Professional Documents
Culture Documents
This guide is intend for those who provide services to those who are
infected or affected by the HIV Infection. It is hoped that its
reference Bill be useful as tool to promote consistency in the field of
Universal Infection Control Precautions for those in the HIV Control
Programs.
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TABLE OF CONTENT
PREFACE
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4. GUIDELINES FOR THE TRANSPORT AND DISPOSAL OF DEAD
BODIES DUE TO HIV INFECTION/AIDS.
4.1 Introduction
4.2 General Precautionary Measures
4.3 Supervision
4.4 Death In The Hospital
4.5 Death In The House
4.6 Transport Of A Dead Body Into/Out Of The Country
5. APPENDICES:
Appendix IV: Guidelines For Health Care Workers Who Have Been
Exposed To Blood, Blood Product and Body Fluids of
Patient's Positive For HIV.
BIBLIOGRAPHY
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CHAPTER 1
1.1 INTRODUCTION
Blood and body fluids may contain blood-borne viruses (eg. Hepatitis B
and HIV) or other bacterial and other viral pathogens. These can
present a risk to other patients and health care workers. As it is not
always possible to know who is infected with these pathogens,
emphasis on infection control effort should focus primarily on 'Universal
Infection Control Precautions' (UICP) which prevent the exposure to
blood and body fluids Which are presumed to be potentially infective.
• HIV;
• hepatitis B,C, non-A non-B
• syphilis
• malaria
• blood-borne viral and bacterial infections
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Link in Definition HIV and HBV
chain
Place of Where the HIV and HBV enter the host
entry microorganism enters the via the penis, vagina, rectal
next host usually the lining, breaks in skin, blood
same way as it left the transfusion and rarely breast-
old host. feeding.
Susceptible A person who may HIV and HBV infection can
host become infected. occur in anyone who has
sexual or blood contact with
an infected person and in
infants of HIV -infected
mothers
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1.4 UNIVERSAL INFECTION CONTROL PRECAUTIONS
Infection control precautions are intended to isolate the virus and the
body fluids, not the patient.
• Blood
• Blood-stained body fluids
• Semen
• Vaginal secretions
• Tissues
• CSF, amniotic, pericardial, pleural fluids etc
• Faeces
• Urine
• Vomit
• Sputm
• Tears
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• Nasal secretions
• Sweat
• Saliva
1.5.1 Gloves
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1.5.3 Eye protection
1.5.4 Masks
1.5.6 Handwashing
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• contact with patients during ward rounds or routine
procedures such as bed-making or lifting should be
followed by decontamination of the hands with
alcohol chlorhexidine or a soap and water hand-
wash.
Hand Disinfection
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• When moving from one patient to another.
• After non-sterile duties not involving body fluids.
• After handling or touching a potentially
contaminated surface.
• Before touching a neutropenic or high-dependence
patient.
Sustained-action disinfectants
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hands. Hand-creams may be applied after washing and
drying the hands.
Single cubicles should be provided only for patients who need high-
dependency nursing. If a special ward or unit is available, all patients
should be treated as high risk and isolation is not necessary.
Requirements
Protective clothing - gloves and aprons are essential. Masks should be
used if indicated.
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• wear domestic or latex gloves; (use a plastic bag over the
hands if gloves
are not available).
• cover the spillage with hypochlorite granules (presept) or
paper towels
soaked with hypochlorite solution (1000 p.p.m of available
chloride or
10 000 p.p.m. for heavy soiling);
• allow 2 minutes contact time;
• clear spillages and dispose of as clinical waste;
• wash surface with water and detergent;
Disinfectants
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Figure 3: Recommended dilutions of chlorine-releasing
compounds
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Chlorine compounds are very unstable. Prepare solutions daily or
store in a covered brown bottle for up to 30 days. The bottle must be
tightly capped between use. Avoid direct sunlight.
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can be introduced safely. Alternatively, lay the cap on the
table with the closed end against anything that offers
resistance and insert the needle carefully - NEVER hold the
cap while resheathing.
