Clinical laboratory

CMT 04211
Session 1: Basic concepts of Infection Prevention
and Control in preventing infections at health
care settings
Definitions
• Infection Prevention and Control- is a practical, evidence-based
approach preventing patients and health workers from being harmed
by avoidable infections.
-Effective IPC requires constant action at all levels of the health system,
including policymakers, facility managers, health workers and those
who access health services.
-Defective IPC causes harm and can kill. Without effective IPC it is
impossible to achieve quality health care delivery.
• Healthcare-Acquired Infections ( HAIs ) or Healthcare-
Associated Infections(HCAIs): Are infections that you get
while receiving treatment at a healthcare facility, like a
hospital, or from a healthcare professional, like a doctor or
nurse
OR
Are infections that patients can get in a healthcare facility while
receiving medical care.
• Standard precaution : 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
-These measures are to be used when providing care to all individuals,
whether or not they appear infectious or symptomatic
OR
Standard precautions : Are the work practices required to achieve a
basic level of infection prevention and control
OR
Standard precautions: Are the minimum infection prevention and
control practices that must be used at all times for all patients in all
situations
 Objectives of IPC

• To protect patients/clients from HAI

• To protect HCW from occupational infections
• To protect communities from infectious diseases
• To prevent the envinroment from pollution
Major types of health care acquired infections

i. catheter-associated urinary tract infections

ii. central line-associated bloodstream infections
iii. surgical site infections
iv. ventilator-associated pneumonia
v. hospital-acquired pneumonia
vi. Clostridium difficile infections.
Risk factors for healthcare
acquired infections
• Anyone getting medical care is at some risk for an HAI; however, some
people are at higher risk than others, including the following:

Very young people – premature babies and very sick children

Very old people – the frail and the elderly
People with certain medical conditions – such as diabetes
People with weakened immune systems – from disease, or because
they are getting treatments that weaken their immune system. Cancer
treatments (like chemotherapy or radiation) or steroids are
treatments that can weaken the immune system.
There are other risk factors that may increase the risk of acquiring an
HAI, these include:
• Increased length of stay – a long hospital stay can increase your risk of
HAI, for example, if you are admitted to hospital for complex or
multiple illnesses
• Surgical procedures – the length and type of surgery can increase the
risk
• Hand hygiene techniques – inadequate hand hygiene practices by
hospital staff and patients may increase your risk
• Invasive procedures – some procedures that bypass the body’s
normal protective layer, the skin, can introduce infection into the
body – for example, insertion of urinary catheters, IV cannulas,
respiratory equipment and drain tubes
• Non-intact skin – wounds, incisions (surgical cuts), burns and ulcers
are more prone to infection than intact skin.
• High-risk patient care areas – some patient care areas are more likely
to have infections, such as hospital intensive care units.
• Overuse or improper use of antibiotics
Components of standard precautions in IPC
a. Hand hygiene
• Hand hygiene is a major component of standard precautions and
one of the most effective methods to prevent transmission of
pathogens associated with healthcare
• Perform hand hygiene by means of hand rubbing or hand washing

- Hand washing (40–60 sec): wet hands and apply soap; rub all
surfaces; rinse hands and dry thoroughly with a single use towel;
use towel to turn off faucet
- Hand rubbing (20–30 sec): apply enough product to cover all areas
of the hands; rub hands until dry
• Perform hand washing with soap and water if hands are visibly soiled,
or exposure to spore-forming organisms is proven or strongly
suspected, or after using the restroom. Otherwise, if resources
permit, perform hand rubbing with an alcohol-based preparation

• Ensure availability of hand-washing facilities with clean running water

• Ensure availability of hand hygiene products (clean water, soap, single

use clean towels, alcohol-based hand rub)

• Alcohol-based hand rubs should ideally be available at the point of

care
 When to wash hands
Before and after any direct patient contact and between patients,
whether or not gloves are worn
Immediately after gloves are removed
Before handling an invasive device
After touching blood, body fluids, secretions, excre-tions, non-intact
skin, and contaminated items, even if gloves are worn
During patient care, when moving from a contami-nated to a clean
body site of the patient
 After contact with inanimate objects in the immediate vicinity of the
patient.
b. Personal protective equipment (PPE)
• Personal protective equipment (PPE) refers to wearable equipment
that is designed to protect a staff from exposure to or contact with
infectious agents
• ASSESS THE RISK of exposure to body substances or contaminated
surfaces BEFORE any health-care activity. Make this a routine!
• Select PPE based on the assessment of risk
• 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 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) or OPIM.
• Use of protective clothing to protect skin and clothing during
procedures or activities where contact with blood or body fluids is
anticipated.(lab coat, apron,gown)
• Use of mouth, nose, and eye protection during procedures that are
likely to generate splashes or sprays of blood or other body
fluids(googles, mask)
c. Handling sharps(use of sharps)
Are concerned with reducing and eliminating the number of ‘sharps’
related injuries which occur within healthcare
Its basic guidance is:
• avoid unnecessary use of sharps
• if use of medical sharps cannot be avoided, source and use a ‘safer
sharp’ device;
• if a safer sharp device is not available then safe procedures for
working with and disposal must be in place eg sticky mats, sharps
bins, safety procedures and training.
• Sharps handling must be assessed, kept to a minimum and
eliminated, if possible, with the use of approved safety devices.
• manufacturers’ instructions for safe use and disposal must be
followed
• needles must not be re-sheathed/recapped or disassembled after use
• sharps must not be passed directly hand to hand
• used sharps must be discarded at the point of use by the person
generating the waste
• always dispose of needles and syringes as 1 unit
• if a safety device is being used safety mechanisms must be deployed
before disposal.
d. Waste disposal
• Clinical waste means waste from a healthcare activity (including
veterinary healthcare) that – contains viable micro-organisms or their
toxins which are known or reliably believed to cause disease in
humans or other living organisms
• contains or is contaminated with a medicine that contains a
biologically active pharmaceutical agent, or
• is a sharp, or a body fluid or other biological material (including
human and animal tissue) containing or contaminated with a
dangerous substance
• Offensive waste (non infectious) and Hazardous waste(infectious
waste)
Safe waste disposal at care area level:
Always dispose of waste:
• immediately and as close to the point of use as possible; and
• into the correct segregated colour coded UN 3291 approved waste bag or
container (rigid container or sharps box if sharp)
• liquid waste, eg blood must be rendered safe by adding a polymer gel or
compound before placing in an orange lidded leak proof bin
• waste bags must be no more than 3/4 full and no more than the UN approved
weight; and use a ratchet tag/or tape (for healthcare waste bags only) using a
‘swan neck’ to close.
• store all waste in a designated, safe, lockable area while awaiting uplift. Uplift
schedules must be acceptable to the care area and there should be no build-
up of waste receptacles.
• local guidance on management of waste at care level, eg domiciliary settings
should be followed.
Sharps containers (for safety devices)
Sharps containers must:
• have a handle (small community boxes do not require a handle) and
temporary closure mechanism, employed when box is not in use
• be disposed of when the manufacturers’ fill line is reached
• be labelled with point of origin and date of assembly and disposal.
Where re-usable sharps containers are used, organisations must have
a protocol in place to assure themselves of safe use and reprocessing.
e. Patient care equipment
• Care equipment is easily contaminated with blood, other body fluids, secretions,
excretions and infectious agents. Consequently, it is easy to transfer infectious agents
from communal care equipment during care delivery.
Care equipment is classified as either:
• single use: equipment which is used once on a single patient then discarded. This
equipment must never be re-used. The packaging will carry the symbol of the number
two in a circle with a diagonal cross
• single patient use: equipment which can be reused on the same patient and may require
decontamination in-between use such as nebuliser masks
• reusable invasive equipment: used once then decontaminated, eg surgical instruments
• reusable non-invasive equipment: (often referred to as communal equipment) – reused
on more than one patient following decontamination between each use, eg commode,
patient transfer trolley.
• NB Needles and syringes are single use devices, they should never be used more than
once or reused to draw up additional medication. Never administer medications from a
single-dose vial or intravenous (IV) bag to multiple patients.
Before using any sterile equipment check that:
• the packaging is intact
• there are no obvious signs of packaging contamination
• the expiry date remains valid
• any sterility indicators are consistent with the process being completed successfully
Decontamination of reusable non-invasive care equipment must be undertaken:
• between each use/between patients
• after blood and/or body fluid contamination
• at regular predefined intervals as part of an equipment cleaning protocol
• before inspection, servicing or repair.
• If providing domiciliary care, equipment should be transported safely and
decontaminated as above before leaving the patient’s home.
• Always adhere to Control of Substances Hazardous to Health (COSHH) risk
assessments and manufacturers’ guidance for use and decontamination of all care
equipment.
• all reusable non-invasive care equipment must be decontaminated
between patients/clients using either approved detergent wipes or
detergent solution, in line with manufacturers’ instructions, before
being stored clean and dry.
• decontamination protocols must include responsibility for; frequency
of; and method of environmental decontamination
• an equipment decontamination status certificate will be required if
any item of equipment is being sent to a third party, eg for inspection,
servicing or repair
• guidance should be sought from the infection, prevention and control
team prior to procuring, trialling or lending any reusable non-invasive
equipment
• medical devices and other care equipment must have evidence of
planned preventative maintenance programmes.
 Organisms Responsible for
different types of HCAIs
• Acinetobacter
• Burkholderia cepacia
• C. difficile
• Enterobacteriaceae (carbapenem-resistant)
• Gram-negative bacteria
• Klebsiella
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Norovirus
• Pseudomonas aeruginosa
• Staph. Aureus
• TB
• Vancomycin-intermediate Staph. Aureus
• Vancomycin-resistant Staph. Aureus
• Vancomycin-resistant Enterococci
Session 2: Hand hygiene in preventing and
controlling infections
Definition
Hand hygiene is a way of cleaning one's hands that substantially
reduces potential pathogens (harmful microorganisms) on the hand
OR
Hand hygiene is considered a primary measure for reducing the risk
of transmitting infection among patients and health care personnel
• Effective hand hygiene kills or removes transient bacteria on the
skin by the following two methods:
• Use of a 70% to 90% alcohol-based hand rub (ABHR) is the
preferred method (when hands are not visibly soiled) for cleaning
hands
• Hand washing with liquid soap and running water must be
performed when hands are visibly soiled.
 Types of hand hygiene
techniques
i. Routine Hand Washing with Liquid Soap and Running Water

