Infection Control in Laboratory PDF

‫اإلدارة العامة لمكافحة عدوى المنشآت الصحية‬ General Directorate of Infection Prevention and Control (GDIPC) Infection Control in Laboratory Presenter by : Abrar Mutlaq  Outline 1 Introduction 2...

‫اإلدارة العامة لمكافحة عدوى المنشآت الصحية‬ General Directorate of Infection Prevention and Control (GDIPC) Infection Control in Laboratory Presenter by : Abrar Mutlaq  Outline 1 Introduction 2 Infection prevention team member 3 Principles of laboratory testing 4 Biosafety Levels (BSLs) 5 Requirements regarding the design 6 Work Practices, Safety Equipment, And Laboratory facilities 7 Laboratory Equipments  Introduction: Laboratories are special and unique, work environment that presents identifiable infectious disease risks to persons or near them. In relation to infection control, laboratories represent an integral part of an infection prevention program. Infection prevention team member Laboratory personnel is at risk of exposure to: Blood-borne pathogens related to injuries from contaminated sharps Splashes to eyes or mouth blood/body fluids onto non-intact skin. Cultures of specific microorganisms in the microbiology laboratory ❖ Consider all patients as potentially infected with blood-borne pathogens and adhere to infection-control precautions to minimize the risk of exposure to blood and body fluids of all patients. ❖ The microbiology laboratory helps to detect and identify microorganisms so that the infection control team can monitor, prevent, and control infection transmission.  Principles of laboratory testing During the 1970s, in an effort to reduce the risks of laboratory-associated infections (LAIs), scientists devised a system for categorizing agents into groups based on their mode of transmission, the type and seriousness of illness resulting from infection, availability of treatment (e.g. antimicrobial drugs), and availability of prevention measures (e.g. vaccination) Biosafety in microbiological and biomedical laboratories (BMBL) guidelines provided categorization of (BL)from 1 through 4 Biosafety Levels (BSLs) Determined by combinations of laboratory practices, techniques, safety equipment, and facilities, which are appropriate for operations performed (depending on potential hazards imposed by agents and laboratory function). Biosafety Level 1 provides the least strict containment conditions and Biosafety Level 4 the strictest. Biosafety level 1 Biosafety Level 1 (BL-1) defines conditions suitable for work involving characterized microorganisms not known to cause disease in healthy adult humans Biosafety level 2 Biosafety level 2 (BL-2) is similar to BL-1 and is suitable for work involving agents of moderate potential hazard to personnel and the environment. Biosafety level 3 biosafety level 3 (BL-3) is applicable to clinical, diagnostic, teaching, research, or production facilities in which work is done with indigenous or exotic agents; such agents may cause serious or potentially lethal disease as a result of exposure by the inhalation route. Biosafety level 4 Biosafety level 4 (BL-4) laboratories are the most sophisticated of laboratories required for work with dangerous and exotic agents that pose a high risk of aerosol transmission for life-threatening diseases such as those caused by Ebola viruses. BSL  Infection control requirements regarding the design and finishing of clinical laboratory Laboratories should be located away from public areas. Entry area: The laboratory doors should be self–closed and be locked. A sign with a universal biohazard symbol must be posted at the entrance of the laboratory  Infection control requirements regarding the design and finishing of clinical laboratory Specimen collection station : Should be outside the laboratory work area. Must have hand washing facilities and proper PPEs. Infection control requirements regarding the design and finishing of clinical laboratory Air control: ∙ Laboratory windows are not recommended. ∙ The laboratory should consider mechanical ventilation systems that provide an inward flow of air without recirculation to space outside the laboratory ∙ Vacuum lines should be protected with HEPA filters, Filters must be replaced as needed. Infection control requirements regarding the design and finishing of clinical laboratory Handwashing stations: - ∙ Must be provided where staff handles specimens, test reagents, or blood products. ∙ Each work area contains a dedicated equipped sink for washing hands and it is easily accessible. ∙ Must have a sink for handwashing, hands-free, or automatically operated to avoid cross-transmission. ∙ It should be located near the exit door. ∙ Each laboratory should contain a sink for handwashing that is separate from that used for the disposal of body fluids or chemicals  Infection control requirements regarding the design and finishing of clinical laboratory General: ∙ A refrigerator should be provided and customizing refrigerators for different purposes ∙ The laboratory should be designed to be easily cleaned and decontaminated. Spaces between benches, cabinets, and equipment should be accessible for cleaning. ∙ Carpets are not permitted. ∙ Laboratory furniture must be capable of supporting anticipated loads and uses. ∙ An eyewash station must be readily available, easily accessible, and checked weekly ∙ BSC should be located away from doors, and windows that can be opened. Work Practices, Safety Equipment, And Laboratory facilities Standard microbiological practices Special practices Safety Equipment (Primary barriers and personal protective equipment) Laboratory facilities (Second barriers) A. standard microbiological practices: 1. The laboratory supervisor must ensure the staff receives adequate training regarding the necessary precautions to prevent exposure. 2. Persons must wash their hands after working with potentially hazardous materials and before leaving the laboratory. 3. Eating and drinking are prohibited in the work area. 4. Food must be stored outside the laboratory area in cabinets or refrigerators designated and used for this purpose. 