Sharps
Broken Glass
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4. Put the wrapped glass in a cardboard box, which should be
marked BROKEN GLASS - HANDLE WITH CARE or with
yellow BIOHAZARD tape.
5. Tell the porters that the box contains broken glass.
Sharp Containers
Disposal
Sharps containers are clinical waste and should be put into clinical
waste bags before being incinerated.
Excreta and other liquid waste should be discarded directly into the
toilet leading to a working sewer system.
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Limlug
To do this safely:
Accidents
Staff safety is very important and inoculation accidents must be
avoided. Where such an accident occurs, it must be documented by
the senior manager and reported to the Head of Department and the
Infection Control Team immediately so that appropriate action can be
taken. (See Appendix VI & VII).
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Needle-stick injuries
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CHAPTER 2
2.1 INTRODUCTION
1. The emergency equipment (e.g. first aid box, wash basin, eye wash
fountain) should be available and easily accessible.
2. Reporting of accidents
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washed and rinsed with water if the face had been splashed
with blood.
2. The top half of the door should be made of clear glass panel, visible
from the outside.
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2.8 COLLECTION, DESPATCH AND RECEPTION OF SPECIMENS
2.10 HISTOPATHOLOGY
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fixed specimens.
2.11 MICROBIOLOGY
2. Pour liquid wastes down a sink into a closed sewer system. If there
is no working sewer, treat potentially contaminated liquid wastes
the same as solids.
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CHAPTER 3
The same basic principle apply to the dialysis unit as to the operating
theatre and delivery room:
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i. Staff should be immunized against hepatitis B before starting work
in the unit.
ii. All patients should be screened and immunized against hepatitis B.
iii. Disposable tubing and heat-labile equipment are recommended for
dialysis.
iv. The outer surfaces of the renal dialysis machine should be cleaned
with warm water and detergent.
v. The inside of the machine should be cleaned with 1 per cent chloro
(hypochlorite) and rinse thoroughly before further use.
vi. Disposable filters should be used to prevent contamination with
blood.
vii. Disposable administration lines, dialyser and needles should be
used.
viii. Equipment to be recycled should be able to withstand autoclave
temperatures of 121ºC.
3.4 Housekeeping
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ii. Housekeepers and cleaners should carry waste in containers which
are small enough to be easily held away from the body to avoid
injuries.
iii. Do not put hand into waste baskets.
iv. Do not clean by hand under cupboards, but use cleaning
equipment.
v. Do not use disinfectant fogging of a room, following patient
discharge. Disinfectant fogging is toxic and expensive. Thorough
cleaning is the most effective way to remove soil and micro-
organisms .
3.5 Laundry
Wash laundry in hot water (at least 71 degrees Centigrade or 160 degrees
Fahrenheit). If only cold water is available, use special chemical detergents
for this purpose or add bleach.
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CHAPTER 4
4.1 INTRODUCTION
1. All staffs/persons handling the body and the soiled linen should
wear gloves.
2. Where there is possibility of injury to the fingers (e.g. cleaning the
oral cavity) double gloves should be worn.
3. If there is danger of fluid spillage such as when disinfecting or
washing the body, the attendant should wear in addition, a mask,
waterproof apron and boots.
4. Further, they must wash their hands thoroughly with soap and
water aft er the procedures.
5. If the relatives request to see the body, they should be allowed but
must be strongly discouraged from embracing or kissing it.
4.3 SUPERVISION
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4.4 DEATH IN THE HOSPITAL
1. The family of the patient would have been advised to inform the
District Health Officer immediately of the death and the nature of
the disease. This can be done directly or through the nearest Police
Station or Penghulu.
2. Subsequent disinfection of the body and clothing should be
supervised by the Health Inspector/Nurse.
3. A minimum number of people should be involved with the
preparation of the body. It is recommended that not more than 5
people be involved.
4. The body is similarly disinfected first with sodium hypochlorite and
then wrapped as in para 4.4.2.5.
5. Water from the washing of the body should be disinfected with
chloride of lime.
6. The patient's clothing, bed, linen, preparation area and areas
possibly contaminated by the body fluids should also be disinfected
with sodium hypochlorite.
