# Presentation: 766378

## SAFETY PRACTICES 

**SAFETY PRACTICES **

**DR. O.R. KRISHNARAJASEKHAR**
**ASSISTANT PROFESSOR**
**GOVERNMENT HOSPITAL OF THORACIC MEDICINE**
**TAMBARAM SANATORIUM**
**CHENNAI **

## GHTM – TAMBARAM : HISTORY

**A 12-bedded private TB sanatorium was established in 1928**
**Govt. of Madras (Tamilnadu) took over the Hospital in 1935**
**Bed strength was enhanced to 776 in 1976**
**Rechristened as Government Hospital of Thoracic Medicine                in 1986**
**1993 witnessed Hospitalisation of two HIV patients**
**Tamilnadu – CDC Collaborative Project was formalized                 in 2002**

## NEW HIV PATIENTS : OP ATTENDANCE

**DAILY**
**30 – 70 PATIENTS**
**MONTHLY**
**1000 – 1100 PATIENTS**
**YEARLY**
**2001 :   5895 patients**
**2002 : 11065 patients**
**2003 : 13085 patients **
***               ***

## NEW HIV PATIENTS : QUARTERLY TREND

**NEW HIV PATIENTS : QUARTERLY TREND**

## HIV PATIENTS : OP ATTENDANCEQUARTERLY TREND

**2001**

**2002**

**HIV PATIENTS : OP ATTENDANCE***QUARTERLY TREND*

**NEW**

**OLD**

**TOTAL**

**2003**

## HIV OUT- PATIENTS : ANNUAL VISITS 

## NEW HIV PATIENTS : DOMICILE

**NEW HIV PATIENTS : DOMICILE**

| STATE | PATIENTS |
| --- | --- |
| TAMILNADU | 17342 |
| ANDHRA | 11578 |
| OTHERS | 456 |
| TOTAL | 29,376 |

**MAR 2001 – DEC 2003**

## TAMILNADU – CDCCOLLABORATIVE PROJECT

**A Memorandum of Agreement was signed between Govt. of Tamilnadu and Centers           for Disease Control, Atlanta, USA, on September 11, 2002.**
**OBJECTIVES :**
**Prevention and Control of HIV / AIDS and other Infectious Diseases in Tamilnadu**
**To support  Surveillance, Prevention, Control, Care & Support and Research      in the field of HIV / AIDS**

## INFORMATION SYSTEM

**INFORMATION SYSTEM**

-  TB/HIV Information System was
-     commissioned on December 6, 2001.
-  Joint effort of CDC, Atlanta ,
-     GHTM,Tambaram and
-     Satyam Computers Limited.
-  Version 2.50 captures patient’s data on
- 	Demography
- 	Clinical profile
- 	Investigations,
-    	Diagnosis
- 	Treatment and
- 	Follow-up.

## INFORMATION SYSTEM : FORWARD STEPS

-   Transition from Manual system
-     to Computerization
-   Tracking HIV families, clinical
-     course of illness, complications
-     and survival period
-   Monitoring Prevention, Care
-     and Support Programs
-  Identification of afflicted clusters
-    for Community Care Projects

## INFORMATION SYSTEM : TRAINING

-   Training in Epi-info
-   Training in Data-analysis
-   Epidemiological Studies
-   Operational Research
-   Training in computer
-     application
-     for GHTM staff

## LABORATORY UPGRADATION

-    Renovation of the Laboratory
-    Establishment of Quality Assured
-       Laboratory
-    More Equipments, more staff and
-      tests – Appropriate diagnostic
-      algorithms
-    Establishment of Lab Information
-      system

## INFRASTRUCTURE

-    Electrical Power enhancement
-    Uninterrupted Power supply
-    Effluent Treatment Plant
-    Internet Browsing Center
-    Library facility

## TRAINING / CAPACITY BUILDING

** **
**Training Center of Excellence on**
**   ****Clinical Training on HIV / AIDS**
**   ****Prevention, Care and Support**
** ****International Training & **
**    ****Education Center on HIV **
**   ****(I-TECH), Washington is developing**
**   ****Tambaram Curriculum for training ****	****Doctors**
**	****Nurses**
**	****Counsellors**
**	****Para-medical workers and **
**	****Patients**