Every HCW should wash their hands:

• Immediately on arrival at work and before leaving work
• After using the toilet
• Before and after each patient contact
• Before and after donning and doffing gloves
• Before preparing, handling, serving, or eating food; before
feeding a patient
• Before and after any clinical procedure
• Whenever there is a chance of contamination such as:
- Touching blood, bodily fluids, secretions, excretions, and exudates from
wounds
- Contact with items known or considered likely to be contaminated with
blood, bodily fluids, secretions, or excretions (e.g., bed pans, urinals,
wound dressings) whether or not gloves are worn
- Attending to children’s needs (after changing a diaper, helping them use
a toilet, feeding, breastfeeding,) and after personal body functions such as
using the toilet, wiping or blowing one’s nose)
- Between all procedures done on the same patient where soiling of hands
is likely to avoid cross-contamination of body sites

*Ensure that all patients and family members are educated in proper
hand washing.
ii/. Hand Washing with Antiseptic and Running Water
This procedure removes transient microorganisms and dirt and kills or
inhibits the growth of resident microorganisms. It also may reduce
the risk of infections in high-risk situations such as:

• Where there is heavy microbial contamination before performing

invasive procedures, (e.g., placement and care of intravascular
devices, indwelling urinary catheters)
• Before contact with patients who have immune defects, damage to
the
integumentary system (e.g., burns, wounds), and percutaneous
implanted devices
• Before and after direct contact with patients who have
antimicrobial-resistant organisms
*Recommended antiseptic agents: Povidone-iodine 7.5% surgical
scrub or chlorhexidine 5% surgical scrub (undiluted)
iii/ Antiseptic (Alcohol) Hand Rub
• Kills or inhibits the growth of most transient and resident microorganisms,
but does not remove organic matter
• Can be used when hand washing with soap and running water is not
possible, as long as hands are not visibly soiled with dirt, blood, or other
organic material
• Standard operating procedure for performing antiseptic hand rub is the
same as normal hand washing
- The use of an antiseptic hand rub is more effective in killing transient and
resident flora than hand washing with antimicrobial agents or plain soap
and water
- It is quick and convenient to perform and gives a greater initial reduction in
hand flora

*Note: Because antiseptic hand rubs do not remove soil or organic matter,
hands that are visibly soiled or contaminated with blood or bodily fluids
should be washed with soap and running water first.
iv/. Surgical Hand Hygiene
This procedure involves hand washing with running water and soap
and hand rubbing with ABHR and friction.

The purposes of surgical hand hygiene are to prevent:

• Wound contamination by microorganisms from hands and arms of
surgeons and assistants
• Growth of microorganisms (rubbing with antiseptic before
beginning surgical procedures)
 Indications for hand hygiene
Before and after any direct patient contact and between patients,
whether or not gloves are worn
Immediately after gloves are removed
Before handling an invasive device
After touching blood, body fluids, secretions, excre-tions, non-intact
skin, and contaminated items, even if gloves are worn
During patient care, when moving from a contami-nated to a clean
body site of the patient
 After contact with inanimate objects in the immediate vicinity of the
patient.
 Soaps and antiseptic/antimicrobial
agents for hand washing
• Plain liquid soap
• Alcohol rinses
• Alcohol foams
• Alcohol wipes
• Alcohol towelettes
• Germicidal hand rinse (Hibistat®)
Antiseptic/ antimicrobial agents:
• Chlorhexidine gluconate scrub strengths: 2% aqueous foam or 4%
liquid preparation
• Povidone-iodine scrub strengths: 10%, 7.5%, 2%, 0.5%
Routine hand washing with soap & water
according to SOP
1) Turn on tap
2) Wet hands thoroughly under running water to at least 4 inches
above the wrist
3) Soap hands adequately
4) Vigorously rub together all surfaces of lathered hands
5) Rub hands vigorously back and front, in between fingers, up to and
including the wrist, followed by thorough rinsing under running
water; do this for 10–15 seconds
6) Dry hands from tip of fingers to wrist with paper towel; if paper
towels are not available, shake off excess water and allow hands to
air-dry
7) Use the same paper towel to turn off tap if tap not elbow
controlled
 Hand rub according to SOP

• SOP for performing antiseptic hand rub is the same as normal hand
washing
Hand antisepsis according to SOP
 Surgical hand washing
according to SOP
• Surgical Handrubbing Technique
- Handwash with soap and water on arrival to OR, after having donned
theatre clothing (cap/hat/bonnet and mask).
- Use an alcohol-based handrub (ABHR) product for surgical hand
preparation, by carefully following the technique illustrated in
Images 1 to 17, before every surgical procedure.
- If any residual talc or biological fluids are present when gloves are
removed following the operation, handwash with soap and water.
Session 3: personal protection in preventing and controlling infections
at health care setting
Definition

PPE :equipment worn to minimize exposure to hazards that cause

serious workplace injuries and illnesses.
Or
PPE :is equipment used to prevent or minimize exposure to hazards.

*PPE includes gloves, masks/respirators, eyewear (face shields,

goggles, or glasses), caps, gowns, aprons, scrub suits, drapes, hoods,
boots and other items.
 Types of PPE and their uses

1. Gloves
Gloves protect hands from infectious materials and protect patients
from microorganisms on staff members’ hands
They are the most important physical barriers for preventing the spread
of infection. There are three categories of gloves:
• Surgical (sterile, single use)
• Examination (non-sterile)
• Heavy duty/utility/household
When to Use Gloves and Types of Procedures
- Gloves should be worn when contact with body and blood fluids is
anticipated.
- Gloves should be worn as an additional measure, not as a substitute for
hand washing.
• Examination gloves shall be worn:
For examination and non-surgical procedures
For contact with blood, bodily fluids, secretions and excretions, mucous
membranes, draining wounds, or non-intact skin (open skin lesions or
oxidative rash)
For handling items visibly soiled with blood, bodily fluids, secretions, or
excretions
When the HCW has non-intact skin on his/her hands
When inserting an IV line
• Surgical gloves shall be worn:
 for surgical and invasive procedures

• Utility gloves are used for cleaning equipment, floors, walls, furniture (such as
beds), handling waste, etc.

