LESSON PLAN ON

INFECTION CONTROL

PREPARED BY
JINCY JOHNY
ASSISTANT LECTURER
Name of the teacher: Venue:
Subject: Number of students:
Unit: Duration:
Topic: Time:
Group: Date:
Method of Teaching:
AV Aids:

Central objectives:
At the end of the class the students will acquire in depth knowledge regarding the Infection control and apply this knowledge in future
Patient care practices with a positive attitude.

Specific Objectives:
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 Specific Tim Content Teacher’s AV Evaluation
Objectives e learner’s Aids
activity
INTRODUCTION
The term “Isolation” is the use of infection prevention and control precautions
aimed at controlling and preventing the spread of infection. There are two types of
isolation – Source Isolation (barrier nursing) where the patient is the source of
infection and Protective Isolation (reverse barrier nursing) where the patient requires
protection i.e. they are immunocompromised.
Barrier nursing is a largely ancient term for a set of strict infection
control techniques used in nursing. The aim of barrier nursing is to protect medical
staff against infection by patients and also protect patients with highly infectious
diseases from spreading their pathogens to other non-infected people. Barrier nursing
was created as a means to maximize isolation care. Since it is impossible to isolate a
patient from society and medical staff while still providing care, there are often
compromises made when it comes to treating infectious patients. Barrier nursing is a
method to regulate and minimize the number and severity of compromises being made
in isolation care, while also preventing the disease from spreading.
DEFINITION

 Barrier nursing or isolation techniques is intended to confined the

microorganisms within a given and recognizing area. It is a set of infection
control techniques used in nursing.
 Reverse Barrier Nursing is a range of practices used to protect highly
susceptible hospital patients from infection.
USES
 Care and treatment of patient with deadly contagious diseases which have no
treatment option; give control the main purpose of this practice.
 Provides protection, for other patients and medical personnel, not infected with
the virus.
PRINCIPLES
 The patient should be nursed in a single room which has a washbasin and
source of hot and cold water.
 All surfaces in the single room should be washable. Hand washing should be
emphasized by the people who are attending the patient.
 The number of people entering the room should be reduced to minimum and all
those who enter the room should be instructed to practice proper gown and
mask techniques. special nurses should be assigned to look after the patient.
 Protective clothing, preferably disposable gowns should be worn by all who
 visit or attend the patient.
 There should be some kind of working surfaces, such as a trolley or table in the
room to give facilities for nursing treatment.
 Clinical thermometer sphygmomanometer, syringes, etc. should be left inside
the room for the whole stay of the patient in the room. Clients chart should be
kept outside.
 In case of children, toys should be washable or disposable and paper bags
which can be incinerated should be provided for adults.
 The room should contain one big foot operation bin lined with the polythene
bag so that articles which are to be incinerated may be placed within it. A
second polythene lined bin should be provided for solid linen.
 Cleaning of the room must be carried out under the supervision of the nursing
staff.
 All surfaces should be washed with antiseptic solution is advised by the
microbiology department using a proper towel or rags which should be
incinerated.
 Staff should know the methods advocated by the microbiology department for
the sterilization or disinfection of equipment, excreta, linen or discharges from
the patient.
 If vacuum cleaner is used, the dust bag should be lined with a paper bag so
that the dust can be removed for incineration and the external part of the
 vacuum cleaner must be washed well. It should be thoroughly cleaned when
once the patient has been discharged.
 Nothing from that room should be kept outside for general use without first
being sterilized.
 Any instruction as regarded to the strength of disinfection and length of time
required for their action must be followed precisely.
 If possible all equipments in the room should be disposable such as linen,
flannels, syringes, bed pans, plates etc. a washing towel should be used
exclusively for the patient and left in his room throughout his stay there.
 Recommended cleaning material antiseptics should be available in the room
and kept exclusively for the patient such as lotions, creams etc.
TYPES OF PRECAUATIONS
 Standard precautions
 Transmission based precautions