7. The body could then be buried or cremated according to the
respective religious practice within 24 hours.
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NOTES
1. 'Body bag': A translucent plastic bag 0.1 mm thick routinely used for
the transport of bodies for forensic purposes.
2. "Sodium hypochlorite": The required strength for use is 1: 10 solution
of 5.25% freshly prepared sodium hypochlorite.
Plastic body bag, gloves, mask, waterproof aprons and boots should be
available in all Health Offices at all times.
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APPENDIX I
1. OBJECTIVES:
2. To render all used disposable syringes and needles useless from use
by potential users (e.g. Drug addicts).
2. PRECAUTIONS
4. RECOMMENDED PROCEDURE
- BY INCINERATION (eg. IN HOSPITAL)
1. The used needles and syringes are put into a suitable puncture-proof
container (hard plastic/glass/tin).
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3. Burn the contents in the incinerator. The melted products are
disposed offthrough the scavenging service.
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APPENDIX II
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APPENDIX III
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11. Never pipette by mouth.
12. Perform all technical procedures in a way that minimizes the risk of
creating aerosols, droplets, splashes, or spills.
13. Do not eat, drink, smoke, apply cosmetics, or store food or personal
items in the laboratory.
14. Make sure that there is an effective insect and rodent control
programme. (This is a standard biosafety recommendation).
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then autoclaved or boiled. Gloves must be worn during disinfection and
cleaning.
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If a laboratory worker is exposed to blood, other body fluids, or virus-culture
material either parenterally or through mucous membranes, the source
material should, if possible, be tested for the presence of virus and/or
antibody. If the source material is positive for HIV antibody, virus, or antigen
or is not available for examination, the worker should be serologically tested
and advised to report and seek medical evaluation any acute febrile illness
that occurs within 12 weeks after the exposure. Such an illness - particularly if
characterised by fever, rash, or Iymphadenopathy - may indicate HIV
infection. During the follow-up that must be instituted the worker should be
instructed to take general precautions for preventing HIV transmission, and
given appropriate counselling. If seronegative, he or she should be retested 6
weeks after the exposure and periodically thereafter (at 3 and 6 months after
exposure).
Records should be kept of all illness and absences of laboratory worker The
results of the HIV testing of laboratory employees should be kept confidential.
2. Biological safety cabinets are not required for the serological testing
of potentially HIV - contaminated material. Safety glasses, face
shields or other protective devices should be worn when necessary to
protect the eyes and face from splashes and impacting objects.
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5. The bench tops should be impervious and resistant to disinfectants,
acids, alkalis, organic solvents and moderate heat.
Facilities for storing outer garments and personal items and space for eating,
drinking and smoking should be provided outside the work-room.
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APPENDIX IV
1. If HIV status of patient is negative, the health care worker may not
need treatment.
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1. 100 mg AZT 4 hourly; or 500 mg daily for 3 months To be given
within one hour after injury/ exposure
2. Contraindications
• Pregnancy
• Breast Feeding The drug and the HIV virus are excreted in
milk.
4. Adverse Reactions:
Please note that AZT has toxic side effects. The risk of long term
toxicity is not known yet.
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4. History
3. Details of exposure:
i.Amount of fluid/material
ii.Type of fluid/material
5. Carry out haematology (FBP) and liver function at each follow up.
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7. Monitor Retrovir (Zidovudine AZT) Using Monitoring Record
established by Burrough Wellcome.
6. Reporting
NOTES
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APPENDIX V
iii.severity of exposure
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BIBLIOGRAPHY
1. Ayliffe, G.A.J., Lowbury, E.J.L., Geddes, A.M. and Williams, J.D. (1992)
Control of Hospital Infection - A practical handbook, 3rd edition. Chapman
and Hall Medical, U.K.
7. WHO AIDS Series No. 9 (1991) Biosafety guidelines for diagnostic and
research laboratories working with HIV.
8.1. Code of Practice for the Prevention of Infection and Accidents in the
Hospital Laboratories and Post-Mortem Rooms, 1987.
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