Gloves shall be changed between care activities and procedures for the same patient
after contact with materials that may contain high concentrations of microorganisms
Gloves shall be removed before moving to another patient or after completion of a
specific task.
Hands shall be washed and dried immediately after removing gloves.
With the exception of utility gloves, other gloves shall not be washed,
decontaminated, and reused
Gloves shall not be worn while walking in corridors and traveling in elevators,unless
in special circumstances, e.g., transporting lab specimens.
Gloves are not required for routine care activities in which contact is limited to a
patient’s skin
 Double gloving

• A reasonable guidelines for when to wear double gloves:

When the procedure involves coming into contact with a large
amount of blood or other bodily fluids (e.g., vaginal deliveries and
caesarean sections)
For orthopaedic procedures in which sharp bone fragments, wire
sutures, and other sharps are likely to be encountered
• Elbow-Length Gloves (gauntlet/gynaecological gloves)
for Obstetrical Procedures
help protect the provider from significant blood and amniotic fluid
contamination

• Orthopaedic Surgical Gloves

These are designed for tough orthopaedic procedures and offer
increased thickness and hydrogel coating.
2. Scrub Suits and Gowns
Scrub suits or cover gowns are worn over, or instead of, home
dressings. It consists of drawstring pants and a shirt. A V-neck shirt
must not be cut so low as to slide off the wearer’s shoulders or
expose men’s chest hair.
The main use of cover gowns is : to protect health providers’ clothing.

Surgical gowns made of fluid- resistant materials play a role:

first used to protect patients from microorganisms present on the
abdomen and arms of the HCW during surgery
in keeping blood and other bodily fluids off the skin of personnel,
particularly in operating, delivery, and emergency rooms
• Lightweight cloth gowns offer little protection and do not provide an
effective barrier because moisture can easily pass through them,
allowing contamination

• Jeans material (denim) or canvas is too dense for steam penetration

(i.e., cannot be sterilized), is difficult to wash, and takes too long to
dry

• The HCW can wear a plastic or rubber apron underneath the gown
to prevent contact of the skin with blood and bodily fluids

• If large spills occur, the best thing to do is shower or bathe as soon

after completing the procedure as possible.
Standard Operating Procedures for Gowns
• Gowns shall be used for protective isolation. The unnecessary use of
gowns is not recommended
• Gowns shall not be worn outside the area for which they are
intended.
• Long gowns shall be worn to protect uncovered skin and to prevent
soiling of clothing during procedures and patient care activities likely
to generate splashes or sprays of blood, bodily fluids, secretions, or
excretions.
• Plastic aprons are recommended where splashes are likely to occur

*Clinical coats and scrub suits should remain in the work place; taking
them home increases the risk of infection to the home environment.
3. Masks
Masks should be large enough to cover the lower face and all facial
hair (to contain it)
They are worn:
 an attempt to contain moisture droplets expelled as HCWs or surgical
staff speak, cough, or sneeze (droplet precautions)
to prevent accidental splashes of blood or other contaminated bodily
fluids from entering the HCW’s nose or mouth
Unless the masks are made of fluid-resistant materials, they are not
effective in preventing either very well.
• Respirators are specialized types of masks, called particulate
respirators (such as N95), which are recommended for situations in
which filtering inhaled air is considered important (e.g., for the care of
a person on airborne precautions).
• They contain multiple layers of filter material and fit the face tightly so
that no air leaks around the mask when the HCW breathes
There are four types of masks:
• The tieback mask, which has four ties to fasten the mask around the mouth and
nose
- The side of the mask with the flexible metal tab is worn away from the face
with the metal tab placed above the bridge of the nose to help secure the mask
and minimize air escaping from the sides (venting)

• The ear-loop mask is similar to the tieback mask except that it has two elastic
bands used for fastening

• Surgical masks have attached faced shields to provide a protective barrier against
splashes and spatters of blood or other infectious material
- These masks are fluid resistant, lightweight, and adequate for most procedures and
isolation precautions
*A surgical mask becomes ineffective as a barrier if the integrity of the mask is
damaged or if it becomes wet (i.e., from perspiration or if splashed with blood or other
potentially infectious material). If this occurs, remove the mask and replace it with another
• An N95 respirator is a protective device designed to achieve a very
close facial fit and very efficient filtration of airborne particles
-N95 means that the respirator blocks at least 95% of very small (0.3
microns) test particles
- If properly fitted, the filtration capabilities of N95 respirators exceed
those of face masks
- However, even a properly fitted N95 respirator does not completely
eliminate the risk of illness or death
*N95 respirators are not designed for children or people with facial hair
Because a proper fit cannot be achieved on children and people with
facial hair, the N95 respirator may not provide full protection
4. Caps
Primary purpose is to protect the wearer from blood and bodily fluid
splashes and sprays
Caps provide some protection to the patient, it keep the hair and
scalp covered so that flakes of skin and hair are not shed into the
wound during surgery
*Caps should be large enough to cover all hair
5. Protective Eye Wear
By covering the eyes, protective eyewear protects staff from
accidental splashes of blood or bodily fluid.
Types of eyewear are as follows:
• Plastic glasses with solid side shields
• Goggles
• Chin-length face shields
Standard Operating Procedure for Eye Wear

Protective eye wear shall be worn where appropriate to protect the

mucous membranes of the eyes during procedures and patient care
activities likely to generate splashes or sprays of blood, bodily fluids,
secretions, and excretions
Use protective eye wear that is appropriate for the particular
procedure
To remove eyewear, hold goggles with one hand, lift the bottom strap
from the back of the head to the front. If gloved hands are used for
these procedures, the gloves should not be contaminated with blood
or other potentially infectious material
6. Boots (Footwear)
• Footwear is worn to protect feet from injury from sharps and heavy
items, blood, and fluids
• Rubber or leather boots are recommended because they protect better;
they should be kept clean and free of contamination from blood or other
fluid spills
• Shoe covers in surgical areas are unnecessary if shoes are clean, closed-
toe, and sturdy

7. Aprons
• The apron is made of rubber or plastic to provide a waterproof barrier
along the front of the health worker’s body
• An apron should be worn when cleaning or during a procedure in which
blood or body spills are anticipated
8. A hood
• This is used for covering of head and neck with an opening for the
face, typically forming part of a coat or cloak
• The material should be plastic or waterproof
9. Laminar Flow/Biological Safety Cabinet
This is a carefully enclosed bench designed to prevent contamination
of biological samples or any particle sensitive materials
10. Drapes
• Surgical drapes (sterile) made of cloth can be placed around a
prepared surgical incision to create a work area
• Although this area is often called the “sterile field,” it is NOT sterile
• Cloth drapes allow moisture to soak through and can help spread
organisms from skin, even after surgical cleansing with an antiseptic
agent, into the incision
Remember
• Once a sterile drape touches the patient’s skin, it is no longer sterile.
• Sterile cloth drapes do not replace good aseptic technique.
 Importance of PPE
• Reduces spread of infection
• Provides protection against hazards
• Promotes good hygiene
• Encourages safety in the workplace

*add more
General Procedure for Donning
PPE
Steps for donning PPE vary depending on the procedure to be
performed (donning for theatre, isolation, etc.)
• Always perform hand hygiene before donning PPE
• If wearing a gown, don the gown first and fasten in back accordingly
• If wearing a facemask or respirator:
- Secure ties or elastic band at the back of the head and/or neck
- Fit flexible band to nose bridge
- Fit snug to face and below chin
• If wearing goggles or a face shield, put it on the face and adjust the
fit
• If wearing gloves in combination with other PPE, don gloves last
General Procedure for Doffing PPE
• Steps for doffing PPE vary depending on the procedure that has been
performed, e.g., after exposure to infectious agents

• Remove PPE before leaving the exam room or patient environment

(except respirators which should be removed after exiting the room)

• Remove gloves:
- Grasp the outside of the glove with opposite gloved hand; peel off
- Hold removed glove in glove hand
- Slide un-gloved fingers under the remaining glove at the wrist; peel
off and discard
• Remove facemask or respirator:
- Avoid touching the front of the mask or respirator
- Grasp the bottom and the ties/elastic to remove and discard

• Remove goggles or face shield:

- Avoid touching the front of the goggles or face shield
- Remove by handling the head band or ear pieces and discard
• Remove gown:
- Remove in such a way to prevent contamination of clothing or skin
- Turn contaminated outside surface toward the inside
- Roll or fold into a bundle and discard if it is not reusable

• Always perform hand hygiene immediately after removing PPE

Session 4: Occupational exposure in preventing and
controlling infections among health care workers
Definition
• Occupation exposure: means reasonably anticipated skin,eye,mucous
membrane or parenteral contact with blood or other potentially
infectiuos materials that may result from the performance of an
employee’s duties
OR
Contacts with a potentially harmful physical, chemical or biological
agent as a result of one’s work

