STANDARD SAFETY MEASURES

BY
M.SENTHIL KUMAR
MSC NURSING II YEAR
CHRI
INTRODUCTION
 DEFINITIONS

• Standards
– A standard is a predetermined level of excellence that
serves a guide for practice.

• Safety
– Safety is the state of being "safe" (from French sauf), the
condition of being protected against physical, social,
spiritual, financial, political, emotional, occupational,
psychological, educational or other types or consequences
of failure, damage, error, accidents, harm or any other
event which could be considered non-desirable
 TYPES OF SAFETY

• Normative safety
• Normative safety is a term used to describe products or designs
that meet applicable design standards.
• Substantive safety
• Substantive, or objective safety means that the real-world
safety history is favorable, whether or not standards are met.
• Perceived safety
• Perceived, or subjective safety refers to the level of comfort of
users. For example, traffic signals are perceived as safe, yet
under some circumstances, they can increase traffic crashes at
an intersection.
 SAFETY MEASURES

Safety measures are activities and precautions taken to improve

safety, i.e. reduce risk related to human health. Common safety
measures include:
1. Root cause analysis
2. Visual examination for dangerous situations
3. Visual examination for flaws such as cracks, peeling, loose
connections.
4. Safety margins/Safety factors
5. Implementation of standard protocols and procedures
6. Training of employees, vendors, product users
7. Instruction manuals
8. Instructional videos
9. Examination of activities by specialists
10. Government regulation
11. Industry regulation.
12. Self-imposed regulation of various types.
13. Statements of Ethics
14. Periodic evaluations of employees, departments, etc.
 STANDARD SAFETY MEASURES IN HOSPITAL

• Physical health
• Bio medical waste management
• Standard precautions
 PHYSICAL ENVIRONMENT

Aim: to provide an environment favourable to recovery

1. Promote comfort
2. Extermination and control of vermin and animal pets
3. Dangers
– Preventing mechanical injury
– Preventing shocks and burns from electrical fixtures
– Prevention of fire
– Protection from chemical injury
 BIO MEDICAL WASTE MANAGEMENT

“any solid, fluid or liquid waste,

including its container and any intermediate
product, which is generated during the diagnosis, treatment
or immunization of human beings or animals, in research
pertaining thereto,
or in the production or testing of biologicals
and the animal waste from slaughter houses
or any other like establishments”.
Classification of waste

• General waste
– General sweeping
– Kitchen waste
– Packaging material
– Paper pieces
– Waste water from laundry, kitchen

• Infectious waste
– Human anatomical waste
– Micro biology & micro technology waste
– Solid waste

• Sharps:
– Hypodermic needles, stitching needles, needles attached with tubings
– Scalpel blades, razors, etc
 CLASSIFICATION OF WASTE CATEGORY

Cat- 1 Human Anatomical Wastes

Cat- 2 Animal Anatomical Wastes

Cat- 3 Microbiology and Biotechnology wastes

Cat- 4 Waste Sharps

Cat- 5 Discarded medicines and Cytotoxic drugs

Cat- 6 Soiled wastes include items contaminated with
blood, body fluids such as cotton, dressings,
linen, beddings etc.
Cat- 7 Solid wastes i.e. waste generated from
disposable items other than sharps such as
tubing, catheters, IV sets.
Cat- 8 Liquid wastes ( washing, cleaning )

Cat- 9 Incineration ash

Cat- 10 Chemical wastes ( disinfectants, insecticides )

 COLOR CODING FOR SEGGREGATION OF BMW
COLOR WASTE TREATMENT

YELLOW Human & Animal anatomical waste / Micro- Incineration / Deep burial
biology waste and soiled
cotton/dressings/linen/beddings etc.

RED Tubings, Catheters, IV sets. Autolaving / Microwaving /

Chemical treatment

BLUE / Waste sharps Autolaving / Microwaving /

( Needles, Syringes, Scalpels, blades etc. ) Chemical treatment &
WHITE Destruction / Shredding

BLACK Discarded medicines/cytotoxic drugs, Disposal in secured landfill

Incineration ash, Chemical waste.
 PRINCIPLES OF CONTROL OF HAZARDS OF BIOMEDICAL
WASTE IN HEALTH CARE ESTABLISHMENTS