1. Standard precautions include

 Perform proper hand hygiene after contact with blood, body fluids,
 secretions, excretions and contaminated objects. Whether or not gloves are
worn.
 perform proper hand hygiene immediately after removing gloves
 Use a antimicrobial agent or an antiseptic agent for the control of
specific outbreak of infection.
 Use an non antimicrobial product for routine hand hygiene
 Wear clean gloves when touching blood, body fluids, secretions, excretions
and contaminated item( that is, soiled gowns).
 Clean gloves can be unsterile unless their use is intended to prevent the
entrance of microorganisms into the body.
 Remove gloves before touching uncontaminated items and surfaces.
 Perform proper hand hygiene immediately after removing gloves
 Wear a mask, eye protection, or a face shield, if splashes or sprays of blood,
body fluids, secretions or excretions can be expected
 Wear a clean, non sterile, water resistant gown if client care is likely to
result in splashes or spray of blood, body fluids, secretions, or excretions. The
gown is intended to protect clothing.
 Remove a soiled gown carefully to avoid the transfer of
microorganisms to others (that is, client to other health care workers
 Cleanse hand after removing gown
 Handle client with equipment that is soiled with blood, body fluids, secretions
 or excretions carefully to prevent the transfer of microorganisms to other and to
the environment.
 Make sure reusable equipment is cleaned and processed correctly.
 Dispose of single use equipments correctly.
 Handle all soiled linen as little as possible. Do not shake it. Bundle it up with
the clean side out and dirty side in and hold away from self so that the nurse’s
uniform or clothing is not contaminated. Use appropriate laundry bags.
Hazards of on-site ward based laundering. Treat all linen as contaminated so
wear gloves.
 Place used needles and other sharps directly into puncture resistant containers
as soon as their use is completed. Do not attempt to recap needles or place
sharps back in their sheaths using two hands; use the one handed scoop
technique or other safety devices. Using two hand can result in a needle stick
puncture injury if the nurse accidently misses the cover.
 Respiratory hygiene/ cough etiquette.
 Informing personnel if they have any symptoms of respiratory
problems.
 Health educate patients and visitors to cover their mouth/ nose while
coughing and sneezing.
 Use surgical masks on coughing person when appropriate.
 Provide alcohol based hand rubbing dispensers and supplies for hand
 hygiene and educating patients and staff in their use.
 Encourage hand hygiene after coughing or sneezing.
 Separating coughing persons at least 3 feet away from others in a
waiting room or have separate locality.
2. TRANSMISSION –BASED PRECAUTIONS
 Transmission based precautions are used to protect the nurse and others from
acquiring the infectious organisms.
 Transmission based precautions are used in addition to standard precautions for
client with known or suspected infections that are spread in one of 3 ways: by
airborne or droplet transmission or by contact.
 The 3 types of Transmission based precautions may be used alone or in
combination but always in addition to standard precautions

A. AIRBORN PRECAUTIONS
 Used to prevent or reduce the transmission of microorganisms that are
airborne in small droplet nuclei or dust particles containing the
infectious agents
 Place client in an airborne infection isolation room [AIIR]. An AIIR is
a private room that has negative air pressure, 6- 12 air changes per hour,
and either discharge of air to the outside or a filtration system for the
room air.
 If private room is not available, place client with another client who is
 infected with the same microorganism.

 Wear an N95 respirator mask when entering the room of a client who is
known to have or suspected of having primary tuberculosis.
 Susceptible people should not enter the room of a client who has
rubeola (measles) or vericella (chickenpox). If they must enter, they
should wear a respirator mask.
 Limit movement of the client outside the room to essential purposes.
Place a surgical mask on the client during transport.
 Keep patient room door closed.

B. DROPLET PRECAUTIONS
 Place client in a private room.
 If private room is not available, place client with another client who is
infected with the same microorganism.
 Used to reduce the risk of transmission of microorganism transmitted by
large particle droplet.
 Droplets usually travels 3 feet or less within air and thus special air
handling is not required, however never recommendations suggest a
distance of 6 feet be used for safety.
 Use of respiratory protection such as mask when entering the room
recommended and definitely if within 3 feet of patient.
 Limit movement and transport of the patient.
 Use mask on the patient if they need to be moved and follow respiratory
hygiene / cough etiquette.
 Keep at least 3 feet apart between infected patient and visitors
C. CONTACT PRECAUTIONS