• Post- exposure prophylaxis (PEP): Is generally understood to mean the

medical response to prevent the transmission of blood-borne
pathogens, including HIV, after exposure to blood and other bodily
fluids.
common occupational exposure
The most common form of occupational exposure to blood and the
most likely to result in infection is needle-stick injury.
The most common causes of needle-stick injury are two
-handed recapping
- Unsafe collection and disposal of sharps
HCWs in areas, such as operating rooms (ORs), delivery rooms, ICU,
emergency rooms, and laboratories, have a higher risk of exposure.
Cleaners, health care waste handlers, and others whose duties involve
handling blood-contaminated items are also at risk.
• Classification of risks associated with different types of occupational exposures to
blood and other bodily fluids

i. High-risk exposure (occupational PEP should be recommended)

- Exposure to a large volume of blood or potentially infectious fluids
- Exposure to blood or bodily fluids contaminated with HIV from a source with a high
viral load
- Injury from a large-bore hollow needle
- Injury from a device used in an artery or vein
- Injury from a blood-stained device
- Deep and extensive injuries
- Confirmed drug resistance in the source person
- Source person has symptomatic HIV infection, AIDS
- Known high viral load, or is in a window period
ii. Low-risk exposure (occupational PEP should be recommended)
- Exposure to a small volume of blood or potentially infectious fluids
- Injury with a solid needle
- Injury with small needle
- Any superficial injury or muco-cutaneous exposure
- Bite from a patient with visible bleeding in the mouth that causes bleeding in the
exposed worker
- Exposure to non-intact skin (e.g., dermatitis, chapped skin, abrasion, or open wound)
with blood, visibly bloody fluid, or any other potentially infectious material
- Source has asymptomatic HIV infection or known low viral load (<1,500 RNA
copies/mL), in the absence of other risks (for example, high risks);
*below is a list of factors that increase risk for the above exposure events:
o Source person is known to be HIV-infected with a high viral load
o Source person has drug-resistant HIV and AIDS
o Source person is in a window period
o Deep skin penetration
iii. No risk (occupational PEP is not warranted)
- Exposure to solid-bore needles or sharps not in recent contact with
blood
- Bite from a patient with visible bleeding in the mouth that causes
bleeding in the exposed worker
Strategies to prevent HCW’s from occupational
exposure
HCAIs are preventable by concurrently applying various control measures from
most effective (elimination) to least effective (PPE):

- Workplace health and safety programs that identify all threats to staff health,
including infectious diseases, and take measures to eliminate or mitigate risk
(elimination)
- Implementation of standard precautions (substitution and engineering control)
- Good environmental cleanliness, waste management, facility design, and
layout
(engineering control)
- Improved water, sanitation, and hygiene (WASH) infrastructure and services
(engineering control)
- Improved work environment that considers the need for differential-pressure
rooms (e.g., negative-pressure rooms with anterooms) to isolate patients with
infectious diseases, including airborne respiratory infections (engineering
control)
- Good administrative structure that supports organisational IPC
(administrative control)
- System for surveillance of key process and outcome indicators of IPC
performance and dissemination of results (administrative control)
- Systems to communicate with staff, patients, and care givers (e.g., to
provide information about HCAI and IPC policies) and surveys to assess
the systems’ efficacy (administrative control)
- Maintaining the health and well-being of HCWs and patients in HFs,
including providing training on workplace improvement, recreational
areas, eating areas, worker benefits, and good compensation
(administrative control)
- IPC program that is part of a risk management system to identify,
assess, mitigate, and communicate potential communicable disease
threats to patients and staff (administrative control)
- Immunization of all health workers against HBV, tetanus, and other
immunizable diseases (administrative control):

o Conduct pre vaccination serological testing

o Measure antibody levels at two to six months after the last dose
o Maintain register of HCWs receiving vaccinations
o Refer infected workers for appropriate care and treatment
o Liaise with occupational health and safety focal person for workers
benefits and compensation
- Provide post-exposure prophylaxis (PEP) (administrative control):
o Clear policy guidelines and procedures posted in visible places
o Orient HCWs on PEP procedure
o Design exposure reporting procedures as per PEP guidelines
o Conduct a thorough assessment of exposure risk
 Type and severity of exposure
 Blood-borne infection status of source person
o Provide appropriate treatment, follow-up, and counselling of
workers after exposure
o Maintain confidentiality of exposed and source persons
o Manage exposure training of health care personnel
o Provide rapid access to clinical care
 PEP
 Testing of source patients/exposed persons
-Standard and transmission-based IPC precautions, including
appropriate use of PPE (PPE control)
• Successful implementation of these strategies requires an effective
quality improvement or infection prevention, occupational health and
safety, WASH, and health care waste management (HCWM) system
with support from the health setting management team
Perform exposure site
management
• Post-Exposure Site Management
Wounds and puncture sites should be washed with soap and water
Exposed mucous membranes should be flushed with water
Post-exposure evaluation should be done (type of bodily fluid
involved)
Type of exposure should be determined (percutaneous, mucosal,
intact skin, etc.)
Severity of exposure should be assessed–quantity of blood, duration
of contact
Provide care to HIV and Hepatitis B and C
exposed health care worker
HBV Post-Exposure
• Several studies have demonstrated that, in susceptible persons (i.e.,
negative hepatitis B surface antigen [HbsAg] test and no history of
receiving immune serum globulin), giving hepatitis B immune
globulin (HBIg) is better than conventional serum immune globulin G
(SIgG), or by inference doing nothing, in preventing acute hepatitis B
and sero-conversion.
• The suggested steps for managing an injury are as follows:

Step 1: Treat the exposure site appropriately (e.g., an open wound or

cut)

Step 2: Give tetanus immunization or booster if indicated (e.g., >10

years since immunization)

Step 3: Assess the risk of HBV exposure and determine the immune
status of the patient (i.e., history of jaundice, hepatitis, or previous
immunization with HBV vaccine). If status is unknown, continue
assessment.
Step 4: Collect a specimen from the source person (the carrier or
person suspected of being infected) if possible and from the patient
for HBsAg testing
If testing is not possible, base the HBV status of the infected person on
clinical history and clinical findings

Step 5: Give HBIgG (5 mL IM) as soon as possible and within 7 days of

exposure, and also give the first dose of HBV vaccine, which should be
repeated at 1 and 6 months
If active immunization with HBV vaccine is not possible, a second dose
of HBIG should be given 1 month later.
HCV Post-Exposure
• There is no post-exposure vaccine or drug prophylaxis for HCV.
Preventing exposure, therefore, is the only effective strategy for
preventing HCV. The institutions should consider for follow-up of
health workers exposed to HCV- positive blood or other bodily fluids:

- Baseline testing of the source patient (if available and a consent form
is signed) for anti-HCV antibody (if the test is available)
- Baseline and 6-month follow-up testing of exposed health worker for
anti-HCV antibody and liver function screen
- If available, treatment of early HCV infection with pegylated
interferon alfa before significant liver damage occours
Hiv post - exposure
• The two-drug PEP regimen as it appears in the current National
Guidelines for Management and Care of HIV and AIDS (April 2012) is
no longer recommended.
• The only indication for dual therapy is if the third drug has been
stopped for reasons of tolerability
• Monotherapy of any kind is not recommended and is now
obsolete(no longer used).
HIV PEP (ARV) regimen Current Comments
MOHCDGEC
recommendations
Tenofovir 300 mg, once - Compared to zidovudine-containing
daily Preferred first option regimen, current evidence shows
Lamivudine 300 mg, for HIV PEP that this combination is better, not
once daily only in terms of tolerability, but also
Efavirenz 600 mg once efficacy in preventing post-exposure
daily, transmission of HIV infection.
- Studies have shown increased
rates of adherence and regimen
completion when tenofovir and
lamivudine are used as components
of HIV PEP regimen

.
Assignment 1
a. Describe steps in managing occupational exposure
b. Link occupationally exposed health care workers to continuum of
care
Session 5: Procedures of health care waste management in preventing
and controlling infections
Definition
• Define health care waste
This contains potentially harmful microorganism that can infect hospital
patients, health workers and the general public(WHO)
Or
All the waste generated by healthcare facilities, medical laboratories
and biomedical research facilities, as well as waste from minor or
scattered sources
Risks associated with health care wastes
• Sharps inflicted injuries
• Toxic exposure to pharmaceutical products, in particular, antibiotic and
cytotoxic drugs released into the surrounding environment, and to substances
such as mercury or dioxins, during the handling or incineration of HC wastes
• Chemical burns arising in the context of disinfection, sterilization or waste
treatment activities
• Air pollution arising as aresult of the release of particulate matter during
medical waste incineration(difficult in breathing)
• Thermal injuries occuring in conjuction with open burning and the operation
of medical waste incinerations (Physical deformation)
• headaches
• Radiation burns
• Eye and skin irritation
Classification of health care wastes