* Each institution should develop its own bio waste management

policy and ensure that the health care workers are adequately
trained to handle biological waste.
* Measures such as universal safety precautions, hand washing and
proper segregation of waste material should be encouraged.
* Rationale patient management policy should be followed
and admissions restricted to those for whom it is felt
absolutely necessary.
* Proper house-keeping is essential and the hospital premises
should be kept clean and well-ventilated.
* Use of disinfectants should be rationalised.
STEPS IN THE MANAGEMENT OF
BIOMEDICAL WASTE

1. Survey of waste generated.

2. Segregation of hospital waste.
3. Collection & Categorization of waste.
4. Storage of waste.( Not beyond 48 hrs. )
5. Transportation of waste.
6. Treatment of waste.
 STANDARD PRECAUTIONS

Standard precautions are meant to reduce the risk of

transmission of bloodborne and other pathogens from both
recognized and unrecognized sources. They are the basic
level of infection control precautions which are to be used,
as a minimum, in the care of all patients.
 Health policy
• Promote a safety climate.
• Develop policies which facilitate the imple-mentation of infection control
measures.

Hand hygiene
• Perform hand hygiene by means of hand rubbing or hand washing (see
detailed indications in table).
• Perform hand washing with soap and water if hands are visibly soiled, or
exposure to spore-forming organisms is proven or strongly suspected, or
after using the restroom. Otherwise, if resources permit, perform hand
rubbing with an alcohol-based preparation.
• Ensure availability of hand-washing facilities with clean running water.
• Ensure availability of hand hygiene products (clean water, soap, single use
clean towels, alcohol-based hand rub). Alcohol-based hand rubs should
ideally be available at the point of care.
 Hand Hygiene Techniques
1. Alcohol hand rub

2. Routine hand wash 10-15 seconds

3. Aseptic procedures 1 minute

4. Surgical wash 3-5 minutes

 Routine Hand Wash

Repeat procedures until hands are clean

Areas Most Frequently Missed

HAHS © 1999
 Hand Care
• Nails
• Rings
• Hand creams
• Cuts & abrasions
• “Chapping”
• Skin Problems
Personal protective equipment (PPE)
ASSESS THE RISK of exposure to body substances or
contaminated surfaces BEFORE any health-care activity.
Make this a routine!

• Select PPE based on the assessment of risk:

– clean non-sterile gloves
– clean, non-sterile fluid-resistant gown
– mask and eye protection or a face shield.
Respiratory hygiene and cough etiquette
• Education of health workers, patients and visitors.
• Covering mouth and nose when coughing or sneezing.
• Hand hygiene after contact with respiratory secretions.
• Spatial separation of persons with acute febrile respiratory
symptoms.
Guidance for the Selection and
Use of Personal Protective
Equipment (PPE) in Healthcare
Settings
 PPE Use in Healthcare Settings:
Program Goal
Improve personnel safety in the
healthcare environment through
appropriate use of PPE.

PPE Use in Healthcare Settings

 Personal Protective Equipment
Definition
“specialized clothing or equipment worn by
an employee for protection against infectious
materials” (OSHA)

PPE Use in Healthcare Settings

 Types of PPE Used in Healthcare
Settings
1. Gloves – protect hands
2. Gowns/aprons – protect skin and/or clothing
3. Masks and respirators– protect mouth/nose
1. Respirators – protect respiratory tract from airborne
infectious agents
4. Goggles – protect eyes
5. Face shields – protect face, mouth, nose, and
eyes
PPE Use in Healthcare Settings
 Factors Influencing PPE Selection
• Type of exposure anticipated
– Splash/spray versus touch
– Category of isolation precautions
• Durability and appropriateness for the task
• Fit

PPE Use in Healthcare Settings

 Gloves
• Purpose – patient care, environmental
services, other
• Glove material – vinyl, latex, nitrile, other
• Sterile or nonsterile
• One or two pair
• Single use or reusable

PPE Use in Healthcare Settings

 Gloves
• Purpose – patient care, environmental
services, other
• Glove material – vinyl, latex, nitrile, other
• Sterile or non-sterile
• One or two pair
• Single use or reusable

PPE Use in Healthcare Settings

 Do’s and Don’ts of Glove Use
• Work from “clean to dirty”
• Limit opportunities for “touch
contamination” - protect yourself, others,
and the environment
– Don’t touch your face or adjust PPE with
contaminated gloves
– Don’t touch environmental surfaces except as
necessary during patient care
PPE Use in Healthcare Settings
 Do’s and Don’ts of Glove Use (cont’d)

• Change gloves
– During use if torn and when heavily soiled (even
during use on the same patient)
– After use on each patient
• Discard in appropriate receptacle
– Never wash or reuse disposable gloves

