**6.1. Sever Acute Respiratory Syndrome (SARS)**

SARS is caused by a novel coronavirus – SARS Co – V [66] which could be found in sputum, tears, blood, urine and faeces. The virus is predominantly transmitted through droplets discharged during coughing, sneezing and talking by the patient.

Both Standard precautions and additional precautions are to be taken to prevent transmission. The patient must be placed in a single room and PPE must be used by all HCWs giving patient care, cleaning staffs, all laboratory staffs and sterilizing service workers. All waste from a SARS patient room should be treated as infectious waste. The specimens from a SARS patient should be transported in a leak proof bag (i.e. a plastic biohazard specimen bag). All infection control precautions must be followed while caring for SARS patient. A post mortem examination of SARS patient or probably having SARS is a very high risk procedure and should be avoided if possible. Staffs of the mortuary or funeral care home must be informed that the deceased had SARS. Embleming is not recommended. Even the preparation of the deceased should be discouraged.

#### **6.2. HIV**

**Dental equipments :** Infection Control Practices regarding HBV and HCV are very important for dental equipments [64]. The instruments must be thoroughly cleaned before disinfection. High speed dental handpieces should be sterilized in between patients. Critical items like extraction forceps, scalpel blades, periodontal scalers etc. must be sterilised after each use. The semicritical items which come in contact with oral tissue i.e. bone amalgam condensers or

**Ophthalmic instruments :** Thorough cleaning of instruments followed by steam sterilization and if the instruments cannot withstand heat, low temperature sterilization with Ethylene

**Surgical instruments :** These may be cleaned manually or mechanically and sterilized [60]. Autoclaving is usually done but if the instrument is heat sensitive, low temperature steriliza‐

These include airborne precautions, droplet precautions and contact precautions. These are taken when patients having or suspected of having infection with highly transmissible / epidemiologically important organism for which additional precautions are needed in

**Air borne pracautions :** These are to be taken when patients with disease spread by droplet nuclei (<5 μm) in diameter or suspected cases are taken care of. Diseases like open/active tuberculosis, measles, chicken pox, pulmonary plague and haemorrhagic fever with pneumo‐ nia can be spread by droplet nuclei. Alongwith standard precautions the patients should be placed in a single room with negative pressure which receives ≥12 air changes per hour (≥ 12 ACH after 2001 construction). The air flow in a negative pressure room should be from outside and also should be exhausted outside but may be recirculated if the air is filtered through a High Efficiency Particulate Filter. The rooms should be closed and patients transport and movement is to be limited i.e. only when necessary. During transportation, patient must use a surgical mask to prevent dispersal of droplet nuclei. Anyone who enters the room must wear

**Droplet Precautions :** These are taken for large particles droplets (>5 μm diameter) and the diseases transmitted are pneumonias, pertusis, diphtheria, influenza type B, mumps and meningitis. The patient is placed in a single room or in a room with another patient infected by same agent. Surgical mask should be used by HCWs and during transportation patient

**Contact precautions :** These are used to prevent transmission of antibiotic resistant bacteria, enteric infections and skin infections. HCWs must use gloves and gowns. The movement and

syringes are sterilized and if cannot withstand heat, HLD may be done.

**5. Transmission — Based additional precautions**

a special high filtration particulate respirator (N 95) mask.

oxide (EtO) can be done.

18 Infection Control

tion with EtO can be done [60].

addition to standard precautions [65].

should put a surgical mask.

transportation of patient should be limited.

The risk of acquiring HIV infection after needle stick or sharps injury is less than 0.5% [67]. Standard precautions using PPE and proper disposal systems for needles and sharps should be followed. The HCWs should be trained in safe sharps practices. The serological testing of patients must be done as early as possible if there is needle prick or injury by sharps. Post exposure prophylaxis should be started according to National guidelines.

#### **6.3. HBV and HCV**

For HBV and HCV same precautions and infection control practices has to be followed as HIV. All HCWs at risk of exposure to HBV must be vaccinated. No post exposure therapy to HCV is available but seroconversion of HCWs must be documented. For occupational exposure to blood borne pathogens, counselling and clinical and serological follow up must be provided.

## **6.4. Tuberculosis**

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

**8. Biomedical waste management**

of generation must be pasted.

black bags for disposal in secured landfill [69].

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:

Infection Control Practices in Health Care Set-Up

http://dx.doi.org/10.5772/55029

21

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

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

Incineration ash and solid chemical waste such as discarded medicines should be collected in

The rates of HAI serve as indicators of quality and safety of patient care at the Health care facility. The Hospital infection Surveillance system is for early detection of outbreaks or appearance of a new organism or new MDRO or even new antimicrobial resistant organism.

are then subjected to autoclaving/microwaving/chemical treatment/shredding.

Surveillance should be done at hospital level and at Regional or National level.

**9. Surveillance of Hospital Acquired Infections(HAI)**

generation, segregation, collection, transport, storage, treatment and final disposal.

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 Infection Control Practices.

**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% case fatality occur [67].

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 additional precautions are to be followed.