1. Non-Hazardous Waste
Non-hazardous waste is waste that has not been in contact with
infectious agents, hazardous chemicals, or radioactive substances and
does not pose a sharps hazard.
A significant proportion (about 85%) of all waste from HFs is non-
hazardous and is usually similar to municipal solid waste
More than half of all non-hazardous waste from HF is paper,
cardboard, and plastics and the rest is discarded food, metal, glass,
textiles, plastics, and wood.
2. Hazardous Health Care Waste
Hazardous waste poses a potential threat to public health and the
environment.
It can be solid, liquid or gaseous
Hazardous waste is classified into the following:

a) Infectious wastes
- Theses are materials that may contain pathogens (bacteria, viruses,
parasites, or fungi) in sufficient concentration or quantity to cause
disease in susceptible hosts
- It includes waste contaminated with blood or other bodily fluids.
b) Highly infectious waste
- All waste materials containing, blood, fluids with viable biological
agents from infected persons or artificially cultivated in significant
elevated numbers; waste from infected patients in isolation wards,
cultures, and stocks; dishes, and devices used to transfer, inoculate,
and mix cultures of infectious agents
- In case of notifiable, highly infectious diseases, i.e. VHFs, such waste
materials should undergo extra treatment procedures

c) Pathological waste
- These wastes consist of tissues, organs, body parts, blood, bodily fluids,
and other waste from surgeries and autopsies. It also includes
human foetuses and infected animal carcasses.
d) Sharps
- These are items that could cause cuts or puncture wounds and
infections
- Sharps include needles, hypodermic needles, scalpels, and other
blades, knives, infusion sets, saws, broken glass, and pipettes.
- Whether or not they are infected, such items are usually considered
hazardous health care waste and should be treated as potentially
infectious

e) Genotoxic wastes
- These include certain cytostatic drugs, vomit, urine, or faeces from
patients treated with cytostatic drugs, chemicals, and radioactive
material
f) Pharmaceutical wastes
- These include expired, unused, spilled, and contaminated pharmaceutical
products, prescribed and proprietary drugs, vaccines, and blood sera that
are no longer required; because of their chemical
or biological nature, they need to be disposed of carefully
- The category also includes discarded items heavily contaminated during
the handling of pharmaceuticals, such as bottles, vials, and boxes
containing pharmaceutical residues, gloves, masks and connectining tubes

g) Chemical waste
- These consist of discarded solid, liquid, and gaseous chemicals; for
example, from diagnostic and experimental work and cleaning and
disinfecting procedures.
- Chemical waste from health care is considered hazardous if it has at least
one of the following properties:
Toxic (harmful)
Corrosive (e.g., acids of pH <2 and bases of pH >12)
Flammable
Reactive (explosive, water reactive, shock sensitive)
Oxidizing
- Wastes from materials with a high heavy-metal content is a subcategory
of
hazardous chemical waste and are usually highly toxic eg. Mercury and
cadmium is of highly toxic yet common substance in HFs
- Mercury wastes are typically generated by spillage from broken clinical
equipment (thermometers and aneroid blood pressure equipment) and
dental amalgam; cadmium waste comes mainly from discarded batteries.
h) Radioactive waste
- These are materials contaminated with radionuclides
- They are produced as a result of procedures such as in vitro analysis of body
tissue and fluid, in vivo organ imaging and tumour localization, and various
investigative and therapeutic practices, which include liquids, gases, and solids
contaminated with radionuclides whose ionizing radiations have genotoxic
effects
- The ionizing radiation of interest in medicine includes X-ray, gamma rays, alpha
and beta particles
- An important difference between these types of radiation is that X-ray
tubes emit only when generating equipment is switched on whereas gamma
rays, alpha and beta particles emit radiation continuously
- The type of radioactive material used in HFs results in low-level radioactive
waste and concerns mainly therapeutic and imaging investigation activities
where cobalt-60, technetium- 99m, iodine-131, and iridium-192 are most
commonly used.
Segregation of health care wastes
HFs shall segregate waste to protect personnel from injury and
infection by preventing hazardous waste from entering inappropriate
waste streams.
All standard operating procedures of health care waste segregation,
packaging, and labelling shall be displayed in each department:

• Segregation of health care waste shall be done at the generation point

and is the responsibility of the person/institution that generate it
• Segregation receptacles must be placed as close as possible to the
waste generator as this will avoid cross-contamination.
• Standard colour-coded receptacles for each category of waste shall
be provided by HFs
• Segregation of health care waste shall consist of separating different
waste materials based on the type, treatment, and disposal or
recycling options
• The mixing of non-hazardous and hazardous waste is not permitted.
If mixing occurs, all waste contained together shall be classified and
treated as hazardous waste
• Staff engaged in the segregation of health care waste shall wear
appropriate PPE
 Storage of health care wastes

For efficient and effective storage of health care waste, authorities or

HFs shall:
- Provide a secured and fenced health care waste storage bay
- The bay should have an impermeable, hard-standing floor with good
drainage system, easy to clean and disinfect in line with standards and
procedures for HCWM
- Ensure separate labelled storage compartments for various types of
health care waste
- Provide a separate compartment for radioactive waste storage
- Not store infectious waste for more than 48 hours from the time of
generation
 Transportation of health care wastes

• For efficient and effective off-site transportation of health care waste,

authorities or HFs shall comply with the following:
Before transportation of waste, dispatch documents should be
completed
All arrangements should be made between consignor, carrier, and
consignee
In case of trans-boundary movement, the consignee should have
confirmed with the relevant, competent authorities that the waste can
be legally transported
 Transport on public roads should only be conducted by licensed
companies
Transport vehicles and drivers must meet legal requirements for the
transport of hazardous waste
Collection and Onsite Transportation of Health Care Waste
For efficient and effective collection and transport of health care waste,
authorities or HF management shall:
• Provide standard equipment for collection and transport of health
care waste
• Provide appropriate PPE
• Supervise staff to adhere to use of PPE
• Collect infectious waste on a daily basis
• Collect hazardous and non-hazardous waste on separate trolleys
• Use the most direct and shortest route from the collection point to
the central storage facility or disposal point and avoid food
preparation areas and heavily populated areas
• Be transported using colour coded/labelled transportation
equipment that is not used for any other purpose
• Collect waste according to scheduled and reliable pick up times
• Not leave collected waste anywhere, even temporarily, other than at the
designated central storage facility
• Not be transported by hands to avoid the risk of accident or injury
• Mark all bin liners and/or containers of waste to identify the unit/ward
where the waste was generated
• Have spare trolleys/wheeled bins available in case of breakdowns and
maintenance
• Clean and disinfect all trolleys and wheeled bins after every use
• Ensure that all waste bag seals are in place and intact at the end of
transport
• There should be separate, secured storage rooms to maintain segregation
of:
- Radioactive waste
- Waste containing mercury
Disposal of health care wastes
The MOHCDGEC recommends the following disposal options for non-
hazardous and hazardous waste that requires direct disposal
Non-Hazardous Waste Disposal
Non-hazardous waste shall be disposed of at public, designated
disposal sites.
In case there is no public disposal site, the authority shall establish a
designated disposal site for non-hazardous waste that meets public
health and environmental requirements.
Open burning is strictly not allowed for all types of waste.
The designated disposal site should be fenced and secured against
unauthorised access.
Incineration
This is a dry oxidation process, is used to reduce organic and
combustible waste into inorganic incombustible matter at high
temperature.
 It provides high temperatures and destroys microorganisms and
therefore is the best method for disposal of contaminated wastes
 Having centralized incineration is acceptable if the HF is not
capable of managing incineration by itself.
 Ashes from the incinerator should be disposed in an ash pit.
 Health care waste that cannot be reused, recycled, or dumped in a
landfill site should be incinerated.
 There should be an efficient monitoring system for proper
functioning of incinerators.
Burning Chamber
 Rural health centers and dispensaries can burn waste in a burning
chamber as per MoHCDGEC HCWM guidelines
Open burning of contaminated waste is not recommended because it is
hazardous
Hazardous Waste Disposal Options
- Hazardous waste must be treated before final disposal. MoHCDGEC
recommends the following disposal options for various types of
hazardous waste.

