MICROBIOLOGY

HAND HYGIENE AND WASTE MANAGEMENT

Hand Hygiene according to CDC means cleaning of the hands by using either handwashing
(washing hands with soap and water), antiseptic hand wash, antiseptic hand rub (alcohol-based
hand sanitizer including foam or gel), or surgical hand antisepsis.

Procedure for Hand Washing

1. Wet your hands with water.

2. Apply enough soap to cover the hands.
3. Rub hands together.
4. Rub hands together and clean in between your fingers
5. Use 1 hand to rub the back of the other hand and clean in between the fingers. Do the same
with the other hand.
6. Rub the back of your fingers against your palms
7. Rub your thumb using your other hand. Do the same with the other thumb.
8. Rub the tips of your fingers on the palm of your other hand. Do the same with other hand
9. Rinse your hands with water
10. Dry your hands completely with a disposable towel.
11. Use the disposable towel to turn off the tap

Alcohol Based Hand Rub

CDC recommends using Alcohol Based Hand Rub with 60-95% alcohol in healthcare settings.
Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in
most clinical situations due to evidence of better compliance compared to soap and water.

When using alcohol-based hand sanitizer:

• Put product on hands and rub hands together • Cover all surfaces until hands feel dry • This
should take around 20 seconds

Surgical Hand Antisepsis

Surgical site infections greatly contribute to nosocomial infections and surgical antisepsis is
crucial to decreasing its incidence. No matter what agent is used, or which scrub technique is
practiced, there is only one goal: infection prevention.
The purpose of surgical hand scrub is to: • Remove debris and transient microorganisms from
the nails, hands, and forearms • Reduce the resident microbial count to a minimum, and •
Inhibit rapid rebound growth of microorganism

Procedure
1. Remove all jewelries from both hands and arms.
2. Inspect the skin and nails.
3. Put on PPE
4. Prewash: If applying antiseptic for the first case of the day or the hands are visibly soiled.
Then use disposable nail pick and discard.
5. Rise hands, arms and dry
 6. Make sure hands are completely dry before applying antiseptic hand rub.
7. Dispense 1 foot pump (approximately 2mls) of antiseptic onto one hand
8. With the opposite had, put fingertips together and dip into the antiseptic. Work
antiseptic under the fingernails and spread the remaining over the had up to 2 or 3
inches above elbow covering all surfaces.
9. Dispense another foot pump on the other had and repeat procedure.
10. Dispense a final foot pump of the antiseptic in either palms and apply to all aspects of
both arms up to the wrist
11. Continue rubbing until it dries
12. To avoid contamination, keep hands above the elbow level ad away from scrub attire.
13. Do not shake or wave hands or use a towel to speed up drying.
14. Wait for antiseptic to dry before doing surgical gown and glove
.

ISOLATION
Isolation refers to separating sick people with a contagious disease from those who are not sick.
Hospitals use isolation for patients who have a known infectious disease that can be spread
easily to others. A person, who finds themselves ill with COVID-19, needs to isolate themselves
in a specific room away from other household members. Household members should use a
separate bedroom and even a separate bathroom if possible. It is also recommended that the ill
person should eat or be fed in their room away from other household members. Household
items such as dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items
should not be shared with the person infected with COVID-19. It is important to prohibit all
visitors and non-essential people from being in the home.

QUARANTINE

Quarantine aims to separate and restrict the movement of people who have been exposed to a
contagious disease to watch and see if they become sick. These people may have been exposed
to a disease and do not know it, or they may have the disease but do not show symptoms.
Quarantine helps to limit the spread of communicable disease.

Quarantines may be used during

•Outbreaks: When there’s a sudden rise in the number of cases of a disease.

•Epidemics: Similar to outbreaks, but generally considered larger and more widespread.
•Pandemics: Larger than epidemics, generally global in nature and affect more people.

What happens when you are quarantined?

Have your own stuff: Don’t swap unwashed “dishes, drinking glasses, cups, eating utensils,
towels or bedding with other people or pets in your home,” says the CDC.