 Contact precautions used for clients known to have or suspected of

having serious illness easily transmitted by direct client contact with
items in the client’s environment.
 Place client as described in standard precautions
 change gloves after contact with infectious material.
 Remove gloves before leaving the client’s room.
 Cleanse hands immediately after removing gloves. Use an
antimicrobial agent. If the client is infected .
 After hand hygiene, do not touch possibly contaminated surfaces
or items in the room.
 Limit movement of the client outside the room.
 Dedicate the use of noncritical client care equipment to be single client or
to clients with the same infecting microorganisms.
 Make sure any infected or colonized areas are confined or covered.
 Ensure that patient care items, bedside equipment and frequently touched
surfaces, receive daily cleaning.
ISOLATION PRACTICES

 Initiation of particles to prevent the transmission of microorganisms is

generally a nursing responsibility and is based on a comprehensive assessment
of the client.
 This assessment takes into account the status of the client’s normal defence
mechanisms, the client’s ability to implement necessary precautions, and the
source and mode of transmission of the infectious agent.
 The nurse then decides whether to wear gloves, gowns, masks and protective
eye wears. In all client situations, nurses must cleanse their hands before and
after giving care.
  Use strict aseptic technique when performing any invasive procedure (eg.
Inserting an IV needle or catheter) and when changing surgical dressing.
 Change iv tubing and solution containers according to hospital policy (every
48- 72 hours).
 Check all sterile supplies for expiration date and intact packaging.
 Prevent urinary infection by maintaining a closed urinary drainage system .
Keep the drainage bag and spout off the floor.
 Implement measures to prevent impaired skin integrity and to prevent
accumulation of secretions in the lung.

HAND HYGIENE:
Hand washing is the simplest and most cost-effective way of preventing the
transmission of infection and thus reducing the incidence of healthcare associated
infections. Appropriate hand washing can minimize micro-organisms acquired on the
hands by contact with body fluids and contaminated surfaces
Definition:
Hand hygiene is defined by the World Health Organization as a general term that
applies to hand washing, antiseptic hand wash, antiseptic hand rub or surgical hand
antisepsis. Hand washing is under the umbrella of hand hygiene
Hand washing is the act of cleaning one’s hands with the use of any liquid with or
without soap for the purpose of removing dirt or microorganisms
Purpose
 Hand washing helps to remove micro-organisms that might cause disease.

 Washing with soap and water kills many transient micro-organisms and allows
them to be mechanically removed by rinsing.

 Washing with antimicrobial products kills or inhibits the growth of micro-

organisms in deep layers of the skin

 Hand washing breaks the chain of infection transmission and reduces person-
to-person transmission.

Types of hand washing

 Hand washing: Hand washing is usually limited to hands and wrists; the hands
are washed for a minimum of 10 – 15 seconds with soap (plain or
antimicrobial) and water
  Medical hand washing: Hand antisepsis removes or destroys transient micro-
organisms and confers a prolonged effect. It may be carried out in one of the
following two ways:

Wash hands and forearms with antimicrobial soap and water, for 15-30 seconds
(following manufacturer’s instructions).
Decontaminate hands with a waterless, alcohol-based hand gel or hand rub for 15-30
seconds. This is appropriate for hands that are not soiled with protein matter or fat.
 Surgical hand washing: Surgical hand antisepsis removes or destroys
transient micro-organisms and confers a prolonged effect. The hands and
forearms are washed thoroughly with an antiseptic soap for a minimum of 2-3
minutes. The hands are dried using a sterile towel. Surgical hand antisepsis is
required before performing invasive procedures.

Facilities and materials required for hand washing

 Running water:

Access to clean water is essential. It is preferable to have running water: large

washbasins with hand-free controls, which require little maintenance and have
antisplash devices. When no running water is available use either a bucket with a tap,
which can be turned on and off, a bucket and pitcher, or 60%-90 % alcohol hand rub.
 Materials used for hand washing/hand antisepsis:

 Soap: Plain or antimicrobial soap depending on the procedure. Plain soap:

 Used for routine hand washing, available in bar, powder or liquid form

 Antimicrobial soap: Used for hand washing as well as hand antisepsis. ·

 If bar soaps are used, use small bars and soap racks, which drain. · Do not
allow bar soap to sit in a pool of water as it encourages the growth of some
micro-organisms such as pseudomonas.
 Clean dispensers of liquid soap thoroughly every day.
 When liquid soap containers are empty, they must be discarded, not refilled
with soap solution.

 Specific antiseptics: recommended for hand antisepsis:

 2%-4% chlorhexidine
 5%-7.5% povidone iodine
 1% triclosan or · 70% alcoholic hand rubs.