## SAFETY PRACTICES

**SAFETY PRACTICES AT GHTM**
**NATIONAL GUIDELINES **
**STATE GUIDELINES**

## WHY SAFETY?

**PATIENTS AND HEALTH CARE WORKERS ALIKE **
**    ****ACQUIRE INFECTIONS IN HEALTH CARE SETTINGS**
_***RISK OF ACQUIRING INFECTION IN HEALTH CARE SETTING:***_
**PATIENT VOLUME**
**MICROBIAL CONCENTRATION**
**VIRULENCE OF ORGANISM**
**EXPOSURE TO RESISTANT STRAINS**
**HOSPITAL ACQUIRED INFECTIONS**
**LEVELS OF CONTAMINATION**
**INTERVENTION RELATED**
**CROSS INFECTION**

## WHY SAFETY?

**	****RISK OF TRANSMISSION OF BLOOD BORNE**_** **_**INFECTIONS TO HCW**
**HIV-PERCUTANEOUS          0.05-0.5%**
**HIV-MUCOCUTANEOUS     0.005-0.05%**
**HBV- PERCUTANEOUS        9-30%**
**HCV-PERCUTANEOUS         3-10%**
_***SAFETY IS THE ONLY PROTECTION***_

## UNIVERSAL PRECAUTIONS
PERSONAL HYGIENE
ENVIRONMENTAL SANITATION
PREVENT SPREAD OF INFECTION FROM 

        PATIENT                         PATIENT

                             HCW

**PERSONAL HYGIENE**
**ENVIRONMENTAL SANITATION**
**PREVENT SPREAD OF INFECTION FROM **
**        ****PATIENT                         PATIENT**
**                                **
**                                **
**                             ****HCW**

- WHY SAFETY?

## WHY SAFETY?

**BASIC MINIMUM SAFETY STANDARD                              NEEDS TO BE ADOPTED BY HCW**
**	****SAFETY NEEDS TO BE INBUILT IN:**
**PLANNING**
**INFRASTRUCTURE DEVELOPMENT**
**KNOWLEDGE **
**ATTITUDE**
**PRACTICES**
**THINKING**

## THE BEGINNING...

**SETTING EXAMPLES**
**PROVISION OF ADEQUATE PROTECTIVE GEAR**
**INSISTENCE OF FREQUENT HANDWASHING**
**INSTITUTION OF POST-EXPOSURE PROPHYLAXIS (PEP)**
**TRAINING PROGRAMS:**
**	****	****PRAM**
**	****	****PARTNERSHIP WITH ITECH**
**FORMATION OF TAMBARAM CURRICULUM**

## SAFETY IN THE TREATMENT ROOM

**SAY NO TO RECAPPING**
**FOLLOWING UNIVERSAL PRECAUTIONS**
**MOTIVATION TO CHANGE GLOVES FOR EVERY PATIENT**
**INSISTENCE OF FREQUENT HANDWASHING**
**PROVISION OF COLOR - CODED BINS**

## Say NO to Recapping

## Follow Universal Precautions

## Colours for Waste Segregation

## Stop Needle Recycling

## Blue for Sharps

## PROVISION OF COLOR - CODED BINS IN ALL WARDS, OPERATION THEATERS

EDUCATION PROGRAMS FOR DOCTORS NURSES AND SANITATION STAFF

ENFORCEMENT OF PERIODIC REMOVAL OF WASTE

DISINFECTION OF LIQUID WASTE BEFORE DRAINING

**EDUCATION PROGRAMS FOR DOCTORS NURSES AND SANITATION STAFF**
**ENFORCEMENT OF PERIODIC REMOVAL OF WASTE**
**DISINFECTION OF LIQUID WASTE BEFORE DRAINING**

- SAFETY IN THE TREATMENT ROOM

## EDUCATION PROGRAMS FOR DOCTORS, NURSES, PARAMEDICS & SANITATION STAFF

ENFORCEMENT OF PERIODIC REMOVAL OF WASTE

DISINFECTION OF LIQUID WASTE BEFORE DRAINING

PROTECTIVE GEAR AGAINST SPILLAGE AND SPLASH

SHARPS ARE NOT PASSED FROM PERSON TO PERSON

**ENFORCEMENT OF PERIODIC REMOVAL OF WASTE**
**DISINFECTION OF LIQUID WASTE BEFORE DRAINING**
**PROTECTIVE GEAR AGAINST SPILLAGE AND SPLASH**
**SHARPS ARE NOT PASSED FROM PERSON TO PERSON**

- SAFETY IN THE TREATMENT ROOM

## SAFETY IN THE LAB

**USE OF ANTISEPTIC PRIOR TO VENEPUNCTURE**
**REMOVAL OF NEEDLE & SYRINGE AT SPECIMEN COLLECTION**
**INTRODUCTION OF VACUTAINERS**
**SAY NO TO MOUTH - PIPETTING**
**DISPOSAL OF SHARPS IN COLOR - CODED BINS FOLLOWED BY AUTOCLAVING**