Wash, rinse, repeat: “Hygiene is an integral part of this, even at home. Handwashing should be
your first line of defense when under quarantine,” relates Dr. Gordon. “And don’t forget to
cough or sneeze into your elbows or a tissue that you then throw away.”

Social distancing: Social distancing involves avoiding large gatherings. If you have to be around
people, keep 6 feet (2 meters) between you when possible.
Wear a cloth face mask: The CDC now recommends doing so in public, especially in places
where it’s hard to maintain at least 6 feet of distance between yourself and another person.

Staying calm: “While fear is normal, educating yourself is a great way to counterbalance your
anxiety,” says Dr. Gordon. “Stay informed from reliable sources — but not too intensely. Hyper-
fixating on the news can be just as detrimental.

Cooperating with the authorities: Following quarantines and other public health mandates like
shelter-in-place orders help slow — and stop — the spread of contagious diseases.

MANDATORY RESTRICTIONS FOR ISOLATION AND QUARANTINE

These restrictions must be followed if you are in mandatory isolation or quarantine.

- Stay home – do not leave your home or attend work, school, social events or any other public
gatherings.
- Avoid close contact with people in your household, especially seniors and people with chronic
conditions or compromised immune systems.
- Do not take public transportation like buses, taxis or ride-sharing - this is prohibited.
- Do not go outside for a walk through your neighbourhood or park. This includes children in
mandatory isolation or quarantine.
- Do not use elevators or stairwells if you live in an apartment building or highrise, you must
stay inside your unit. If your balcony is private and at least 2 metres away from your closest
neighbour's, you may go outside on the balcony.
- Get fresh air in your backyard, if you have one, but you must remain on private property not
accessible by others.
CONTACT TRACING

Contact tracing is the process of identifying persons who may have come into contact with an
infected person ("contacts") and subsequent collection of further information about these
contacts. By tracing the contacts of infected individuals, testing them for infection, isolating or
treating the infected, and tracing their contacts, public health aims to reduce infections in the
population. Diseases for which contact tracing is commonly performed include tuberculosis,
vaccine-preventable infections like measles, sexually transmitted infections (including HIV).

The goals of contact tracing are:

1)To interrupt ongoing transmission and reduce the spread of an infection
2)To alert contacts to the possibility of infection and offer preventive services or prophylactic
care
3)To offer diagnosis, counseling and treatment to already infected individuals
If the infection is treatable, to help prevent reinfection of the originally infected patient
4)To learn about the epidemiology of a disease in a particular population.

Contact tracing is broken down into three processes

1.Contact identification: Once someone is confirmed as infected with a virus, contacts are
identified by asking about the person’s activities and the activities and roles of the people
around them since onset of illness. Contacts can be anyone who has been in contact with an
infected person: family members, work colleagues, friends, or health care providers.

2.Contact listing: All persons considered to have contact with the infected person should be
listed as contacts. Efforts should be made to identify every listed contact and to inform them of
their contact status, what it means, the actions that will follow, and the importance of receiving
early care if they develop symptoms. Contacts should also be provided with information about
prevention of the disease. In some cases, quarantine or isolation is required for high risk
contacts, either at home, or in hospital.

3. Contact follow-up: Regular follow-up should be conducted with all contacts to monitor for
symptoms and test for signs of infection.

Steps in Contact Tracing

All contact tracing should be undertaken whilst respecting the individual patient's sensitivities
and needs and should not result in harm. The approach in contact tracing may vary depending
on the population involved. Refer to the Special Populations section for additional information
if required.

STEP 1. Introduce the reasons for contact tracing.

Patients should be informed about:

• Asymptomatic infection. Sexual contacts that are infected are usually asymptomatic and
unaware of their infection.
• Possible serious complications for partners if partners are not tested and treated.
• Risk of reinfection where relevant.

STEP 2. Help identify who needs to be notified

• Discuss mode of transmission and likely duration of infection.
• Trace back contacts from the relevant time periods for the particular time.