PPE Use in Healthcare Settings

 Gowns or Aprons
• Purpose of use
• Material –
– Natural or man-made
– Reusable or disposable
– Resistance to fluid penetration
• Clean or sterile

PPE Use in Healthcare Settings

 Face Protection
• Masks – protect nose and mouth
– Should fully cover nose and mouth and
prevent fluid penetration
• Goggles – protect eyes
– Should fit snuggly over and around eyes
– Personal glasses not a substitute for goggles
– Antifog feature improves clarity

PPE Use in Healthcare Settings

 Face Protection
• Face shields – protect face, nose, mouth, and
eyes
– Should cover forehead, extend below chin and
wrap around side of face

PPE Use in Healthcare Settings

 Respiratory Protection
• Purpose – protect from inhalation of
infectious aerosols (e.g., Mycobacterium
tuberculosis)
• PPE types for respiratory protection
– Particulate respirators
– Half- or full-face elastomeric respirators
– Powered air purifying respirators (PAPR)

PPE Use in Healthcare Settings

PPE Use in Healthcare Settings:
How to Safely Don, Use, and
Remove PPE
 Key Points About PPE
• Don before contact with the patient,
generally before entering the room
• Use carefully – don’t spread contamination
• Remove and discard carefully, either at the
doorway or immediately outside patient
room; remove respirator outside room
• Immediately perform hand hygiene
PPE Use in Healthcare Settings
 Sequence* for Donning PPE
• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves

*Combination of PPE will affect sequence – be practical

PPE Use in Healthcare Settings

 How to Don a Gown
• Select appropriate type and size
• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two gowns
– Gown #1 ties in front
– Gown #2 ties in back

PPE Use in Healthcare Settings

 How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit

PPE Use in Healthcare Settings

 How to Don a Particulate Respirator

• Select a fit tested respirator

• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with elastic
• Adjust to fit
• Perform a fit check –
– Inhale – respirator should collapse
– Exhale – check for leakage around face

PPE Use in Healthcare Settings

 How to Don Eye and Face Protection

• Position goggles over eyes

and secure to the head using
the ear pieces or headband
• Position face shield over face
and secure on brow with
headband
• Adjust to fit comfortably
PPE Use in Healthcare Settings
 How to Don Gloves
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation gown cuffs

PPE Use in Healthcare Settings

 How to Safely Use PPE
• Keep gloved hands away from face
• Avoid touching or adjusting other PPE
• Remove gloves if they become torn;
perform hand hygiene before donning new
gloves
• Limit surfaces and items touched

PPE Use in Healthcare Settings

PPE Use in Healthcare Settings:
How to Safely Remove PPE
 “Contaminated” and “Clean” Areas
of PPE
• Contaminated – outside front
• Areas of PPE that have or are likely to have been in contact with body
sites, materials, or environmental surfaces where the infectious
organism may reside

• Clean – inside, outside back, ties on head

and back
• Areas of PPE that are not likely to have been in contact with the
infectious organism

PPE Use in Healthcare Settings

 Sequence for Removing PPE
• Gloves
• Face shield or goggles
• Gown
• Mask or respirator

PPE Use in Healthcare Settings

 Where to Remove PPE
• At doorway, before leaving patient room or
in anteroom*
• Remove respirator outside room, after door
has been closed*
* Ensure that hand hygiene facilities are available at the point needed, e.g.,
sink or alcohol-based hand rub

PPE Use in Healthcare Settings

 How to Remove Gloves (1)
• Grasp outside edge near
wrist
• Peel away from hand,
turning glove inside-out
• Hold in opposite gloved
hand

PPE Use in Healthcare Settings

 How to Remove Gloves (2)
• Slide ungloved finger
under the wrist of the
remaining glove
• Peel off from inside,
creating a bag for both
gloves
• Discard
PPE Use in Healthcare Settings
 Remove Goggles or Face Shield
• Grasp ear or head
pieces with ungloved
hands
• Lift away from face
• Place in designated
receptacle for
reprocessing or disposal
PPE Use in Healthcare Settings
Removing Isolation Gown
• Unfasten ties
• Peel gown away from
neck and shoulder
• Turn contaminated
outside toward the
inside
• Fold or roll into a
bundle
 Removing a Mask
• Untie the bottom, then
top, tie
• Remove from face
• Discard

