood and other body fluids.

5) Prevention of Bio-hazards by the First-Aid workers.

a) Mouth to mouth resuscitation.

1) Mouth to mouth resuscitation is a life saving procedure which should not be with held through fear of contracting HIV or other infections.

2) If there is a bleeding from the mouth wipe out the blood with clean cloth or handkerchief from the patients mouth before resuscitation.

b) Bleeding patients

Health worker should not hesitate to handle the bleeding patients effectively.

6) Pregnant health care workers

Pregnant health care workers are not known to be at greater risk of contracting infectious diseases. however if health care worker develops HIV/HBV infection during pregnancy the infant is at risk of infection resulting from perinatal transmission.

7) Precautions during invasive procedure

All the health care workers who participate in invasive procedures must routinely use appropriate barrier precautions to prevent skin and mucous membrane contact with blood and other body fluids of all patients. All the health care workers who perform or assist in vaginal or cesarean deliveries should wear gloves and gowns when handling the placenta or the infant until blood and amniotic fluid have been removed from the infant’s skin and should wear gloves during post delivery care of the umbilical cord.

Precautions in dentistry

Blood, saliva, gingival fluid from all dental patients should be considered infective, dental workers should wear surgical mask and protective eye wear.

House keeping and laundry:

1) Environmental surfaces such as walls, floors and other surfaces are not associated with transmission of infections to patients or health care workers. Therefore extraordinary attempts to disinfect or sterilize these environmental surfaces are not necessary.

2) Although soiled linen has been identified as a source of large number of certain pathogenic microorganisms, the risk of actual disease transmission is negligible. All soiled linen should be bagged at the location where it was used; it should not be sorted or rinsed in patient care areas. Linen soiled with blood or body fluids should be placed and transported in bags that prevent leakage. If hot water is used, linen should be washed with detergent in water at 71°c for 30 minutes.

3) Any item which has contact with blood, exudates, or secretion may be potentially infective, it is not usually considered practical or necessary to treat all such waste as infective. Infective waste in general should either be incinerated or should be autoclaved before disposal, in a sanitary landfill. Bulk blood, suctioned fluids, excretions and secretions may be carefully poured down a drain connected to a sanitary sewer.

When none of the modern facilities are available the infectious waste should be deposited in trenches, covered with earth and compacted daily. The controlled fill must be fenced off, and scavenging is strictly prohibited.

Vaccination for Prevention of Hepatitis B Infection.

HBV vaccine should be available to all health care workers who are at risk due to professional responsibilities.

E mail; tvraodoctor2000@yahoo.co.in

About the Author

Dr.T.V.Rao MD works as Professor of Microbiology in Indian Medical College,Free lance writer on Issues realted to Medicine and Infectious Diseases.Interaction on the issues is welcome.

Why do dental tools need to be dry before being autoclaved?

Just wondering if there is any specific reason dental tools are recommended to be dried before being put in the autoclave or sterilizer? Or is it just ot help prevent corrosion? Does it affect the sterility of an item if it is not dried? Thanks!

If instruments are moist or wet, they will get corroded, and will get rusted very very fast. Mainly instruments should be kept dried all the times, not just at the time of keeping them for autoclaving,

I have seen many dentists not able to keep their instrument dried properly, who end up finally with rust on the handles of mouth mirrors and probes and explorers as well as other instruments.

It does not affect the sterility of an item if its not dried. To understand this fact you need to know a little bit about sterilization processes.
There are lot of sterilization processes, viz. dry heat sterilization, moist sterilization, sterilization by boiling, pasteurization.
Similarly there are different kind of sterilizers for different materials, which can be sterilized either using DRY HEAT methods, or MOIST HEAT methods.
Autoclaving is Steam sterilization, that comes into moist heat sterilization. where instruments gets sterilized at 121 Degree centigrade under pressure.

So being dry or wet will not affect the sterilization process.
Hope you got your doubt cleared.

Regards,
Dr. Shoeb
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