Pathological Waste Disposal

Every HF should have a standard, designated placenta pit within the
facility premises.
Other pathological waste must be treated, incinerated, or buried.
In case of human remains, they must be cremated or buried in a
public cemetery.
Disposal of Hazardous Ash
Fly ash and bottom ash from incineration is generally considered
hazardous because of the possibility that it contains heavy metals,
dioxins, and furans.
Hazardous ashes should be disposed of in centralized sites designed
for hazardous wastes.
In the absence of designated disposal sites, HFs should construct a
standard ash pit within or offsite the facility premises
Sharp Waste Disposal
Even after sterilization, sharp waste may still pose physical risks. HFs
should do the following:
Sterilized sharp waste can be disposed of in safe sharp pits on the HF
premises or encapsulated by mixing waste with immobilizing material
like cement before disposal.
If recycling opportunities exist, sharp waste should be sterilized and
taken to licenced companies for recycling.
Sharps can be incinerated if a high technology incinerator exists;
needles can be smelted and the ash disposed of by burial.
Disposal Options in Emergency Situations
The authority should take appropriate health care waste
management practices in line with the type of waste generated.

Appropriate disposal options and procedures must be followed,

including interim minimal disposal practices.

Open dumping of boxes/bagged waste should be avoided.

Special Waste Classes
Chemical wastes contain heavy metals (mercury), Unintentional
Persistent Organic Pollutants (UPOPs), pharmaceutical and cosmetic
waste, radioactive waste, and e-waste (refer to HCWM guidelines for
management and disposal).

Pharmaceutical waste and chemical waste should be stored until a

safe disposal option has been identified (refer to guidelines for
pharmaceutical disposal).

Equipment or instruments containing mercury should be replaced

with non- mercury instruments/equipment.
Session 6 : Procedures of processing equipment and
materials in preventing and controlling infections
Definition of terms
Decontamination: Is “the use of physical or chemical means to remove,
inactivate, or destroy blood-borne pathogens on a surface or item to
the point where they are no longer capable of transmitting infectious
particles and the surface of an item is rendered safe for handling, use,
or dispose.”

Cleaning : Is the physical removal of organic materials and debris from

used items by washing with soap and water and friction

Antiseptics: Are chemicals that are applied to the skin or other living
tissues to inhibit or kill microorganisms (both transient and resident),
thereby reducing the total bacterial count
Disinfectants :Are chemicals that kill or inhibit all microorganisms
except bacteria endospores on inanimate objects

High Level Disinfection : Is the process that eliminates all

microorganisms (including bacteria, viruses, fungi, and parasites), but
does not reliably kill all bacterial endospores, which cause diseases,
such as tetanus and gas gangrene

Sterilization: Protects patients by eliminating all microorganisms

(bacteria, viruses, fungi, and parasites), including bacterial
endospores, from instruments and other items.
Outline commonly used antiseptics and disinfectants

Antiseptics
• Alcohol (60-90% ethyl or isopropyl or methylated spirit)
• Chlorhexidine gluconate 2-4% (e.g., Hibitane®, Hibiscrub®, Hibiclens®)
• Iodine preparation 3%
• aqueous iodine Iodophors 7.5-10% eg. Betadine®
• Chloroxylenol (Para- chloro- metaxylenol) 0.5-4% and other
concentrations (e.g., Dettol)
• Triclosan (0.2-2%)
• Ortho-phthalaldehyde (OPA)
Disinfectants
High-Level Disinfectants
- Sporicidin 2%
- Chlorhexidine 4%
- centrimide 5%
- Hydrogen peroxide 6%
- Chlorine 0.5%

Intermediate-Level Disinfectants
- Isopropyl 60-70%
- Ethanol 70-90%
- Methylated spirit 60-90%
- Iodines and iodophor 10% solutions
- Povidone-iodine 2.5%
- Formaldehyde 8%
Low-Level Disinfectants
- Hydrogen peroxide 3%
- Phenolics 1-2%
- Dettol
- Lysol 5%
- Carbolic acid 5%
Preparation of dilute chlorine soln from the
conc. liquid or powder form

When preparing disinfectants and antiseptics, one should:

• Wash hands before and after each procedure
• Read the manufacturer’s guide
• Follow the dilution formula
• Measure the required amount of water, antiseptics and disinfectant
Making Chlorine Solution from Dry
Powder
• Check concentration (% concentrate) of the powder being using
• Determine grams of bleach powder needed
• Grams/litre = (% desired dilution) X 1000
(% Manufacturer concentrate)
• Mix measured amount of bleach powder with 1 litre of water
Eg: To make a 0.5% chlorine solution from calcium hypochlorite powder
containing 35% active chlorine:
(0.5%) x 1000 = 0.0143 × 1000 = 14.3g
(35%)
• Therefore, dissolve 14.3 g of calcium hypochlorite powder in 1 L of
water to get a 0.5% chlorine solution.
Note: When bleach powder is used, the resulting chlorine solution is likely
to be cloudy (milky)
Preparing Dil. Chlorine Soln from Liquid
Bleach (Sodium Hypochlorite Solution)
• Chlorine in liquid bleach comes in different concentrations. Any concentration
can be used to make a dilute chlorine solution by applying the following
formula:
• Total parts (TP) of water = (% manufacturer concentrate) − 1
(% desired dilute)

eg. Make a 0.5% chlorine solution from 3.5% bleach

• TP water = (% manufacturer concentrate) – 1) = (3.5%) − 1 = 6
(% desired dilute) (0.5%)

• Take 1 part concentrated solution, add 6 parts boiled (filtered, if necessary) water to make a
0.5% chlorine solution

Example 2: Make a 0.1% solution from 5% concentrated solution

• Calculate TP water = (5.0%) − 1 = 50 − 1 = 49
(0.1%)
Take 1 part concentrated solution and add to 49 parts boiled (filtered, if necessary) water
to make a 0.1% solution
Instruments processing

• Instruments processing is a very important in ensuring that the

instruments are processed in cyclical manner as clarified in figure
below
*High-Level Disinfection
• Boil or steam for 20 minutes
• Chemical: Soak in 0.3% OPA (Cidex OPA) for 12 minutes
Decontamination of equipment, instruments and surfaces

Decontamination of Reusable Equipment According to the Spaulding Classification

• The risk of transmission is classified according to the site where the instrument has been used.
Contact sites for instruments may be classified as:
Critical: Instruments or devices that are introduced directly into the blood
stream or normally sterile areas of the body. These will require sterilization, i.e.,
surgical instruments, implants.

Semi-critical: Instruments or devices that come into contact with intact mucus
membranes but do not penetrate the blood barrier may be either sterilized or
HLD, i.e., non-invasive flexible and rigid fiber optical endoscopes, endotracheal
tubes, and anaesthesia breathing circuits

Non-critical: Instruments or devices that do not touch the patient or touch only
intact skin. Those items can be cleaned and then disinfected with intermediate-
level disinfectant, sanitized with low-level disinfectants, or cleaned with soap
and water; includes blood pressure cuffs, bed pans, linens, furniture, floors, and
other medical accessories.
Levels of decontamination
Cleaning of equipment, instruments and surfaces

• Cleaning that follows decontamination can remove up to 90% of

microorganisms (bacteria, viruses, fungi, and parasites) and is the best
way to reduce the number of endospores, which cause tetanus and
gangrene.
• Cleaning should be done under water using liquid soap or enzymatic
detergent and friction to remove all organic material from
instruments
• After cleaning, rinse items in clean water until no detergent remains
• Air dry items whenever possible.
• Use heavy-duty gloves for cleaning instruments.
• Wash hands after removing gloves.
Care of All Instruments
• Instruments with moving parts should be lubricated after drying.
• Avoid oils that may protect bacteria during autoclaving.
• Water-soluble lubricant is recommended (Karl Zsort or Olympus
instrument oil).
• Never use steel wool or abrasive powders on stainless steel
instruments.
• Never label surgical instruments with masking tape.
• Staining/spotting of instruments can be caused by moisture or water.
• When instruments do stain in spite of all the good care taken, they
can be cleaned by using a commercially available rust and stain
remover
New Instruments
• All new instruments are supplied without lubrication. It is
recommended that all be carefully washed and dried and any moving
part lubricated