STEP 3. Explain the methods available and proceed to contact trace.

• Contacts can be notified by Patient referral or Provider referral
• Work with the patient to decide the most appropriate method for each of their contacts.

STEP 4. Notification

Public health notification requirements differ between conditions. Most laboratories will
automatically notify the public health unit when a notifiable condition is detected. Public health
notification can also be clinician initiated.

CASE CONTROL
A study that compares patients who have a disease or outcome of interest (cases) with patients
who do not have the disease or outcome (controls), and looks back retrospectively to compare
how frequently the exposure to a risk factor is present in each group to determine the
relationship between the risk factor and the disease.

Advantages
-Good for studying rare conditions or diseases
-Less time needed to conduct the study because the condition or disease has already occurred
-Lets you simultaneously look at multiple risk factors
-Useful as initial studies to establish an association
-Can answer questions that could not be answered through other study designs.
Disadvantages

-Retrospective studies have more problems with data quality because they rely on memory and
people with a condition will be more motivated to recall risk factors (also called recall bias).
-Not good for evaluating diagnostic tests because it’s already clear that the cases have the
condition and the controls do not
-It can be difficult to find a suitable control group.

NOTIFICATION

A notifiable disease is any disease required by law to be notified to the government or other
health authority. Diseases to be notified to WHO are outlined in the International Health
Regulations but most countries have their own list of nationally notifiable diseases. Making a
disease legally ‘notifiable’ by doctors and health professionals allows for intervention to control
the spread of highly infectious diseases such as influenza, poliomyelitis or yellow fever. In less
infectious conditions it improves information about the burden and distribution of disease.

ROLES OF CLINICIANS IN DISEASE NOTIFICATION

The roles of clinicians in ensuring a functional and responsive disease surveillance and
notification system in Nigeria are outlined as follows:

-Detection of suspected cases of notifiable diseases for laboratory confirmation using the
epidemiological surveillance standard case definition and differential diagnosis as stipulated in
the national technical guideline.
World Health Organization and Federal Ministry of Health recommended surveillance case
definition for immediate reporting of selected notifiable diseases.

-Immediate reporting of detected cases to designated local public health surveillance officers
(LGA DSNO) for investigation including the collection of specimen for laboratory analysis.

-Provide support to designated LGA surveillance officers during case investigation to ensure
adequate samples are collected from the reported cases to ensure accurate laboratory analysis.
-Case management using the recommended treatment protocol especially as specified in the
national technical guideline.

LIST OF NOTIFIABLE DISEASES IN NIGERIA

Here is the comprehensive list of notifiable diseases in Nigeria:

Cholera Diphtheria Leprosy Meningococcal Meningitis Pertussis

(Whooping cough) Tetanus Tuberculosis Typhoid fever

Acquired Immunodeficiency Syndrome Dengue fever

INFECTIUOUS WASTE

The World Health Organization’s (WHO) definition of infectious waste is:

“Waste contaminated with blood and its by-products, cultures and stocks of infectious agents,
waste from patients in isolation wards, discarded diagnostic samples containing blood and body
fluids, and contaminated materials (swabs and bandages) and equipment (such as disposable
medical devices.

WASTE MANAGEMENT
Waste management (or waste disposal) includes the processes and actions required to manage waste
from its inception to its final disposal. This includes the processes of

a. Collection and segregation b. Transport c. Treatment d. Disposal of waste e. Monitoring and

regulation of the waste management process

EFFECT OF INFECTED MATERIALS

The effect of infected materials on the health of humans generally leads to infection which in
turn leads to degenerative health and may eventually lead to the death of the person.

The infectious cycle caused by these infected materials is as follows;

1. The presence of an infectious agent that is capable of invading and multiplying within a
human host.
2. An environment for the infectious agent that functions as a reservoir, allowing it to
survive and, perhaps, to multiply.
3. A mechanism for the agent to escape from the reservoir.
4. A mode of transmission from the reservoir to a human host.
5. A means for the agent to invade, penetrate, or enter a human host.
6. A human host that is susceptible to infection by the agent.