 Waterless, alcohol-based hand rubs: with antiseptic and emollient gel and
alcohol swabs, which can be applied to clean hands.

Dispensers should be placed outside each patient room.

 Facilities for drying hands:

Disposable towels, reusable single use towels or roller towels, which are suitably
maintained, should be available. If there is no clean dry towel, it is best to air-dry
hands
Common towels must not be used as they facilitate transmission of infection

WHEN TO PERFORM HAND WASHING

Steps in hand washing

Preparing for hand washing:
 Remove jewellery (rings, bracelets) and watches before washing hands

 Ensure that the nails are clipped short (do not wear artificial nails)

 Roll the sleeves up to the elbow

Steps
 Step 0 - Wet hands with water.

 Step 1- Apply enough soap to cover all hand surfaces.

  Step 2 - Rub hands palm against palm.

 Step 3 - Right palm over left dorsum with interlaced fingers and vice
versa.

 Step 4 - Palm against palm with fingers interlaced.

 Step 5 - Backs of fingers to opposing palms with fingers interlocked.

 Step 6 - Rotational rubbing of left thumb clasped in right palm and vice
versa.

 Step 7 - Rotational rubbing, backwards and forwards, with clasped

fingers of right hand in left palm and vice versa.

 Step 8 - Rinse hands with water.

 Step 9 - Dry hands thoroughly with a single use towel.

Using antiseptics, hand rubs, gels or alcohol swabs for hand antisepsis
 Step 1 - Apply a palm full of the product in a cupped hand covering all
surfaces.

 Step 2 - Rub hands palm against palm.

 Step 3 - Right palm over left dorsum with interlaced fingers and vice versa.
  Step 4 - Palm against palm with fingers interlaced.

 Step 5 - Backs of fingers to opposing palms with fingers interlocked.

 Step 6 - Rotational rubbing of left thumb clasped in right palm and vice versa.

 Step 7 - Rotational rubbing, backwards and forwards with clasped fingers of

right hand in left palm and vice versa.

 Once dry, your hands are safe

Note: When there is visible soiling of hands, they should first be washed with soap
and water before using waterless hand rubs, gels or alcohol swabs. If soap and water
are unavailable, hands should first be cleansed with detergent-containing towellettes,
before using the alcohol-based hand rub, gel or swab.

PERSONAL PROTECTIVE EQUIPMENT

Personal protective equipment (PPE) refers to protective clothing, helmets,
gloves, face shields, goggles, facemasks and/or respirators or other equipment
designed to protect the wearer from injury or the spread of infection or illness.
Definition
Personal protective equipment, or PPE, as defined by the Occupational
Safety and Health Administration, or OSHA, is “specialized clothing or equipment,
worn by an employee for protection against infectious materials.”
Use of full personal protective equipment
 PPE acts as a barrier between infectious materials such as viral and bacterial
contaminants and your skin, mouth, nose, or eyes (mucous membranes). The
barrier has the potential to block transmission of contaminants from blood,
body fluids, or respiratory secretions.

 PPE may also protect patients who are at high risk for contracting infections
through a surgical procedure or who have a medical condition (for example
immunodeficiency) from being exposed to substances or potentially infectious
material brought in by visitors and healthcare workers.

 When used properly and with other infection control practices such as
handwashing, using alcohol-based hand sanitizers, and covering coughs and
sneezes, it minimizes the spread of infection from one person to another.

FULL PERSONAL PROTECTIVE EQUIPMENT

 Hair cover (Cap)

 Eye wear (goggles)

 Mask

 Gown /Apron

 Gloves
  Shoe covers

1. CAPS
Caps that completely cover the hair are used when splashes of blood and body fluids
are expected.
They should protect the hair from aerosols that may otherwise lodge on the hair and be
transferred to other parts of the health care worker such as face or clothing by the
hands or onto inanimate objects.
Selecting cap: Use a disposable, waterproof cap of an appropriate size which
completely covers the hair.
Wearing cap: Place or tie cap over the head so as to cover hair completely.
Removing cap: Remove by holding inside of the cap lifting it straight off head and
folding inside out. Discard in proper container. Wash hands immediately.