• Whenever cleaning, regardless of method, keep ratchets unlocked

and box joints open

• When instruments are no longer new, avoid as far as possible contact

between stainless steel instruments and any of the following
substances: barium chloride, aluminium chloride, and bromide- and
iodine-containing compounds.
 Manual Cleaning of Soiled Instruments & Equipment
• When an operation is in progress, do not drop instruments into a holding
solution of disinfectant. If the instruments are not cleaned first, disinfectants,
such as chlorine, act as fixatives of any organic material present, making it
difficult to remove.
• Instruments should not be soaked in saline, as they will become pitted.
• Dilute detergent properly as per supplier’s directions.
• Completely dismantle all items and leave instruments open.
• Use warm water, detergent, and a hard brush to completely remove blood,
tissue, food, and other residue, paying special attention to small teeth of
instruments and joints.
• Finally rinse with clean water to remove traces of detergent.
• Dry properly. Failure to remove water from trapped areas will cause corrosion.
• Consider the item contaminated when packaging is torn, damaged, wet,
dropped on the floor, and when the expiry date has passed.
Perform disinfection
• Dfn
• HLD can be performed by boiling, soaking in chemicals, or steaming.
i. HLD by Boiling
Step 1: Clean all items to be boiled.
• Open all hinged items and disassemble those with sliding or
multiple parts.
• Completely submerge all items in the water in the pot or boiler.
• Place bowls and containers upright, not upside down, and fill with
water.
Step 2: Cover the pot or close the lid on the boiler and bring the water
to a gentle rolling boil.
Step 3: When the water comes to a rolling boil, start timing for 20
minutes.
• Use a timer to make sure to record the time that boiling begins.
• From this point on, do not add or remove any water and do not add
any items to the pot or boiler.
Step 4: Lower the heat to keep the water at a gentle, rolling boil.

*Note: If the water boils too vigorously, it will evaporate and the
items may become damaged if they bounce around the container and
hit the sidewalls and other items being boiled. Lower heat also saves
fuel or electricity.
Step 5: After 20 minutes, remove the items using dry, HLD pickups
(lifters, cheatle forceps). Place the items on an HLD tray or in an HLD
container away from insects and dust
Step 6: Allow air-drying before use or storage.
Step 7: Use items immediately or keep them in a covered, sterile or HLD
container for up to one week.

*Note: Never leave boiled items in water that has stopped boiling;
they can become contaminated as the water cools down
Tips for HLD by Boiling
• Items must be completely covered with water. Open all hinged
instruments and disassemble items with sliding or multiple parts

• Always boil for 20 minutes. Start timing when the water reaches a
rolling boil. If you forget to start timing the procedure, start timing at
the point at which you realize this.

• Do not add anything to or remove anything from the boiler once

boiling begins.
ii. HLD by Steaming
After instruments and other items have been decontaminated and
thoroughly cleaned, they are ready for HLD by steaming.
Step 1: Place instruments, plastic MVA cannulas and other items in one of
the steamer pans with holes in the bottom. To make removal from the
pan easier, do not overfill the pan.
Step 2: Repeat this process until up to three steamer pans have been filled.
Stack the filled steamer pans on top of a bottom pan containing water
for boiling. A second empty pan without holes should be placed on the
counter next to the heat source.
Step 3: Place a lid on the top pan and bring the water to a full rolling boil.
(When water only simmers, very little steam is formed and the
temperature may not get high enough to kill microorganisms.)
Step 4: When steam begins to come out between the pans and the lid, start
the timer or note the time on a clock and record the time in the HLD
log.
Step 5: Steam items for 20 minutes.

Step 6: Remove the top steamer pan and put the lid on the pan that was below
it (the pan now on top). Gently shake excess water from the pan just
removed.

Step 7: Put the pan just removed onto the empty pan. Repeat until all pans are
restacked on this empty pan and the top pan is covered with the lid. (This
step allows the items to cool and dry without becoming contaminated).

Step 8: Allow items to air dry in the steamer pans (1-2 hours) before using.

Step 9: Using HLD forceps, transfer the dry items to a dry, high-level disinfected
container with a tight-fitting cover. Instruments and other items can also
be stored in the stacked and covered steamer pans as long as a bottom
pan (no holes) is used
iii. HLD by Chemicals
Step 1: Clean, and thoroughly dry all instruments and other items to be
processed. Water from wet items will dilute the chemical solution,
thereby reducing its effectiveness.

Step 2: When using OPA solution: Prepare the 0.3% solution according to
the manufacturer’s instructions. Ideally, an indicator strip should be
used each time the solution is used to determine if the solution is still
effective. After preparing the solution, place in a clean container with a
lid. Mark the container with the date the solution was prepared and the
date it expires. Fresh solution should be made each day or more often if
the solution becomes cloudy. Put the solution in a clean container with
a lid.

*Note: Use chlorine solution with boiled water and not tap water.
Step 3: Open all hinged items and disassemble those with sliding or
multiple parts. The solution must contact all surfaces to achieve HLD.
Completely submerge all items in the solution. All parts of the items
should be under the surface of the solution. Place any bowls and
containers upright, not upside down, and fill with the solution.

Step 4: Cover the container and allow the items to soak for 20 minutes.
Do not add or remove any instruments or other items once timing
has begun.
Step 5: Remove the items from the solution by using dry, HLD pickups
(lifters, cheatle forceps).

Step 6: Rinse thoroughly with sterile or boiled water to remove the

residue that chemicals leave on items. This residue is toxic to skin and
tissue.

Step 7: Place the items on an HLD tray or in an HLD container and allow
to air dry before use or storage. Use items immediately or keep in a
covered, dry HLD container and use within one week.
Tips for Chemical HLD

• Items must be completely covered with solution.

• Open all hinged instruments and disassemble items with sliding or multiple
parts.

• Soak for 20 minutes. If you forget to start timing, start at the point you
remember.

• Do not add or remove anything once timing begins.

• Rinse items thoroughly with boiled water.

• Antiseptics should never be used for HLD

Sterilize equipment and instruments
• Sterilization is recommended for instruments and other items that will
come in contact with the bloodstream or tissues under the skin, as well
as on draped and some surgical attire. Sterilization can be performed
using dry heat (oven), high- pressure steam (autoclaving), and soaking
in chemicals (cold sterilization)

• Heat (autoclaving/steam and dry heat) is the most effective method of

sterilization and reliable if monitored carefully. It is also cheaper than
chemical methods. It should be considered first for all medical
equipment that can withstand heat.
•
- Chemicals are the alternative where heat cannot be used, e.g.,
ethylene oxide and glutaraldehyde
i. Sterilization by Dry Heat
Time/temperature:
• 1 hour at 170 ° C (340 °F)
• 2 hours at 160 °C (320 °F)
• 21/2 hours at 150 °C (300 °F)
• 3 hours at 140 °C (285 °F)

ii. Sterilization by Steam

• Time 20 minutes (or 30 minutes if wrapped)
• Temperature 121 °C (250 °F)
• Pressure 106 KPA (15 lbs/sq inch)
iii. Sterilization by Chemicals
Chemical sterilization method is used for instruments and other items
that are heat-sensitive or when heat sterilization is not available.
Step 1: Clean and thoroughly dry all instruments and other items to be
sterilized. Water from wet instruments and other items dilutes the
chemical solution, thereby reducing its effectiveness

Step 2: Prepare the glutaraldehyde or other chemical solution by

following the manufacturer’s instructions or use a solution that was
prepared previously, as long as it is clear (not cloudy) and has not
expired. After preparing the solution, put it in a clean container with a
lid. Always mark the container with the date the solution
was prepared and the date it expires.
Step 3: Open all hinged instruments and other items and disassemble
those with sliding or multiple parts; the solution must contact all
surfaces to achieve sterilization. Completely submerge all instruments
and other items in the solution. Place bowls and containers upright,
not upside down, and fill with the solution.

Step 4: Follow the manufacturer’s instructions regarding the time

necessary for sterilization to be achieved. In general, if the solution
contains glutaraldehyde, cover the container and allow the
instruments and other items to soak for 10 hours. Do not add or
remove any instruments or other items once timing has begun.
Step 5: Remove the instruments and other items from the solution by using
large, sterile pickups (lifters, cheatle forceps).

Step 6: Rinse thoroughly with sterile water to remove the residue that
chemicals . leave on instruments and other items; this residue toxic to skin
and tissues.

Step 7: Storage: Place the instruments and other items on a sterile tray or in
a sterile container and allow to air dry before use. Use the instruments
and other items immediately or keep in a covered, dry, sterile container
and use within one week.