The absence of any one of these factors will interrupt the infectious process and human disease
will not ensue.

METHODS OF DISPOSAL
General steps for safe disposal:

1. Wearing protective equipment.

2. Proper cleaning procedures for contaminated surfaces.
3. Proper sanitization or disposal.

Colour description for bagging day to day waste

 Orange bag: infectious or anatomical waste which requires incineration

 Yellow bag: with black stripes- continence pads and other waste produced from human
hygiene(urine, faeces, sputum, tears, nasal secretions, vomit). Disposed equipment that does
not pose a risk of infection.
 Purple: Cytotoxic and cytostatic waste (waste which requires treatment to be `rendered safe`.
 Black: Domestic waste for landfill
 White: Amalgam waste for recovery (includes extracted teeth with amalgam present and
cages from suction if amalgam was removed.
 Red: Healthcare waste for special recovery e.g X-ray processing chemicals.
 Sharp waste : Sharps are items that could cause cuts or puncture wounds- including
needles, syringes with needles attached, broken glass ampoules, scalpels and other blades or
infusion.

SAFETY MEASURES WHILE DISPOSING WASTE MATERIALS

Proper sanitation or disposal

There are certain procedures for moving, removing, or destroying infectious materials.

Consider all stages: from storage, through handling and bagging, to transportation and
laundering.

1. sterilizing equipment of infectious waste

2. Minimize contact, i.e. handle materials as little as possible and transfer them via routes
that minimize exposure to others.
3. Discard materials into a suitable container or bag. It must conform to the required
standards (e.g. UN approved).
4. Use bags that are marked or coloured for infectious waste. This includes orange or
yellow bags (or signs), and text or symbols indicating the bag contains hazardous waste
for treatment or incineration.
5. Transfer non-disposable infectious materials safely to the sterilization department for
decontamination. You must adhere to the local policy for cleaning the equipment.
6. Always use puncture-resistant containers sharps, as they will not leak.
7. Use pierce-proof waste containers and close them in between use for safety.
8. Never fill a bag or container more than ¾ full.
9. Never over fill waste receptacles.
10. Remove waste in accordance with local clinical waste disposal policy; it may be collected
by the relevant authorities, removed by an infection control team, or incinerated.
 DOS AND DON`T WHEN HANDLING WASTE

Don`t

1. Throw bags
2. Carry close to body
3. Empty one bin to another
4. Attempt to retrieve items from waste
5. Leave waste areas unsecured
6. Overfill bags or container

Always
1. Apply standard infection control precautions
2. Wear personal protective equipment (PPE)
3. Provide patients with a waste receptacle
4. Dispose waste immediately at point of use
5. Label and secure correctly
6. Give information to patients/caregivers on appropriate waste disposal
STORAGE OF WASTE

Within the clinical area:

1. Solid sided, foot operated bin 2. Bags not more than three-quarters full
3 Segregation of waste streams 4. Tied securely
5Bins kept clean inside and out 6 Not left in corridors or public spaces

After removal from clinical area:

1. Securely away from public access
2. Safe from pests and animals
3. In locked wheeled bins
4. Away from other items
5. In an area where hand hygiene facilities are close by

DISPOSAL OF SPECIMEN

All Body fluids are potential carriers of pathogens and other organisms that can transmit
infections. When body fluids are collected for medical investigations they are referred to as
specimens which includes a variety of substances like blood, urine, drainage from cuts, vomit,
feces, nasal discharge, semen, and saliva. There is a risk of infection by coming in direct contact
with these specimens. The risk is higher if the fluids come into contact with a break in the skin
or through penetrable contact such as with a needle.