## Avoid Needle – Stick Injury

## Say NO to Mouth Pipetting

## SAFETY IN THE LAB

**CONSIDER ALL SAMPLES AS INFECTIOUS**
**USE OF LAB COATS, GLOVES, MASKS, APRONS**
**ENCOURAGE FREQUENT CHANGE OF GLOVES**
**REPORTING OF SPILLAGE & NEEDLE - STICK INJURIES**

## Consider all samples Infectious

## Use Protective Gears

## SAFETY IN THE LAB

**USE OF BIOHAZARD SYMBOL**
**RESTRICT ACCESS TO THE LAB**
**INTRODUCTION OF UNIVERSAL SCREW - CAPPED CONTAINERS FOR SAMPLES**

## Ensure Proper and Safe Specimen collection

## Bio-Hazard : Restrict Access

## SAFETY IN THE LAB

**DECONTAMINATING ALL LIQUID AND SOLID WASTE GENERATED**
**CARE WHILE HANDLING LAB SPECIMENS -COLLECTION, TRANSPORTATION, PROCESSING, DISPOSING**

## Disinfect and Dispose

## Autoclaving of Bio - Waste

## HOSPITAL WASTE MANAGEMENT

***FUNCTIONS  OF HIC COMMITTEE:***
**PLANS, IMPLEMENTS, EVALUATES, REVIEWS,                 **
**     ****CORRECTS IC PRATICES**
**BLOOD BANKING**
**HOSPITAL ACQUIRED INFECTION**
**ENVIRONMENT SANITATION**
**HOUSEKEEPING**
**WASTE DISPOSAL**

## HOSPITAL WASTE MANAGEMENT

**PROVISION OF PROTECTIVE GEAR FOR SANITATION STAFF**
**MECHANICAL STEAM LAUNDERING OF SOILED LINEN**

## Protect Health Care Workers

##  Steam Laundry

## NATIONAL GUIDELINES

**ENVIRONMENT (PROTECTION) ACT,1986                                - SECTIONS 6, 8, 25**
**NOTIFICATION**-**BIO-MEDICAL WASTE              (MANAGEMENT & HANDLING) RULES, 1998**
**APPLICABLE TO THOSE WHO GENERATE,           COLLECT, RECEIVE, STORE, TRANSPORT,                TREAT, DISPOSE OR HANDLE BMW**

## NATIONAL GUIDELINES

***BMW ***:
-                                                                                                                **WASTE GENERATED DURING DIAGNOSIS, TREATMENT OR IMMUNISATION OF HUMANS                OR ANIMALS, OR IN RESEARCH ACTIVITIES                  OR DURING PRODUCTION OR TESTING OF BIOLOGICALS**
***    ******OPERATOR OF BMW FACILITY***:
**	****A PERSON WHO OWNS OR CONTROLS OR OPERATES FACILITY FOR COLLECTION, RECEPTION, STORAGE, TRANSPORT,  TREATMENT, DISPOSAL OF BMW**

## NATIONAL GUIDELINES

**EVERY INSTITUTION GENERATING BMW                       SHALL SET UP BMW TREATMENT FACILITIES               LIKE INCINERATOR, AUTOCLAVE, MICROWAVE SYSTEM FOR TREATMENT OF WASTE, OR           ENSURE REQUISITE TREATMENT AT A COMMON WASTE TREATMENT FACILITY                **

## INCINERATOR

## Waste to Ash

**Waste to Ash**

## NATIONAL GUIDELINES

**SEGREGATION, PACKAGING TRANSPORTATION &**
**STORAGE**
**BMW SHALL NOT BE MIXED WITH OTHER WASTE**
**BMW SHALL BE SEGREGATED INTO LABELLED BAGS/CONTAINERS AT POINT OF GENERATION**
**UNTREATED BMW SHALL BE TRANSPORTED ONLY IN AUTHORISED VEHICLE**
**NO UNTREATED BMW SHALL BE KEPT STORED BEYOND A PERIOD OF HOURS**

## NATIONAL GUIDELINES

***PRESCRIBED AUTHORITY***:
**GOVERNMENT OF EVERY STATE / UNION  TERRITORY  SHALL ESTABLISH A PRESCRIBED AUTHORITY WITH MEMBERS FOR GRANTING AUTHORISATION & IMPLEMENTATION OF RULES**
**SHALL FUNCTION UNDER THE SUPERVISION AND CONTROL OR STATE GOVT / UNION TERRITORY**
**SHALL GRANT OR RENEW AUTHORISATION FOR 3 YEARS**
**SHALL CANCEL OR SUSPEND AUTHORISATION**