5. Mouth pipette is prohibited mechanical pipette devices must be used. 6. Policies for handling sharps and needle stick injuries must be developed and implemented. 7. Perform all procedures to minimize the creation of splashes and/ or aerosols. 8. an effective pest control program must be implemented.  b. Special practices:. 1. Laboratory personnel must be provided with immunization against those handled in the laboratory. 2. A laboratory-specific biosafety manual must be available and easily accessible. 3. The laboratory supervisor must ensure that the personnel demonstrates proficiency in standard and microbiological practices. 4. Potentially infectious materials must be stored well. 4. Animals and plants are not allowed in the laboratory. 5. All procedures that involve generating aerosols must be done in a biosafety cabinet (BSC). C. Safety Equipment (Primary barriers and personal protective equipment): 1. Well-maintained BSCs preferred to be class II must be used when : a. Procedures that will generate aerosol will be conducted. b. High concentrations or large volumes of infectious agents are used 2. Should use selected PPE such as gowns, and coats. 3. Eye and face protection goggles must be used when dealing with potential splashes. 4. Gloves must be used when handling infectious materials. 5. Respiratory protection must be followed when dealing with infected animals, and microorganisms based on the risk assessment. D. Laboratory facilities (Second barriers): 1. laboratory doors must be self-closing and have locks. 2. The laboratory should have sink for hand washing. 3. The laboratory design and surfaces must be easily cleaned. 4. The laboratory furniture must support the type of work conducted 5. BSCs must be installed in a manner that it will not affect with the operation. 6. An eye wash station must be readily available LABORATORY EQUIPMENT BIOSAFETY CABINETS It is the standard device used to provide containment of hazardous biological agents and toxins when conducting microbiological activities. BIOSAFETY CABINETS  BIOSAFETY CABINETS There are three general types of BSCs: Class I, II, and III. All must be recertified annually Class I BSCs: the cabinet is similar to a chemical fume hood cabinet Class II BSCs: Designed to protect the worker. Both the supply air and the exhaust air are HEPA-filtered. There are four types of Class II BSCs (IIA, IIB1, IIB2, and IIB3) They are different in the amount of recirculation Class III BSCs: are totally enclosed, ventilated cabinets of gas-tight construction that offer the highest degree of protection from infectious aerosol. It is suitable for use with hazardous agents that require containment at BL-3 or BL-4. The work conducted through attached rubber gloves, and the cabinet operated under negative pressure.  Decontaminations Cultures Surfaces Repair Equipment Decontaminate work surfaces after completion of work and after any spill or splash of potentially infectious material with appropriate disinfectant. (approved MOH Disinfectant). Decontaminate all cultures, stocks, and other potentially infectious materials before disposal using an effective method (e.g.: Steam autoclave) Materials to be decontaminated outside of the laboratory must be placed in a durable, leak-proof container and secured for transport. Laboratory Equipment must be decontaminated before repair or removal from the laboratory.  Microbiology accident emergency plan A. Centrifuge Spills Cleaning: ▪ Shut off the instrument, Do NOT open the centrifuge for at least one hour. ▪ In addition to gloves, the person responsible for clean-up of the area is to wear a mask and gown ▪ Remove glass by forceps ▪ Absorbent materials should be used, leave for two minutes or as per the manufacturer’s recommended contact time. ▪ Pick up all absorbent material and carefully place it in the infectious yellow bag for disposal. ▪ Seal the yellow bag. ▪ Remove PPEs and place them in a yellow bag for disposal. ▪ Wash hands thoroughly with soap and water. Use safety precautions to decrease the risk associated with centrifuge. a) Use sealed tubes b) Filling centrifuge tubes, rotors, and accessories in a BSC. c) Always balance tubes, and rotors properly before centrifugation.  Microbiology accident emergency plan B. Spills occurring within the Biosafety Cabinet: 1. Wearing a mask, gown, and gloves. 2. With cabinet airflow running, cover the affected area immediately with absorbent material. 3. Using hospital-approved disinfectant, gently spray the top of the covered spill. a.Leave for the recommended contact time. b. Pick up the absorbent material and place it in a small autoclave bag inside the biosafety cabinet. c.Clean the affected area again with disinfectant. If chlorine bleach is used, the affected area should be cleaned with 70% ethanol afterward to remove residual bleach. (Chlorine bleach will pit and corrode the stainless-steel work area inside the biosafety cabinet ) d.Place the sealed bag in a biohazard waste receptacle. 3. Remove PPEs and place them in a yellow bag for disposal.  Transporting Biohazardous material Transporting hazardous material must be done based on the local and national regulations The personnel performing the transporting of hazardous material must be trained and monitored regularly. The personnel must be immunized and protected with proper PPE during the transport of hazardous materials. Bags for packaging must be able to withstand rough handling and passage. Clear labeling of biohazardous waste is attached to all packages. Infectious waste management Cultures Body Fluid Stocks  Infectious waste management The clinical laboratory is responsible for the proper handling and disposal of infectious waste. Infectious laboratory waste includes cultures, and stocks of infectious waste, pathological waste includes tissues, organs, and body parts (buried according to kingdom law). Method of elimination depends on the type of waste: Fluid must be poured into the facility within 24 hours. Culture plates should be autoclaved before disposal. Sharps must be disposed in puncture-proof containers. Infectious waste management Thank you Abrar Mutlaq [email protected]