2. PROTECTIVE EYEWEAR/GOGGLES
Protective eyewear/goggles should be worn at all times during patient contact when
there is a possibility that a patient’s body fluids may splash or spray onto the
caregiver’s face/eyes (e.g. during throat, endotracheal and tracheostomy suctioning,
removal of in dwelling catheter etc).
The amount of exposure can be reduced through the use of protective eyewear. Full
face shields may also be used to protect the eyes and mouth of the health care worker
in such high-risk situations.
Ordinary spectacles do not provide adequate protection, although caregivers may wear
their own glasses with extra protection added at the sides. Goggles that fit over glasses
are available. Protective eyewear should be changed after each shift
Protective eyewear should be washed and decontaminated after removal and in
between use.
Selecting protective eyewear
 Goggles should be made of clear polycarbonate plastic with side and forehead
shields. These should be optically clear, antifog and distortion-free.

 Goggles that fit over glasses are also available. Disposable goggles are
preferred but reusable ones can be used after cleaning and decontamination.

Wearing protective eye wear

 Wear the eyewear by securing it over the bridge of the nose and also over the
mask.

Removing protective eye wear

 Remove and place in appropriate container for cleaning and decontamination
prior to reuse by next person.

3. MASKS
A surgical mask protects health care providers from inhaling respiratory pathogens
transmitted by the droplet route. It prevents the spread of infectious diseases such as
varicella (chickenpox) and meningococcal diseases (meningococcal meningitis).
An N95 mask protects health care providers from inhaling respiratory pathogens that
are transmitted via the airborne route. This helps to prevent the spread of infectious
diseases such as TB, MDR-TB.
Selecting a mask
 A surgical mask should be worn in circumstances where there are likely to be
splashes of blood, body fluids, secretions and excretions or when the patient
has a communicable disease that is spread via the droplet route.

 An N95 respirator mask needs to be chosen for those circumstances when a

patient has a communicable disease that is spread via the airborne route.

 A mask with a higher level of filtration may be required when dealing with
highly transmissible diseases such as viral hemorrhagic fever.

TYPE OF WHEN TO USE COMMENTS

MASK

N95 or P2 Open/active Ideally recommended; but single-use,

pulmonary TB, cost and continuous availability may
pneumonic restrict the use. In such situations,
plague, SARS standard surgical masks may be used
 During invasive Ideally recommended; but the fact that
N100 or P3 procedures, filters need to be kept continuously
collection of available and can be used only once,
respiratory may mean that cost considerations
secretions, restrict their use. In such situations,
laboratory work standard surgical masks may be used.
and work in an
environment
where organisms
in concentrated
form may be
encountered
Standard Mainly when Change mask when wet, soiled or
surgical dealing with contaminated.
Splash proof droplet infections; Do not reuse
masks use for airborne Discard according to health care facility
(not gauze infections when protocol
mask) N95 masks are
not available
Wearing the mask
 Wash hands and dry.

 Remove the clean mask from the container with clean hands.

• Place over nose, mouth and chin

• Fit flexible nose piece over nose bridge

• Secure on head with ties or elastic

• Adjust to fit

 Ensure the mask is fitted properly. Each N95 mask/respirator is different and
must be appropriately fitted to each health care worker– called a “fit test”.
Health care workers must ensure they know how to properly fit a respirator
according to the manufacturers’ instructions.

 If glasses are worn, fit the upper edge of the mask under the glasses. This will
help to prevent them from clouding over. A secure fit will prevent both the
escape and the inhalation of micro-organisms around the edges of the mask and
fogging of the eyeglasses.
Precautions
 Avoid talking, sneezing, or coughing if possible.

 Masks cannot be worn with beards/unshaven faces.

 The mask should completely seal the face at all times to ensure Effective
filtering of micro-organisms

Removing the mask

 Wash hands and remove mask - handle only the strings.

 Discard in an appropriate bag/container and seal the bag.

 Wash hands.
 4. GOWN
Gowns made of impervious material are worn to protect the wearer’s clothing/uniform
from possible contamination with micro-organisms and exposure to blood, body fluids
secretions and excretions.
The gown should be used only once for one patient and discarded or sent for
laundering. Health care workers should remove gowns before leaving the unit.
Selecting a gown
 Gowns should be clean and non-sterile.

 The gown should be impervious and water repellent.