PPE Use in Healthcare Settings

 Removing a Particulate Respirator
• Lift the bottom
elastic over your
head first
• Then lift off the top
elastic
• Discard

PPE Use in Healthcare Settings

 PPE for Expanded Precautions
• Expanded Precautions include
– Contact Precautions
– Droplet Precautions
– Airborne Infection Isolation

PPE Use in Healthcare Settings

 Use of PPE for Expanded
Precautions
• Contact Precautions – Gown and gloves for
contact with patient or environment of care (e.g.,
medical equipment, environmental surfaces)
• In some instances these are required for entering patient’s
environment
• Droplet Precautions – Surgical masks within 3 feet
of patient
• Airborne Infection Isolation – Particulate
respirator*
 Hand Hygiene
• Required for Standard and Expanded
Precautions
• Perform…
– Immediately after removing PPE
– Between patient contacts
• Wash hands thoroughly with soap and water or
use alcohol-based hand rub
PPE Use in Healthcare Settings
 Standard precautions –key components

1. Hand hygiene
Summary technique:
 Hand washing (40–60 sec): wet hands and apply soap; rub all surfaces; rinse hands and
dry thoroughly with a single use towel; use towel to turn off faucet.
 Hand rubbing (20–30 sec): apply enough product to cover all areas of the hands; rub
hands until dry.

Summary indications:
 Before and after any direct patient contact and between patients, whether or not gloves are
worn.
 Immediately after gloves are removed.
 Before handling an invasive device.
 After touching blood, body fluids, secretions, excretions, non-intact skin, and
contaminated items, even if gloves are worn.
 During patient care, when moving from a contaminated to a clean body site of the patient.
 After contact with inanimate objects in the immediate vicinity of the patient.
2. Gloves
 Wear when touching blood, body fluids, secretions, excretions,
mucous membranes, nonintact skin.
 Change between tasks and procedures on the same patient after
contact with potentially infectious material.
 Remove after use, before touching non-contaminated items and
surfaces, and before going to another patient. Perform hand
hygiene immediately after removal
3. Facial protection (eyes, nose, and mouth)
 Wear
(1) a surgical or procedure mask and eye protection (eye visor,
goggles) or
(2) a face shield to protect mucous membranes of the eyes, nose,
and mouth during activities that are likely to generate splashes
or sprays of blood, body fluids, secretions, and excretions.
4. Gown
 Wear to protect skin and prevent soiling of clothing during
activities that are likely to generate splashes or sprays of
blood, body fluids, secretions, or excretions.
 Remove soiled gown as soon as possible, and perform hand
hygiene.
5. Prevention of needle stick and injuries from other sharp
instruments
Use care when:
 Handling needles, scalpels, and other sharp instruments or
devices.
 Cleaning used instruments.
 Disposing of used needles and other sharp instruments.
6. Respiratory hygiene and cough etiquette
Persons with respiratory symptoms should apply source control
measures:
 Cover their nose and mouth when coughing/sneezing with tissue or mask,
dispose of used tissues and masks, and perform hand hygiene after contact
with respiratory secretions.

Health-care facilities should:

 Place acute febrile respiratory symptomatic patients at least 1 metre (3 feet)
away from others in common waiting areas, if possible.
 Post visual alerts at the entrance to health-care facilities instructing persons
with respiratory symptoms to practise respiratory hygiene/cough etiquette.
 Consider making hand hygiene resources, tissues and masks available in
common areas and areas used for the evaluation of patients with
respiratory illnesses.
7. Environmental cleaning
 Use adequate procedures for the routine cleaning and
disinfection of environmental and other frequently touched
surfaces.

8. Linens
Handle, transport, and process used linen in a manner which:
 Prevents skin and mucous membrane exposures and
contamination of clothing.
 Avoids transfer of pathogens to other patients and or the
environment.
9. Waste disposal
 Ensure safe waste management.
 Treat waste contaminated with blood, body fluids, secretions
and excretions as clinical waste, in accordance with local
regulations.
 Human tissues and laboratory waste that is directly associated
with specimen processing should also be treated as clinical
waste.
 Discard single use items properly.
10. Patient care equipment
 Handle equipment soiled with blood, body fluids, secretions,
and excretions in a manner that prevents skin and mucous
membrane exposures, contamination of clothing, and transfer
of pathogens to other patients or the environment.
 Clean, disinfect, and reprocess reusable equipment
appropriately before use with another patient.
NABH GUIDELINES ON SAFETY
MEASURES
CONCLUSION & SUMMARY
THANK YOU