RPBI Waste Management

RPBI Management

• RPBI stands for Biológico-Infecciosos
• RPBI wastes are those that can transmit diseases due to their content of infectious biological agents
• RPBI is generated in hospitals, clinics, laboratories, and other health centers
• Inadequate management can endanger health workers, patients and the environment
• In Mexico, RPBI management is regulated by NOM-087-SEMARNAT-SSA1-2002, which aims to reduce risks and ensure proper disposal

RPBI Characteristics

• For waste to be considered RPBI, it must contain infectious biological agents capable of causing diseases
• This occurs if four conditions are met including:
  • Sufficient concentration (inoculum)
  • Environment conducive to survival
  • Presence of an entry route into the body
  • Susceptible host
• The main pathogenic agents that can be found in these wastes include:
  • Prions
  • Viruses (e.g., HIV, Hepatitis B)
  • Bacteria (e.g., Mycobacterium tuberculosis)
  • Fungi (e.g., Candida spp.)
  • Protozoa and other pathogenic microorganisms

RPBI Classification and Generation Areas

• RPBI is classified into five groups according to their nature namely:
  • Blood and its components (including liquid blood and non-commercial derivatives), generated in blood banks, laboratories, operating rooms, emergencies, bioterios
  • Cultures and stocks of infectious agents in culture media inoculated with pathogens, generated in microbiology laboratories, research and diagnostic centers
  • Pathological wastes including tissues, organs and parts removed in surgeries or necropsies, found in pathology laboratories, operating rooms, bioterios, necropsy rooms
  • Non-anatomical wastes including materials impregnated with blood or bodily fluids such as gauzes, dressings, bandages with secretions, generated in blood banks, emergencies, hospitals, bioterios
  • Sharps including needles, scalpels, blades, lancets, capillary tubes used in contact with humans or animals, generated in laboratories, operating rooms, blood banks, medical care units

RPBI Packaging

• Blood in liquid state must be placed in a red hermetic container
• Infectious cultures and strains in solid state are placed in a red polyethylene bag
• Pathological items can be solid or liquid and are placed in yellow polyethylene bag or hermetic container
• Non-anatomical wastes can be solid or liquid and are placed in a red polyethylene bag or hermetic container
• Sharps are solid and need to be placed in red rigid polypropylene container

Management of RPBI

• Internal management involves:
  • Identification: Separating RPBI from common waste
  • Packaging: Use suitable containers
  • Labeling: Mark containers with waste classification
  • Temporary Storage: Store waste in specific areas before transfer
  • Internal Treatment: Depending on the type of RPBI, they can be disinfected or inactivated before final disposal
• External management involves:
  • Storage in designated areas
  • External collection and transport by authorized companies
  • Specialized treatment such as incineration, autoclaving, chemical disinfection, among others
  • Final disposal in approved sites
  • In rural areas with limited access, labeled containers and disposal in special pits are allowed

Importance of Correct Management

• Improper RPBI management poses a risk to health personnel, the public, and the environment
• The main consequences of poor management include:
  • Spread of infectious diseases
  • Soil and water contamination
  • Exposure risks for sanitation workers and waste collectors
• It is essential to train staff in proper identification, classification, and packaging of RPBI to avoid these problems

Venipuncture

• Venipuncture is the procedure to obtain blood samples for diagnostic purposes

Common Puncture Sites

• Antecubital fossa (arm): basilic, cephalic, and median veins
• Forearm: radial and superficial cubital veins
• Back of the hand: dorsal venous plexus
• Ankle and foot: saphenous veins and dorsal venous plexus

Important Precautions

• Choose the vein well to avoid complications
• Do not use veins close to nerves or arteries
• If there is pain, swelling, or hematoma, remove the needle and look for another vein