 It should be long enough to cover the clothing of the wearer and should have
long sleeves and high neck.
  Disposable gowns are preferable. If they are not available, cotton reusable
gowns can be used with a plastic apron underneath.

Wearing the gown

 Wash hands, and dry.

 Hold the gown at the neck on the inside permitting to unfold.

 Slide hands and arms down the sleeves.

 Fasten the ties at the neck.

 Overlap the gown at the back as much as possible and secure the waistband.
Request assistance to fasten the waist ties.
Removing the gown
 Remove the gown after removing gloves.

 Untie the waistband with a gloved hand if it is tied in front before removing the
 gloves.

 Remove gloves and wash hands.

 Untie the neckties (be sure not to touch outside of the gown).

 Slide the gown down the arms and over the hands by holding in inside of the
sleeves.

 Hold the gown with both the hands (inside the shoulders) at the shoulder
seams.

 Turn the gown inside out (contaminated side in). The hands are then brought
together, and the gown is rolled and discarded in the container provided.

 Discard appropriately

 If reusable - discard if visibly contaminated. If there is shortage of gowns, they

may be reused during one shift for the same patient. Hang gown with outside
facing in when not in use. Discard at the end of each shift. Wash hands
thoroughly before touching anything else.
\
Apron
An apron protects the wearer and the uniform from contact with the contaminated
body fluids. Plastic aprons are used over the gown when caring for patients where
possible splashes with blood and body substances may occur.
Need not be used if the gown is of impermeable material.
Selecting the apron
 Select water repellent, plastic aprons, which are disposable

 If disposable ones are not available then reusable plastic aprons can be used.

 Size: long enough to protect the uniform and the gown but should not touch the
ground. Should cover the front and sides. It should open in the back. A tie
 around the waist keeps the apron in place.

Wearing the apron

 Wash hands.

 Ensure that the sleeves are rolled above the elbows before putting on the apron.

 Wear the apron over the uniform and tie around the waist at the back.

Removing the apron

 Wash hands and dry.

 Remove, touching only the inside part of apron.

 Discard, folding the outside part in.

 Decontaminate or dispose according to the health care facility guidelines.

 Wash hands thoroughly before touching anything else.

5. GLOVES
Use gloves when there is potential exposure to blood, body fluid, excretions or
secretions.
Change gloves between patients, between tasks and procedures on the same patient,
and when they become soiled.
Remove gloves promptly after touching contaminated items and environmental
surfaces and before moving to another patient.
Selecting gloves
 Use disposable gloves that are:

 Clean/non-sterile for routine care of the infectious patients;

 Sterile for invasive procedures.

 Use heavy-duty rubber gloves for cleaning instruments, handling soiled linen
or dealing with spills of blood and body fluids. They can be washed and
reused.

 Choose gloves that fit properly.

 Check there is no puncture in gloves.

 Do not use gloves if they are torn, as punctured gloves do not provide
protection.

Wearing gloves
 Wash hands and dry them.

 Pick up the first glove by its cuff.

 Wear the first glove. Bunch the glove up and then pull it onto the hand; ease
fingers into the glove.
  Repeat for the other hand.

Removing gloves
 When removing personal protective equipment, remove gloves first

 Grasp the outside of one glove, near the cuff, with the thumb and forefinger of
the other hand. Pull the glove off, turning it inside out while pulling and
holding it in the hand that is still gloved.

 Hook the bare thumb or finger inside the remaining glove and pull it off by
 turning it inside out and over the already removed glove to prevent
contamination of the ungloved hand.

 Roll the two gloves together taking care not to contaminate the hands.

 Discard appropriately.

 Wash hands and decontaminate with 70% alcohol hand rub/solution.