How to Dispose Of Blood And Body Fluids

Wear Protective Gloves

Face Protection
Flush Body Fluids down the Toilet
Using a Bedpan Washer

FUNCTIONS OF THE INFECTION CONTROL UNIT IN THE HOSPITAL

The infection prevention team plays a crucial role in minimizing risk to patients and staff in
everyhealthcare organization. This team may include: infection preventionists, physicians,
nursing staff, quality assurance personnel as well as microbiologists or epidemiologists (Figure
1). This team is not only part of the day-to-day quality and safety operations in a facility, but a
crucial part of the design team.

ORGANIZATION OF AN INTERDISCIPLINARY INFECTION PREVENTION TEAM

CORE TEAM MEMBERS RESPONSIBILITIES

Infection preventionist  Coordinate the development of a comprehensive

plan and implement proactive strategies to
reduce outbreak of infection

 Collect, analyze and interpret data on the

occurrence of infections
  Teach and monitor infection prevention and
control policies and procedures

Infection control doctors / nurses  Assess the effectiveness of policies

 Recommend changes based on clinical

judgments and observation

 Audit, survey and report incidents

Environmental Services (EVS) Personnel  Clean hospital floors, surfaces and furnishings

 Mix appropriate quantities of cleaning liquids

and chemicals in accordance with safety
regulations

 Distribute clean linen and hospital surgical gowns

to appropriate floors

Quality control personnel  Plan and outline realistic goals for infection
prevention and quality control

 Conduct surveillance and monitoring of cleaning

practices

 Incorporate surveillance systems or protocols

Microbiologists/ Epidemiologists  Conduct a culture work up to understand the

Epidemiology of HAIs and pathogen trend

 Manage antimicrobial stewardship initiatives

Capital planning personnel  Ensure building design, construction and surfaces

help to minimize HAIs

 Engineer airflow to minimize migration and

settling of microbes on surfaces

HOW THE INFECTION CONTROL UNIT PREVENT AND CONTROL INFECTION

PLANNING
Successful prevention and control of infection requires careful planning. The Infection Control
Committee is actively involved with the planning and implementation of new procedures that
pose a potential infection control risk. 

Its role in the planning process is to examine the proposal, identify potential areas of concern,
and recommend a course of action that provides the best method of infection control.

MONITORING
 The Infection Control Committee also monitors infectious processes within the healthcare
facility. They track nosocomial infections and incidents that have the potential to cause
infections. They review infection control statistics from the facility in an effort to minimize risk,
identify problem areas, and implement corrective actions

When infections do occur, the committee undertakes epidemiological investigations to

determine the cause of the problem and recommends the necessary education or changes in
protocols

Functions of infection control team:

 Detects and investigates hospital acquired infections
 Investigation of environmental problems related to hospital infections
 Detects community acquired infections in the hospital and refers them to the
appropriate authority follow-up.
 Prompts initiation by physicians of hospitals infection report
 Take-up necessary follow-up measures of NCI cases after discharge including
periodic laboratory monitoring
 Assists in the development and review of infection control procedures to be
forwarded to the central committee annually
 Monitoring of hospital policy compliance on isolation procedures
 Development and implementation of employees in service orientation
program related to infection control
 Monitoring the effectiveness of infection control program
 Organizing employees health programs
 Guiding and monitoring of hospital infection through the cleaning company,
catering agency, water supply department and other environmental agencies.

CHALLENGES FACED BY INFECTION CONTROL UNIT IN THE HOSPITAL

 Poor healthcare funding

 Inadequate diagnostic capacity
 Lack of infection control awareness
 Poor waste segregation and disposal
Inadequate sanitation protocols

