EPHRAIM E IBADIN MPhil MSc BMLS AMLSCN MEDICAL MICROBIOLOGY UNIT MEDICAL LABORATORY SERVICES UNIVERSITY OF BENIN TEACHING HOSPITAL 1 OUTLINE INTRODUCTION WHAT ARE BIOLOGICAL HAZARDS ID: 1045242
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1. BIOLOGICAL HAZARDS IN THE HOSPITAL COMMUNITYEPHRAIM E IBADIN (M.Phil, MSc, BMLS, AMLSCN)MEDICAL MICROBIOLOGY UNIT, MEDICAL LABORATORY SERVICES, UNIVERSITY OF BENIN TEACHING HOSPITAL1
2. OUTLINEINTRODUCTIONWHAT ARE BIOLOGICAL HAZARDS?TYPES/EXAMPLES OF BIOLOGICAL HAZARDSRISK FACTORSSOURCES OF BIOHAZARDSPREVENTIONROUTES OF TRANSMISSION RISK GROUPSPOTENTIAL SOURCES OF EXPOSURECONTROLCONCLUSION2
3. INTRODUCTIONHealthcare workers (HCW) are potentially exposed to many occupational hazards, including physical, chemical, biological, ergonomic-related, and psychological hazards while carrying out their work (1).Exposure to biological occupational hazards or biohazards seems to be particularly prevalent in the healthcare sector (1, 2).In hospitals, infections are among the most important risks for HCW.3
4. DEFINITIONOccupational biohazards are infectious agents or hazardous biological materials that exert harmful effects on workers' health, either directly thorough infection or indirectly through damage to the working environment, and it can also include medical waste or samples of a microorganism, virus, or toxin from a biological source (3)4
5. TYPES OF BIOHAZARDSThey include:viruses, such as Coronavirus (COVID-19), Ebola and Japanese encephalitistoxins from biological sourcessporesfungibacteriaprotozoabio-active substances (1, 2, 3)5
6. RISK FACTORSVirulence: It refers to the aggressiveness or severity of the pathogen – its ability to cause damage to the host. Greater virulence does not necessarily mean greater infectivity.Infectivity: It is the ability of a pathogen to produce, transmit or establish an infection – how frequently it spreads among hosts. Infectivity of pathogens is affected by the infectious period of a disease and by the route of transmission.SurvivabilityInfectious dose (2, 3)6
7. SOURCES OF BIOHAZARDSBiomedical wastesDifferent categories of Biomedical/Biohazardous waste:Pathological waste (tissue, detached organ)laboratory wasteSharpsblood soaked cotton wool, towels or gauzepetri dishes/microbiological cultures orany contaminated laboratory ware Infected patientInfected HCW (4, 5)7
8. PREVENTIONStrict adherence to standard precautionsStandard precautions are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes (1, 3, 4).8
9. Hand HygieneSTANDARD PRECAUTIONSRespiratory etiquetteProtective WearPatient PlacementSafe injection practices & sharp managementCare of medical devicesEnvironmental hygieneWaste managementOccupational HealthLinen handling9
10. WHY IS IT OF CONCERN?Potential for Healthcare associated infection (HAI) for patients and HCWs Local infection Local outbreaks EpidemicContamination of the environmentBioterrorismPublic perception (2, 3)10
11. Healthcare Associated Infections (HAIs)Infections occurring in a patient during the process of care in a hospital or other health-care facility which was not present or incubating at the time of admission (or attendance). Includes infections acquired in the health-care facility but appearing after discharge, and also occupational infections among health-care workers of the facility (5, 6).Also referred to as “nosocomial” or “hospital-acquired infection.11
12. Healthcare Associated Infections (HAIs)…The impact of HAIsHAIs can cause:more serious illnessprolonged stay in a health-care facilitylong-term disabilitypreventable deaths additional financial burdenhigh personal costs on patients and their familiesCourtesy of WHO
13. 13
14. ROUTES OF TRANSMISSIONBiological hazards can enter the body in several ways to exert their pathogenic effects. Knowledge of this is important to help in risk assessment as well as determine protective measures14
15. Direct Contact TransmissionDirect contact transmission occurs through direct body contact with the tissues or fluids of an infected individual. Physical transfer and entry of microorganisms occurs through mucous membranes (e.g., eyes, mouth), open wounds, or abraded skin. Direct inoculation can also occur with the aid of the hands and is probably the most common and highest-risk route of pathogen transmission to patients and personnel. (2)Examples of organisms transmitted by this means include staphylococci, Enterobacteriales, multidrug-resistant (MDR) species: methicillin-resistant Staphylococcus aureus carbapenemase-producing Enterobacteriaceae, Candida spp and so on (1, 4).15
16. Direct Contact transmissionThe Hands in HAIsHands are the most common vehicle to transmit health care-associated germs.Up to 80% of all HAIs are transmitted by HCW’s hands.Courtesy of WHO
17. BLOOD BORNE PATHOGENSPathogenic organisms can be present in the blood and cause disease. In healthcare settings, acquiring a blood pathogen occurs via a percutaneous sharp injury (injury with a contaminated needle or other sharp object ).Examples of infectious agents spread through this means include Hepatitis B, C, and D viruses or Human Immunodeficiency Virus (HIV) (1, 4), 17
18. Aerosol (Airborne) TransmissionAerosol transmission encompasses the transfer of pathogens via very small particles or droplet nuclei. Aerosol particles may be inhaled by a susceptible host or deposited onto mucous membranes or environmental surfaces. This can occur from breathing, coughing, sneezing, or vocalization of an infected individual, but also during certain medical procedures (e.g., suctioning, bronchoscopy, dentistry, inhalation anesthesia). Infectious agents can be aerosolized as droplets (SARS-CoV-2, Mycobacterium tuberculosis) or may be airborne (chicken pox virus). (1, 4, 7)18
