Aseptic Precautions

1. It is important to restrict injections. Administer parenteral thereapy only if alternative effective oral therapy is not possible.
2. Use Sterilized needles/syringe for every injection/immunization
3. Chemical disinfection must not be used for sterilization of needles and syringes
4. Both autoclaved reusable reusable and pre-sterilized disposable needles and syringes are equally safe.

If above precautions are always strictly observed, the risk of transmission of HIV through injections and other skin piercing procedures can be greatly minimized.

Sterilization and Disinfection

Sterilization is a process of freeing an article from all living organisms including bacterial, fungal spores and viruses. The most dependable method of sterilization in health care setting is moist heat (steam) under pressure utilizing different types of autoclaves.

A high level of sterilization can be achieved instruments at a temp. of 121 oC at 15 Ibs/sq inch pressure for 15-20 minutes in specially modified pressure cooker (WHO/UNICEF type). Remember all skin and mucous membrane piercing instruments needles, lancets, scalpels, scissors etc.) and equipment coming in contact with blood and mucous membrance must be sterilized before use.

High Level Disinfection

High level of disinfection is a process of destroying all micro organism, however, some spores may survive particularly if initially present in large numbers. This can be achieved by:

Boiling

Completely immersing instruments in boiling water for 10 minutes. This is a simple and reliable method of freeing all article from most of the pathogenic microorganisms in situations where sterilization by autoclaving is not possible.

Chemical Disinfectants

Following chemicals are approved for use as ‘hospital disinfectants’ in recommended dilution to achieve high level of disinfection. Commonly used disinfectants are:

1. Ethanol – 70% (700 gm/litre)
2. Glutaradehyde? – 2% (Available commercially as Code:)
3. Household bleach?? – 1% solution (Available in market as 3.5% ready made solution Polar. Dilute it with 2.5 volumes of tap water to give 1% solution)
4. Sodium Hypochlorite? – 1% solution
5. Hydrogen peroxide?? – 3% solution
6. Lysol – 2.5% solution
7. Savlon – 5.0%
8. Dettol – 4.0%

Remember

• Instruments that require sterilization or disinfection should bethoroughly cleaned before being exposed to disinfectants and the manufacturer’s instruction for use of disinfectant should followed.
• A solution of Sodium hypochlorite prepared daily is inexpensive, effective and easily available disinfectant. Concentration ranging from 0.1 to 2.0 per cent of available chlorine are effective, depending on the amount contamination.

Handling of Soiled Linen

All the linen soiled with blood/body fluid should preferably be dipped into 1% household bleach/sodium hypochlorite for half and hour before washing.

Management of parenteral and mucous membrane exposure of personnel to blood and body fluid: In case of an accidental exposure with contaminated blood or body fluids the following care should be taken:

1. Allow the accidental wound to bleed and then
2. Promptly wash the exposed surface with running tap water adequately.
3. Clean the area with soap and water.
4. In case of splashing of blood/body fluids into the eyes and silicon contact lenses, if any. Wash eyes gently with water or saline, keeping the eyes open, wash contact lenses also. Clean and disinfect the contact lenses before reuse.
5. If blood gets into the mouth, spit it out and rinse your mouth with water several times.
6. Any of the above incidences should be notified to the physician for risk assessment, treatment, referred for HIV testing and counselling. Establish the HIV status of the person with whose blood/body fluid the exposure wash caused.

Disposal of Infected Waste

In the health care setting all the potentially infected waste should be appropriately disposed off. Safaiwalas should always wear gloves and apron when handling waste.

The infected waste in Health care setting can be disposed off by:

1. Burning-Incineration is a sophisticated method of burning the waste.
2. Deep Burial with bleach or lime.