STANDARD PRECAUTIONARY MEASURES

 Standard Precautionary measures are the minimum infection prevention practices that
apply to all patient care, regardless of suspected or confirmed infection status of the patient, in
any setting where health care is delivered. These practices are designed to protect and prevent
spreading of infection among patients. Standard Precautions include —
1. Hand hygiene.
2. Use of personal protective equipment (e.g., gloves, masks, eyewear).
3. Respiratory hygiene / cough etiquette.
4. Sharps safety (engineering and work practice controls).
5. Safe injection practices (i.e., aseptic technique for parenteral medications).
6. Sterile instruments and devices.
7. Clean and disinfected environmental surfaces.
Each element of Standard Precautions is described below. Education and training are critical
elements of Standard Precautions, because they help to make appropriate decisions and
comply with recommended practices.
Hand Hygiene
Hand hygiene is the most important measure to prevent the spread of infections among
patients and health workers. Education and training programs should thoroughly address
indications and techniques for hand hygiene practices before performing routine and oral
surgical procedures.
For routine examinations and nonsurgical procedures, use water and plain soap (hand washing)
or antimicrobial soap (hand antisepsis) specific for health care settings or use an alcohol-based
hand rub. Although alcohol-based hand rubs are effective for hand hygiene in health care
settings, soap and water should be used when hands are visibly soiled (e.g., dirt, blood, body
fluids). For surgical procedures,1 perform a surgical hand scrub before putting on sterile
surgeon’s gloves. For all types of hand hygiene products, follow the product manufacturer’s
label for instructions. 
Personal Protective Equipment
Personal protective equipment (PPE) refers to wearable equipment that is designed to
protect us from exposure to or contact with infectious agents. PPE that is appropriate for
various types of patient interactions and effectively covers personal clothing and skin likely to
be soiled with blood, saliva, or other potentially infectious materials (OPIM) should be available.
These include gloves, face masks, protective eye wear, face shields, and protective clothing
(e.g., reusable or disposable gown, jacket, laboratory coat). Examples of appropriate use of PPE
for adherence to Standard Precautions include—
Use of Gloves

Use of gloves in situations involving possible contact with blood or body fluids, mucous
membranes, non-intact skin (e.g., exposed skin that is chapped, abraded, or with dermatitis)

Gloves should be worn when a health care worker has contact with any patient’s secretions or
excretions and must be discarded after each patient care contact.

Change gloves 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.
Change if a perforation or puncture is suspected; and Appropriate for use, fit for purpose and
well-fitting to avoid excessive sweating and interference with dexterity.

Use of Gowns and Aprons

Wear an apron or gown to protect skin and prevent soiling of clothing during procedures and
patient care activities that are likely to generate splashing or sprays of blood, body fluids,
secretions or excretions, or cause soiling of clothing.
Select a gown or apron (i.e., long or short sleeves) that is appropriate for the activity and the
amount of fluid likely to be encountered. If an apron is used, staff should ensure they are “bare-
below-the-elbows”.
Remove the used gown as promptly as possible and roll it up carefully and discard
appropriately.
Perform hand hygiene immediately after removal.
Healthcare Practitioners should be trained to select and put on appropriate PPE and remove
PPE so that the chance for skin or clothing contamination is reduced. Hand hygiene is always
the final step after removing and disposing of PPE. Training should also stress preventing
further spread of contamination while wearing PPE by:
 Keeping hands away from face.
 Limiting surfaces touched.
 Removing PPE when leaving work areas.
 Performing hand hygiene.
Steps for Donning and Doffing Personal Protection Equipment (PPE)
DONNING (putting on) PPE DOFFING (taking off) PPE
- Perform hand hygiene - Remove Shoe covers
- Put on shoe covers (If applicable) - Remove gown and gloves together
- Put on gown - Perform hand hygiene
- Put on mask/respirator - Remove eye protection
- Put on eye protection - Remove mask/respirator
- Put on gloves - Perform hand hygiene

Respiratory Hygiene/Cough Etiquette

Respiratory hygiene/cough etiquette infection prevention measures are designed to limit the
transmission of respiratory pathogens spread by droplet or airborne routes. The strategies
target primarily patients and individuals accompanying patients to the hospital who might have
undiagnosed transmissible respiratory infections, but also apply to anyone with signs of illness
including cough, congestion, runny nose, or increased production of respiratory secretions.
Use of mouth, nose, and eye protection during procedures that are likely to generate splashes
or sprays of blood or other body fluids.
When the health care provider is involved in an activity in which body fluids may be sprayed or
splashed, appropriate barriers must be used. If a splash to the face may occur, goggles and
facemask are warranted.
Wear a surgical or procedure mask and eye protection (eye visor, goggles) or 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.