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
• 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
BOOTS/SHOE COVERS
Boots/shoe covers are used to protect the wearer from splashes of blood, body fluids,
secretions and excretions.
Waterproof boots should be worn for heavily contaminated, wet flooring and floor
cleaning.
Selecting boots/shoe covers: Shoe covers should be disposable and waterproof.
Waterproof boots should be washable.
Wearing boots/shoe covers: Wear waterproof boots if needed, or wear shoe covers
over your personal shoes so as to cover your shoes adequately.
Removing boots/ shoe covers: Remove shoe covers first with gloved hands and
discard. Remove boots last, before leaving the room and disinfect. Wash hands
thoroughly.
WASTE DISPOSAL
INTRODUCTION
Biomedical waste or hospital waste is any kind
of waste containing infectious (or potentially infectious) materials generated during the
treatment of humans or animals as well as during research involving biologics. It may
also include waste associated with the generation of biomedical waste that visually
appears to be of medical or laboratory origin (e.g. packaging, unused bandages,
infusion kits etc.), as well research laboratory waste containing biomolecules or
organisms that are mainly restricted from environmental release. As detailed below,
discarded sharps are considered biomedical waste whether they are contaminated or
not, due to the possibility of being contaminated with blood and their propensity to
cause injury when not properly contained and disposed. Biomedical waste is a type of
biowaste.
 DEFINITION
Hospital waste are the waste produced in the course of health care activities
during Treating, Diagnosing, and Immunizing Human being or animals or while doing
Study/Research activities.
WHO CLASSIFICATION
Categories
1.General Waste
2.Pathological Waste
3.Sharps
4.Infectious waste
5.Chemical waste
6.Radio-active waste
SOURCES OF HOSPITAL WASTE
The sources of health-care waste can be classified as MAJOR or MINOR
according to the quantities produced.
MAJOR SOURCES
 Hospitals
 University hospital
 General hospital
 District hospital
 Other health care establishments
Emergency medical care services
  Health care centers and dispensaries
 Obstetric and maternity clinics
 Outpatient clinics
 Dialysis centers
 First aid posts
 Transfusion centers
 Military medical services
 Related laboratories and research centers
 Medical and biomedical laboratories
 Biotechnology laboratories and institutions
 Medical research centers
 Mortuary and autopsy centers
 Animal research and testing
 Blood banks and blood collection services
 Nursing homes for the elderly
MINOR SOURCES
Small health-care establishments
 Physicians' offices
 Dental clinics
 Acupuncturists
 Chiropractors
 Specialized health-care establishments and institutions with low waste generation
 Convalescent nursing homes
 Psychiatric hospitals
 Disabled persons institutions
 While minor and scattered sources may produce some health-care waste in categories
similar to hospital waste, their composition will be different.
• For example:
 they rarely produce radioactive or cytostatic waste;
 human body parts are generally not included
 sharps consist mainly of hypodermic needles
 The composition of wastes is often characteristic of the type of source. For example,
the different units within a hospital would generate waste with the following
characteristics:
 Medical wards: mainly infectious waste such as dressings, bandages, sticking
plaster, gloves, disposable medical items, used hypodermic needles and
intravenous sets, body fluids and excreta, contaminated packaging, and meal
scraps.
 Operating theatres and surgical wards: mainly anatomical waste such as
tissues, organs, foetuses, and body parts, other infectious waste, and sharps.
HEALTH HAZARDS OF HOSPITAL WASTE.
Waste is hazardous if it exhibits one or more of the following four characteristics:
● IGNITABILITY: waste capable of burning or causing fire. They can irritate the skin,
eyes, and lungs and may give harmful vapors. Examples include gasoline, industrial
alcohols, paint, furniture polish.
• CORROSIVITY: waste capable of corroding metals and burning human tissues on
contact. E.g. alkaline cleaners, some chlorides, fluorides, and acids.
REACTIVITY: materials capable of reacting with other chemicals in air or water,
causing an explosion or release of poisonous fumes. E.g. peroxides, isocyanides,
cyanides, and chlorine.
● TOXICITY: toxic wastes are harmful or fatal when ingested or absorbed. E.g. heavy
metals such as lead and mercury, and pesticide wastes.

SEGREGATION AND DISPOSAL OF BIOMEDICAL WASTE

OPTION WASTE CATEGORIES TREATMENT AND
S DISPOSALS
Category Human anatomical waste (human tissues, Incineration/deep
1 organs, body parts). burial

Category Animal waste (animal tissues, organs, body Incineration/deep

2 parts carcasses, bleeding parts, fluid, blood, burial
and experimental animals used in research,
waste generated by veterinary hospital,
discharge from hospitals, animal houses)

Category Microbiology and biotechnology waste Local

3 (wastes from laboratory Local autoclaving/microwavi
autoclaving/microwaving/incineration ng
cultures, stocks of specimen of / Incineration
microorganisms, live or attenuated
vaccines, human and animal cell culture
used in research and infectious agents from
research and industrial laboratories, wastes
from production of biological toxins, dishes
and devices used for transfer of cultures)
Category Sharps waste (e.g. needles, syringes, Disinfection (chemical
4 scalpels, blades, and glass that may cause treatment/autoclaving/
punctures and cuts. This includes both used microwaving and
and unused sharps waste) mutilation/shredding)