## NATIONAL GUIDELINES

***AUTHORISATION:***
**EVERY OCCUPIER OF AN INSTITUTION GENERATING, COLLECTING, RECEIVING, STORING, TRANSPORTING, TREATING,DISPOSING & / OR HANDLING BMW *****EXCEPT OCCUPIER OF CLINICS, DISPENSARIES, PATHOLOGICAL LABS, BLOOD BANKS PROVIDING SERVICE TO <1,000 PATIENTS/MONTH*****, SHALL APPLY FOR AUTHORISATION**
**EVERY OPERATOR OF BMW FACILITY SHALL MAKE AN APPLICATION FOR GRANT OF AUTHORISATION**

## ADVISORY COMMITTEE:
EVERY STATE / UT SHALL CONSTITUTE AN ADVISORY COMMITTEE INCLUDING EXPERTS IN FIELD OR MEDICINE & HEALTH, ANIMAL HUSBANDRY AND VETERINARY SCIENCES, ENVIROMENTAL MANAGEMENT, MUNICIPAL ADMIN & NGO

STATE POLLUTION CONTROL BOARD SHALL BE REPRESENTED

THE ADVISORY COMMITTEE SHALL ADVISE THE STATE GOVT / UT ON IMPLEMENTATION OF THESE RULES

**EVERY STATE / UT SHALL CONSTITUTE AN *****ADVISORY COMMITTEE***** INCLUDING EXPERTS IN FIELD OR MEDICINE & HEALTH, ANIMAL HUSBANDRY AND VETERINARY SCIENCES, ENVIROMENTAL MANAGEMENT, MUNICIPAL ADMIN & NGO**
**STATE POLLUTION CONTROL BOARD SHALL BE REPRESENTED**
**THE ADVISORY COMMITTEE SHALL ADVISE THE STATE GOVT / UT ON IMPLEMENTATION OF THESE RULES**

- NATIONAL GUIDELINES

##    STATE GUIDELINES		

**IN CONSONANCE WITH THE ORDERS ISSUED BY THE GOVT. OF INDIA THE GOVT OF TAMILNADU HAS ISSUED SIMILAR ORDERS**
***VIDE G.O.( Ms ) No. 373 DATED 29/12/1998 - ENVIRONMENT & FORESTS DEPARTMENT ***

## TAMILNADU POLLUTION CONTROL BOARD:

ESTABLISHED IN 1982
OBJECTIVE: TO CONTROL, ABATE & PREVENT POLLUTION IN THE STATE TO PROTECT ENVIRONMENT FROM DEGRADATION
IMPLEMENTS POLLUTION CONTROL LEGISLATION , RULES AND NOTIFICATIONS FRAMED
TAKES LEGAL ACTION AGAINST DEFAULTERS
INVESTIGATES, COLLECTS & DISSEMINATES DATA RELATING TO POLLUTION CONTROL
LAYS DOWN STANDARDS FOR SEWAGE / EFFLUENTS / EMISSIONS

**ESTABLISHED IN 1982**
**OBJECTIVE: TO CONTROL, ABATE & PREVENT POLLUTION IN THE STATE TO PROTECT ENVIRONMENT FROM DEGRADATION**
**IMPLEMENTS POLLUTION CONTROL LEGISLATION , RULES AND NOTIFICATIONS FRAMED**
**TAKES LEGAL ACTION AGAINST DEFAULTERS**
**INVESTIGATES, COLLECTS & DISSEMINATES DATA RELATING TO POLLUTION CONTROL**
**LAYS DOWN STANDARDS FOR SEWAGE / EFFLUENTS / EMISSIONS**

**   **STATE GUIDELINES	**	**

## PROBLEM AREAS

**EVER INCREASING WORKLOAD**
**INCREASING VOLUMES OF BMW**
**VASTNESS OF LAND AREA**
**SHORTAGE OF MANPOWER**
**COORDINATION BETWEEN DEPARTMENTS**
**SHORTAGE OF FUNDING**
**MORE INTENSE AWARENESS CAMPAIGNS           AMONG STAFF & PUBLIC**

## FUTURE...

**HIV/AIDS IS A TREATABLE DISEASE**
**MORE HCW SHOULD JOIN THE FIGHT AGAINST HIV/AIDS**
**MORE PARTNERSHIPS ARE REQUIRED**
**HANDS ON TRAINING & CONCERTED EFFORTS ARE THE NEED OF THE HOUR**

## VISION

**LET US MAKE**
**   ****HEALTH CARE FACILITIES **
**A SAFE PLACE TO WORK**

## THANK YOU