Possible Risks

• Pain, hematomas, and dizziness
• Difficulty finding veins in some patients

Osmolality Impact on Erythrocytes

• Osmosis includes solvent movement from dilute solution to a more concentrated one through semipermeable membrane
• Osmotic pressure is the force needed to prevent solvent movement toward more concentrated solution
• Osmolarity refers to osmoles per liter of solution
• Osmolality refers to osmoles per kilogram of solvent

Solution Tonicity

• Isotonic solutions (285-295 mOsm/Kg) are equal to plasma
• Hypertonic solutions (>295 mOsm/Kg) are more concentrated than plasma
• Hypotonic solutions (<285 mOsm/Kg) are less concentrated than plasma

Objectives

• Observe changes in erythrocytes according to the solution's osmolarity
• Analyze red blood cell packet volume with different solutions
• Identify intravenous solutions and their clinical uses

Methodology

• Blood is drawn, centrifuged, and the supernatant liquids are removed
• Erythrocytes are washed with isotonic solution
• Erythrocytes are placed in NaCl solutions of different concentrations:
  • Hypotonic (0.45%): Cells swell and may lyse
  • Isotonic (0.9%): Cells maintain their normal size
  • Hypertonic (1.8%): Cells shrink (crenation)
• Changes in volume and appearance of erythrocytes is observed

Clinical Case: Gastroenteritis Dehydration

• Situation: Loss of fluids and electrolytes due to vomiting and diarrhea
• Recommended solution:
  • Isotonic crystalloids (NaCl 0.9%) to replenish volume and electrolytes
  • Crystalloids with dextrose (NaCl 0.9% + dextrose 5%) if additional energy is needed

Clinical Case: Hypovolemic Shock Due to Hemorrhage

• Situation: 51-year-old man with severe hemorrhage, hypotension, and tachycardia
• Recommended solution:
  • Isotonic crystalloids (NaCl 0.9% or Ringer Lactate) to restore volume
  • Colloids (Albumin or artificial plasma expanders) if the loss is severe
  • In critical cases, blood transfusion

Serum Electrolytes

• Serum electrolytes are substances with free ions capable of conducting electricity, helping to maintain fluid balance in the body
• They include sodium (Na+), potassium (K+), calcium (Ca2+), magnesium (Mg2+), chloride (Cl-), bicarbonate (HCO3¯), and phosphate (HPO42-)

Key Functions of Electrolytes

• Regulate fluid balance inside and outside cells
• Control osmotic pressure (water movement)
• Aid nerve and muscle function (including the heart)

Electrolyte Normal Values and Common Alterations

• Sodium (Na+): 137-145 mEq/L
  • Hyponatremia (low) can cause nausea, vomiting, seizures
  • Hypernatremia (high) due to dehydration or renal problems
• Potassium (K+): 3.5-5.1 mEq/L
  • Hypokalemia (low) causes muscle weakness and arrhythmias
  • Hyperkalemia (high) can cause serious cardiac problems
• Chloride (Cl-): 98-107 mEq/L
  • Altered in vomiting, diarrhea, dehydration, and kidney diseases
• Bicarbonate (HCO3¯): 22-26 mmol/L
  • Used to assess acid-base balance

Anion Gap (AG)

• AG calculation formula: \text{AG} = [\text{Na}^+] - ([\text{Cl}^-] + [\text{HCO}_3^-])
• Normal values: 8-16 mEq/L
• High value may indicate renal failure or diabetic ketoacidosis

Experiment Objectives

• Identify normal values of serum electrolytes
• Detect imbalances of fluids and acid-base

Analysis Method

• Draw blood sample with a Vacutainer tube
• Centrifuge the sample at 3500 rpm for 10 minutes
• Analyze in Fujifilm equipment

Clinical Case

• 82-year-old patient with vomiting, diarrhea, and dehydration
  • Sodium: 155 mEq/L (hypernatremia)
  • Chloride: 122 mEq/L (hyperchloremia)
  • Potassium: 4.6 mEq/L (normal)
  • Bicarbonate: 24 mEq/L (normal)
• Likely diagnosis: Hypernatremia due to severe dehydration