Category Discarded medicines and cytotoxic drugs Incineration/

5 (wastes comprising of outdated, destruction and drug
contaminated and discarded medicines) disposal in secured
landfills

Category Solid waste (items contaminated with blood Incineration

6 and body fluids including cotton, dressings, /autoclaving/microwav
solid plaster casts, linens, beddings, other ing
material contaminated with blood)
Category Solid waste (wastes generated from Disinfection by
7 disposable items other than sharps such as chemical treatment,
tubings, catheters, intravenous sets, etc.) autoclaving/
microwaving and
mutilation/ shredding
Category Liquid waste (waste generated from Disinfection by
8 laboratory and from washing, cleaning, chemical treatment and
house-keeping and disinfecting activities) discharge into drains.

Category Incineration ash (ash from incineration of Disposal in municipal

9 any biomedical waste) landfill

Category Chemical waste (chemical used in Chemical treatment

10 production of biological, chemicals used in and discharge into
disinfection, as insecticides, etc.) drains for liquids and
secured landfill for
solids

TIPS
 Chemical treatment must be done using at least 1% hypochlorite solution or
any other equivalent chemical reagent.
 Ensure that chemical treatment guarantees disinfection.
 Mutilation/shredding must be such that unauthorized reuse should be
prevented.
 Ensure that there is no chemical pretreatment before incineration. Chlorinated
plastics are not to be incinerated.
 Deep burial shall be an option available only in towns with population less than
5 lakhs and in rural areas.
Category Type of Color and type of bag to Treatment and disposal
waste be used options

Yellow-colored Incineration or plasma

nonchlorinated plastic bags pyrolysis or
Yellow-colored deep burial
nonchlorinated plastic bags Incineration or plasma
pyrolysis or
deep burial In the absence of
above facilities, autoclaving
or microwave/ hydroclaving
followed by shredding/
mutilation/ combination of
sterilization. and shredding
Treated waste to be sent for
energy recovery
Yellow
Expired Yellow-colored Expired cytotoxic drugs and
or nonchlorinated plastic bags items contaminated with
discarde cytotoxic drugs to
d be returned back to the
 medicin manufacturer or supplier for
es incineration at temperature
>1200°C or to CBMWTF or
hazardous waste treatment,
storage, and disposal facility
for incineration at >1200°C
or encapsulation or plasma
pyrolysis at 1200°C

Chemic Yellow-colored Disposed of by incineration

al waste nonchlorinated plastic bags or plasma pyrolysis or
encapsulation in hazardous
waste treatment, storage, and
disposal facility

Chemic After resource recovery, the

Yellow al liquid chemical liquid waste shall be
waste pretreated before mixing with
other waste forms

Discard Nonchlorinated yellow Nonchlorinated chemical

ed plastic bags or suitable disinfection followed by
linen, packing material incineration or plasma
mattress pyrolysis or for energy
es recovery
bedding
s
contami
nated
with
blood or
body
fluids

Microbi Autoclave safe plastic bags Pretreat to sterilize with

ology, or containers nonchlorinated chemicals on-
biotech site as NACO or WHO
nology, (National Aids Control
and Organization or World Health
other Organization) guidelines, and
clinical thereafter for incineration
laborato
 ry waste

Red Contam Red-colored nonchlorinated Autoclaving or microwaving/

inated plastic bags or containers hydroclaving followed by
waste shredding or mutilation or
(recycla combination of sterilization
ble) and shredding Treated waste
to be sent to registered
recyclers or for energy
recovery or plastics to diesel
or fuel oil or for road making

White Waste Puncture proof, leak proof, Autoclaving or dry heat

(translucen sharps tamper proof containers sterilization followed by
t) includin shredding or mutilation or
g metals encapsulation in metal
container or cement concrete;
combination of shredding
cum autoclaving and sent for
final disposal to iron
foundries
Blue Glassw Cardboard boxes with blue- Disinfection or through
are colored marking autoclaving or microwaving
Metallic or hydroclaving and then sent
body for recycling
implant
s