19. INGESTIONPathogens that cause gastroenteritis are gotten by consumption of food/water contaminated with food-borne pathogens or their toxins. Examples include Vibrio cholerae, Salmonella typhi, Shigella spp, Escherichia coli pathotypes. Viral food borne pathogens include rotavirus, Norwalk virus and Hepatitis A.Infection can also occur via the fecal-oral route (7, 8).19
20. RISK GROUPSRisk Group 1 (low to no individual or community risk) – Biological agents or organisms that are unlikely to cause diseases to healthy humans or animalsRisk Group 2 (moderate individual risk, low community risk) – Pathogens that are likely to cause diseases to humans or animals but have minimal potential to be serious hazards to the workers, community, or the environmentRisk Group 3 (high individual risk, low community risk) – Pathogens causing serious diseases to humans or animals that don’t typically spread from one infected individual to another, for which preventive and treatment measures may be presentRisk Group 4 (high individual and community risk) – Pathogens causing serious diseases to humans or animals that are directly or indirectly transmissible and for which preventive and treatment measures may not be available (9).20
21. RISK GROUPS WHO, 2020 21
22. RISK ASSESSMENTBiological hazard risk assessment is a process used to Identify the hazardous characteristics of a known infectious agent or materialThe activities that can result in a person’s exposure to an agent,The likelihood that such exposure will cause harm The probable effects of that harmThe information gathered from RA would therefore be helpful in assigning appropriate biosafety level and microbiological practices, safety equipment and facility safeguards. (9, 10, 11)22
23. HEIRACHY OF CONTROLS23
24. ENGINEERING/BIOENGINEERING CONTROLSVaccinesProphylactic and anti-viral medicationsVentilation systemsEngineered safe needle devicesAutomated equipmentAppropriate container for proper disposal of biohazard waste(11, 12)24
25. ADMINISTRATIVE CONTROLSPolicies and proceduresObservance of universal precautionsImmunization programmesTraining Routine practices such physical distancing, personal hygiene and other safe work proceduresSignages/appropriate biohazard labels (11, 12)25
26. PERSONAL PROTECTIVE EQUIPMENT (PPE)Types of PPE availableGlovesMasksGooglesHair coversFoot coversLab coatPPEs help protect against exposure but cannot totally prevent exposure. Good work practices in conjunction with PPEs would help minimize or reduce risks to the barest minimum (11, 12)26
27. CONCLUSIONHCWs and patients are exposed to biohazards to various degrees in the hospital setting. It is therefore imperative that HCWs are brought up to speed with standard precautions in order to minimize the risk of infection and build an aseptic environment for healthcare delivery.27
28. THE WAY FORWARDInstitutional levelNeed to have an infection prevention & control (IPC) committeeDepartmental levelNeed to have clearly defined policies and SOPs on biosafety & BiosecurityQuality Assurance Officer & Safety OfficerTrainings28
29. REFERENCESSacadura-Leite E, Mendonça-Galaio L, Shapovalova O, Pereira I, Rocha R, Sousa-Uva A: Biological Hazards for Healthcare Workers: Occupational Exposure to Vancomycin-Resistant Staphylococcus aureus as an Example of a New Challenge. Portugese Journal of Public Health 2018; 36:26-31. doi: 10.1159/000487746. .Dowlati, M., Seyedin, H., & Moslehi, S. Hospital Preparedness Measures for Biological Hazards: A Systematic Review and Meta-Synthesis. Disaster Medicine and Public Health Preparedness 2021; 15(6), 790-803. doi:10.1017/dmp.2020.132AIHS (Australian Institute of Health and Safety). (2021). The Core Body of Knowledge for Generalist OHS Professionals. 2nd Ed. Tullamarine, VIC: Safety Institute of Australia.Jones, A. (2021). Biological Hazards. In The Core Body of Knowledge for Generalist OHS Professionals. 2nd Ed. Tullamarine, VIC: Australian Institute of Health and Safety.Bianchi FB, Vimercati L, Mansi F, De Nitto S, Stefanizzi P, Rizzo LA, Fragnelli RG, Cannone ESS,De Maria L, Angela Maria Vittoria Larocca AMV, Tafuri S. Compliance with immunization and a biological risk assessment of health care workers as part of an occupational health surveillance program: The experience of a university hospital in southern Italy. American Journal of Infection Control 2020; 48: 368−37429
30. REFERENCES Association for Professionals in Infection Control and Epidemiology (APIC) (2012). The Infection Preventionist’s Guide to the Lab. Kulich PA, Taylor DA, eds. Washington, DC: APIC.APIC. 2014a. Infectious disease disasters: bioterrorism, emerging infections, and pandemics (Chapter 120). In: APIC Text of Infection Control and Epidemiology, 4th ed. Washington, DC: APIC.APIC. 2014b. Microbiology (Chapter 24). In: APIC Text of Infection Control and Epidemiology, 4th ed. Washington, DC: APICWorld Health Organization 2020. Laboratory biosafety manual. – 4th ed.Biosafety programme management. Geneva: World Health Organization; 2020 (Laboratory biosafety manual, fourth edition and associated monographs) EU-OSHA (European Agency for Safety and Health at Work). (2019). Biological agents and work-related diseases: results of a literature review, expert survey and analysis of monitoring systems. Retrieved from https://osha.europa.eu/en/publications/biologicalagents-and-work-related-diseases-results-literature-review-expert-survey-and/view .ACSQH (Australian Commission on Safety and Quality in Healthcare). (2019). Australian Guidelines for the prevention and control of infection in healthcare. NH&MRC. Retrieved From https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-preventionand-control-infection-healthcare-2019#block-views-block-file-attachments-content-block-1 . 30