**8. Biomedical waste management**

**6.4. Tuberculosis**

20 Infection Control

Infection Control Practices.

case fatality occur [67].

schedule.

additional precautions are to be followed.

tive wards should be planned.

negative organisms.

HCWs have varying risks for exposure to tuberculosis. Multidrug resistant tuberculosis (MDR - TB) arises in countries where tuberculosis control is poor and increased incidence of HIV infection because of HIV/TB co-infection. As for infection control measure rapid detection and treatment of tuberculosis is to be done. Standard Precaution and additional airborne precau‐

HCWs working in areas such as chest clinic, bronchoscopy unit, radiology unit, TB laboratories are at greater risk of occupational exposure to TB and MDR - TB. Hence, they have to follow

**Viral haemorrhagic fevers :** Viral haemorrhagic fevers include Ebola, Marburg virus disease etc. The case fatality rate of Marburg virus disease is 25% whereas with Ebola virus 50 – 90%

Human to human transmission occurs by direct contact with infected blood, secretions, organs, semen, even vomitus of the patient etc. Standard precautions, isolation precautions, and

The multidrug resistant organisms are prevalent in Health care set up now a days because of overuse and misuse of antimicrobials. The empirical use of antimicrobials in health care set up has to be stopped and must be guided by antibiotic sensitivity test with proper dosage

In every health care set up, an antimicrobial use committee should be there, which establishes prescribing policies, audits antibiotic use etc. Antimicrobial use committee may be a subcom‐

Transmission of MRSA, Vancomycin Resistant Enterococci (VRE) occurs through hands of HCWs, hence, transfer of staffs and patients should be reduced. Early detection of cases and placing MRSA/VRE/MDRO infected patients in a single room or in a large ward putting all MRSA infected patients (cohorting). The operating surgeons should not do surgeries until declared negative for carriage of MRSA / MDRO. Early detection of the organism and measures for managing any outbreak especially in nurseries and postopera‐

The same strategy has to be adopted for ESBL, AmpC β – lactamase and MBL producing Gram

All HCWs and patient's visitors strictly follow standard and contact precautions.

mittee of HICC or an independent committee working hands in hands with HICC.

tion is to be followed. During transportation, patient must wear surgical masks.

**7. Multidrug resistant organisms and infection control practices**

Biomedical waste is defined as any waste generated during diagnosis, treatment or immuni‐ zation of human beings or animals or in research activity. Hospital waste include biological or nonbiological waste, which is a reservoir of pathogenic microorganisms and require safe and reliable handling and disposal. The risk of transmitting infection is maximum with sharps contaminated with blood [68]. The steps to be followed in biomedical waste management are: generation, segregation, collection, transport, storage, treatment and final disposal.

The basic principle of Hospital waste management is to segregate hazardous and nonhazar‐ dous waste. The clinical waste (infectious) is subclassified into sharps or nonsharps. About 75 – 90% of biomedical waste is nonhazardous and 10 – 25% is hazardous. Sharps should be discarded in puncture proof containers with covers. The Govt. of India under the provision of the Environmental Act 1986, notified the Bio – Medical Waste (Management and handling) (second amendment) Rules 2000 [69]. The biomedical waste are classified into Category 1 to 10 which are segregated at source in any Health care set up. After categorization, wastes are to be put in colour coded plastic bags like yellow, red and black. The waste bags should be tied once filled to ¾ th of their capacity and should be labeled with appropriate biohazard symbol or cytotoxic waste symbol etc. On all the bags, the labels with information on the point of generation must be pasted.

Infectious nonsharp waste should be put in yellow bags which include soiled dressing, microbiology waste, cotton etc. and then incineration or deep burial is to be done. The deep burial should be 2 – 3 meters deep and atleast 1.5 meters above the ground water table.

Except anatomical waste red bags may be needed for nonsharp waste if autoclaving/micro‐ waving/chemical treatment followed by landfill is the option (Red bags should not be incin‐ erated as red colour contains cadmium which cause toxic emissions. Plastic disposable items e.g. gloves, catheters and i.v. sets should be put into blue/white transparent bags for shredding and disinfection before disposal by landfill. Sharps (syginges, needles, scalpel blades) should be discarded in blue/white transluscent puncture proof container). Needles should not be recapped or bent by hand. Needle should be destroyed in a needle destroying machine. Sharps are then subjected to autoclaving/microwaving/chemical treatment/shredding.

Incineration ash and solid chemical waste such as discarded medicines should be collected in black bags for disposal in secured landfill [69].
