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CRRICON
Module
Synopsis
• Guidelines on Specimen Collection , Storage ,
Transport & Request for Microbiology
Testing ( Microscopy / Culture / Serology /
PCR)
• Standard work Precautions
• Biomedical Waste Management
Important questions before collecting a specimen
• Are you suspecting an Infection ?
• Which tests are your priority ?
• When to collect the specimen ?
• How to collect the specimen ?
• Am I choosing the correct container ?
• Why to send the specimens promptly, if not what I should do ? ( storage / transport)
General guidelines• Specimen should represent the disease process• Sufficient material collected • Before antimicrobial therapy• Aseptic precautions while collecting all specimens ( especially blood &
body fluids)• Avoid contamination from neighboring sites• Patients to be given proper instructions for collection ( urine , sputum etc.,)• Sterile, easy to open, leak proof, dry containers and free of disinfectants.• Avoid delay in transport to laboratory ( in that case proper cold storage )• Use of Transport media , wherever applicable• Request forms & labels….
Specimen collection & transportation are critical considerations, because any results the laboratory generates is limited by the quality of the specimen & its condition on arrival in the laboratory.
Problems in delay or inappropriate storage.
• Delay may lead to:pathogens die.contaminants overgrow.
• Blood cultures directly into incubator not refrigerator!• CSF & other body fluids straight to lab.• Urine , Blood ( for serology) - cold storage• Don't put an entire surgical specimen into formalin!
But: Send a portion to microbiology in a sterile container.
An Ideal Request Form
• Name: Age: Sex: • IP/OP No: Time: Date: • Ward: (Urgent/Routine )• Relevant clinical history:• Diagnosis :• Type of Specimen:• Investigation required:
Doctor/Staff Signature Contact No.
* Whether on antibiotic ? - if yes means Name & Duration
Label High risk Specimens
•Sputum with suspected Tuberculosis
•Feacal samples suspected with Cholera
•Serum when suspected with HIV/ HBV/HCV infections
Requirements
Blood culture
Body fluids
Urine - Voided
Urine – catheterized
Never collect from distal end of the indwelling catheter / uro bag
Culture of Foley’s catheter tip is not suitable/ reliable
Exudates / Tissues
Sputum
Throat swab
Nasal swab
IV Catheter – Central / Peripheral
Always Remember….
• The complete address of the patient along with their contact No. should be filled in the request form for the following diseases:
Dengue Chikungunya Japanese Encephalitis Typhoid Malaria Cholera Leptospira Hepatitis A Hepatitis E Influenza A H1N1
Standard Work Precautions
Set of precautions to protect Health Care
Workers (HCW) from occupational exposure to
blood borne pathogens
• Hand Hygiene
• Personal Protective wears
• Vaccination
• Safe Handling of Sharp items / waste
Effective Hand Washing
Personal Protective Equipments (PPE)
Gloves: Protect hands
Gowns/aprons: Protect skinand/or clothing
Masks and respirators: Protectmouth/nose
Respirators: Protect respiratory tractfrom airborne infectious agents
Goggles: Protect eyes
Face shields: Protect face, mouth,nose and eyes
Vaccinated: If you have received the vaccine (all 3 shots) & have developed Immunity ( antibody titre 100 IU/ML in India, 10 IU/ML in USA,virtually no risk for infection. Get Your Antibody titer estimated today
Unvaccinated: Risk from single needlestick or cut 6-30%,Depends on Viral Load Get your vaccine today if unvaccinated
Hepatitis B
Limited studies available but risk seems to be about 1.8%.
HIV
Average risk for HIV infection to develop after needlestick or cut exposure to HIV blood is 0.3%
Risk after exposure to HIV blood through splashes to eyes, mouth or nose is 0.1%
Hepatitis C
Hepatitis B Vaccination
Relative Risk of Seroconversionwith Percutaneous Injury
Source: CDC. MMWR 2001;50(RR11): 1-42
Biomedical Waste
• Bio-medical waste means any waste which is
generated during the diagnosis, treatment (or)
immunization of human beings (or) animals or
in research activities pertaining thereto or in
the production (or) testing of biological.
WasteCategory
NoWasteCategoryType Treatmentand
DisposalOptions
1 Human Anatomical Waste Incineration / deep burial
2 Animal Waste Incineration/deep burial
3 Microbiology andBiotechnological Waste
Autoclaving / microwaving /incineration
4 Waste Sharps Incineration / destructionandDisposal in secured landfills
5 Discarded Medicines &Cytotoxic drugs
Incineration / destruction andDisposal in secured landfills
Categories of waste
Courtesy: Tamilnadu Health System Project
WasteCategory
NoWasteCategoryType Treatmentand
DisposalOptions
6 Soiled wastes Incineration / deepburial
7 Solid wastesDisinfection/auto/Microwaving andmutilation/shredding
8 Liquid wastes Disinfection and dischargeInto drains
9 Incineration ash Disposal municipal landfill
10 Chemical waste Disinfection and dischargeInto drains
Categories of waste
Courtesy: Tamilnadu Health System Project
Colour coding for
bags/bins
Waste category TypeContainer
Type TreatmentatHospital
FinalDisposal
Blue15L25L50L
Waste sharpsBroken glass,Ampoules, vials & sutures
Plastic bag
1%sodiumhypochlorite
solution
autoclaving/microwaving
andmutilation/shredding
Broken needles,needles,blades,scalpels,lancet,etc
Puncture proofContainer (twin Bin system)
Red(big)50L
Solid wasteDisposable wast eitems liketubing’s,catheters,intraVenous sets, plastic salinebottles, pouche setc.,
Plastic bag1%sodiumhypochlorite
solution
autoclaving/microwaving
andmutilation/shredding
Red(small)15L25L
Microbiology andBiotechnology waste6.Soiled wasteBlood and body fluidContaminated items
Plastic bag NILIncineration/
Deep burial
Colour Coding
Colourcodingfor
bags/bins
WastecategoryType
ContainerType Treatmentat
HospitalFinal
Disposal
Yellow15L25L50L
Human wasteAnimal waste
Plastic bag NILIncineration/
Deep burial
Black15L25L
Expiry drugs,Cytotoxic drugsIncineration ashChemical waste
Plastic bag NILDisposal insecuredlandfill
Green15L25L50L
Municipal Waste Plastic bag NIL
AsundertakenBy municipalagencies
Colour Coding