Sharps Safety
Most percutaneous injuries (e.g., needlestick, cut with a sharp object) among Healthcare
practitioners involve burs, needles, and other sharp instruments. Implementation of the
Bloodborne Pathogens Standard has helped to protect health workers from blood exposure and
sharps injuries. However, sharps injuries continue to occur and pose the risk of blood borne
pathogen transmission to health workers and patients. Most exposures in hospital are
preventable; therefore, each practice should have policies and procedures available addressing
sharps safety. Healthcare practitioners should be aware of the risk of injury whenever sharps
are exposed. When using or working around sharp devices, Health care practitioners should
take precautions while using sharps, during cleanup, and during disposal.
Engineering and work-practice controls are the primary methods to reduce exposures to blood
from sharp instruments and needles. Whenever possible, engineering controls should be used
as the primary method to reduce exposures to blood borne pathogens. Engineering controls
remove or isolate a hazard in the workplace and are frequently technology-based (e.g., self-
sheathing anesthetic needles, safety scalpels, and needleless IV ports). Employers should
involve health workers who are directly responsible for patient care (e.g., Medical officers,
Nurses, hygienists, nursing assistants) in identifying, evaluating and selecting devices with
engineered safety features at least annually and as they become available. Other examples of
engineering controls include sharps containers and needle recapping devices. Work-practice
controls are behavior-based and are intended to reduce the risk of blood exposure by changing
the way health practitioners perform tasks, such as using a one-handed scoop technique for
recapping needles between uses and before disposal. Other work-practice controls include not
bending or breaking needles before disposal, not passing a syringe with an unsheathed needle
by hand, removing burs before disassembling the hand-piece from the dental unit, and using
instruments in place of fingers for tissue retraction or palpation during suturing and
administration of anesthesia.
All used disposable syringes and needles, scalpel blades, and other sharp items should be
placed in appropriate puncture-resistant containers located close to the area where they are
used. Sharps containers should be disposed of according to state and local regulated medical
waste rules.
Safe Injection Practices
Safe injection practices are intended to prevent transmission of infectious diseases between
one patient and another, or between a patient and Health workers during preparation
and administration of parenteral (e.g., intravenous or intramuscular injection) medications. Safe
injection practices are a set of measures Health workers should follow to perform injections in
the safest possible manner for the protection of patients. Healthcare practitioners most
frequently handle parenteral medications when administering local anesthesia, during which
needles and cartridges containing local anesthetics are used for one patient. Unsafe practices
that have led to patient harm include 1) use of a single syringe — with or without the same
needle — to administer medication to multiple patients. 2) reinsertion of a
used syringe — with or without the same needle — into a medication vial or solution container
(e.g., saline bag) to obtain additional medication for a single patient and reusing that vial or
solution container for subsequent patients. 3) preparation of medications
in close proximity to contaminated supplies or equipment.

Sterilization and Disinfection of Patient-Care Items and Devices

Instrument processing requires multiple steps using specialized equipment. Each practice
should have policies and procedures in place for containing, transporting, and handling
instruments and equipment that may be contaminated with blood or body fluids.
Manufacturer’s instructions for reprocessing reusable instruments and equipment should be
readily available. Most single-use devices are labeled by the manufacturer for only a single use
and do not have reprocessing instructions. Use single-use devices for one patient only and
dispose of appropriately.
Cleaning, disinfection and sterilization of instruments and equipment should be assigned to
healthcare with training in the required reprocessing steps to ensure reprocessing results in a
device that can be safely used for patient care. Training should also include the appropriate use
of PPE necessary for safe handling of contaminated equipment.
Patient-care items (e.g., surgical instruments, devices, and equipment) are categorized as
critical, semi critical, or noncritical, depending on the potential risk for infection associated with
their intended use.