Step 8: After processing, items should be used immediately or stored in

such a way that they do not become contaminated. Proper storage is as
important as proper processing.
Session 7: Use medical laboratory techniques in
collecting specimen
Define the term Specimen
Specimen
Is a small sample or part taken to show the nature of the whole.
Such as a small quantity of urine for urinalysis, or a small fragment
of tissue for microscopic study.

Explain the types of specimen

There are two types of specimen
i. routine specimen
ii. non-routine specimen
Routine specimen
- Urine
- Stool
- Blood
- Semen
- Oral fluid
- Sweat
- Sputum
Non routine specimen
-Pus swabs
- Nails
- skin snips/slit
- seminal fluid
- CSF
- tissues for autopsy, biopsy or body fluids for cytology
• Methods of collecting routine specimens includes
• Individual collection
• Assisted collection such as blood
Sites of blood collection
Phlebotomy: The procedure of opening the blood vessel and drawing
blood from it.
It comes from two Greek words:
o Phlebo = veins
o tomy = cutting
Blood is commonly collected from:
o The veins (venous samples)
o Capillaries (capillary samples by a finger prick)
o Arteries (arterial samples; not routinely done except for specialized
investigations)
Overview of Vein Anatomy for
Venepuncture
1. Median Cubital Vein: A superficial vein, most commonly used for
venepuncture. It lies over the cubital fossa and serves as an
anastomosis between the cephalic and basilic vein

2. Cephalic Vein: Shown in both the forearm and arm, it can be

followed where it empties into the axillary vein

3. Basilic Vein: Seen in the forearm and arm, it dives

to join the brachial
• Finger prick specimen is a Capillary blood collected from a pierced
finger
• Venous blood sample blood collected from a Vein

• Venous blood is used for all blood examinations, including

haematological, parasitological, biochemical and serological tests, and
for blood culture.
• Blood samples are collected into plain tubes or tubes containing
anticoagulant, or into blood bottles, as required.
Preparations for Taking a Venous Blood Sample
• Health worker preparation
- It is important for the health worker to be adequately prepared before clients
are called in the phlebotomy room.
- This includes the assembly of all equipment and supplies necessary for the
procedure
• Educating the patient. It is important to put the patient at ease when
drawing blood.
• The providers should:
- Explain that the supplies are sterile and have never been used on another
person
- Describe the procedure and how much time is needed for the results to be
available
- Assure them that the procedure is safe and results of the test are confidential
Identify different materials used for collecting blood sample
Specimen containers
- Specific container depends on which test will be done
- Correct specimen bottle can be identified by the colour of its top or the
label they carry
- Vacutainer tubes identified by the label on it
Tourniquet
Needles and syringes
Small bore needles
Gloves, Aprons or laboratory coats(PPE)
Cotton Gauze/Wool
Alcohol swabs
Hand towels (Preferably disposable)
Waste disposal containers
o Sharps bin (For disposal of sharps)
o Infectious waste bin (For disposal of non sharp infectious materials)
o Non infectious bean (For disposal of non infectious materials)
Marker pen for marking or labelling of specimen and forms
Disinfectant (e.g. Jik, Clorox)
Antiseptic for hand washing
Bandages or plasters
Collection of Blood Sample from
Patients
Safety Precautions
• Always follow standard safety precautions when drawing blood
- Consider every person (patient or staff) as potentially infectious and
susceptible to infection
- Wash hands before and after taking a sample from each patient
- Put on new gloves before collecting blood
- If blood is spilled, mop and disinfect area immediately
- Keep work area organized, clean, and disinfected
- Discard all used items in appropriate containers
Procedure of taking a venous blood
• Explain the procedure to the patient
• Ensure the patient has consented to the procedure
• Explain to the patient the turn-around time for obtaining results, and
where to get the results when they are ready
• Position the patient in a rested sitting position
• Label the tube with patient ID number
• Apply tourniquet on patient’s arm
• Have the patient form a fist so that the veins are more prominent
• After palpating path of vein, clean the site with alcohol using a
circular motion an allow area to dry.
• Assemble needle and vacuum tube holder
• Insert collection tube into holder until tube reaches needle
• Remove cap from needle
• Use your thumb to draw skin tight about 1- 2 inches (2.5-5 cm) below
venepuncture site. Hold skin tight through Step 13.
• Insert needle, bevel side up, into vein and penetrate vein at a 15 degree angle
• Push vacutainer tube completely onto needle. Blood should begin to flow into
tube
• Release tourniquet
• Place dry gauze over the venepuncture site and apply mild pressure to pad and
slowly remove needle
• Apply mild pressure until bleeding has stopped
• Discard vacutainer tube and cotton wool in separate appropriate waste containers.
• Thank the patient and remind them about where and when the results should be
available
1. Organise materials and equipments
Figure 2
Label the tubes
Figure 3
Apply tourniquet
Figure 4
Instruct the
patient to form
fist
Figure 5
Clean Venepuncture Site with
Alcohol Using a Circular
Motion (after palpating path
of vein) and Allow Area to
Dry
Figure 6
Assemble Needle
and Vacuum Tube
Holder
 Insert Collection Tube into Holder
Figure 7
Until Tube Reaches Needle
 Remove Cap from Needle
Figure 8
Figure 9
Use Your Thumb to Draw
Skin Tight About 1- 2”
Below Venepuncture Site
Figure 10 Insert Needle, Bevel Side Up, Into Vein
and Penetrate Vein at a 15 Degree Angle
Figure 11
Push Vacutainer
Tube Completely
onto Needle.
Blood Should
Begin to Flow into
Tube and Release
Tourniquet
Figure 12
Place Dry Gauze
over the
Venepuncture Site
and Apply Mild
Pressure to Pad
and Slowly
Remove Needle
Figure 13
Apply Mild Pressure Until
Bleeding Has Stopped
Figure 14
Waste Disposal of used
materials
Figure 14
Waste Disposal of used
materials
Finger prick blood collection
Purpose of finger prick blood collection
Is to obtain capillary blood which is may be used for haematological
examinations, including haemoglobin estimation, total and differential
white blood cell counts and blood cell morphology, detection of blood
parasites, and sickle-cell screening.

• Collection of capillary blood

• Capillary blood is collected from the side of the finger in adults and children.
Avoid the tip of the finger as it is very sensitive. In infants, collect capillary from
the side of the heel.
Materials
• Gloves
• Antiseptic (70% alcohol)/alcohol pads
• Waste disposal containers
• Register books
• Gauze (sterile )
• Request forms
• Specimen containers
• Glass slides
• Marker pens and ball pen
• Pencil ƒ
• Sterile lancets ƒ
• Capillary tube/loop/pipette
Procedure for Finger Prick
 Finger Prick: Finger Preparation

1. Position hand palm-side up. Choose 2. Apply intermittent pressure to

whichever finger is least calloused. the finger to help the blood to flow.

3. Clean fingertip with alcohol. Start in 4. Hold finger and firmly place a
middle and work outward to prevent new sterile lancet off-center on the
contaminating area. Allow area to dry. fingertip.

Slide 20
5. Firmly press lancet to 6. Wipe away the first drop of blood
puncture the fingertip with a sterile gauze pad or cotton ball

7. Collect specimen. Blood may 8. Apply a gauze pad or cotton ball

flow, best if the finger is held lower to the puncture site until the
than the elbow bleeding stops
Caution on Heel pricking Technique
• Infant heels are appropriate for blood collection until approximately 6 months
to one year

• Never exceed 2.4 mm in puncture depth

• Never puncture the posterior curvature of the heel or the arch of the foot

• Never use sites previously punctured, bruised, swollen or red in color

• Never puncture the heel more than twice for any one collection
 Heel pricking Procedure

• Wipe away the first drop of blood

• Ease thumb pressure and apply intermittent pressure. Avoid milking
and scraping
• Follow recommended order of draw
• When blood collection is complete, clean area, apply pressure.
• Never apply band-aid under the age of two
• Label specimens immediately after the draw; never before
HEEL PRICK PROCEDURE
Proper Disposal of Used Materials and
Handling of Specimen
• Proper waste disposal is important in order to prevent potential harm
and transmission of diseases with a contaminated sharp object.
• It is important to always dispose sharps in a puncture-resistant
container and other infectious materials in an appropriate container
with a non-leaking plastic bag inside.
• Sharp and wet materials should be disposed separately
Proper Handling of Specimen
• Specimens must be properly handled from point of collection to
delivery in the laboratory.
• Results of laboratory investigations are only as good as the sample
received by the laboratory.
• Use appropriate collection containers for specific testing needs.
• Store specimens upright, in racks at the appropriate temperature.
• Note the time of taking the specimens to ensure processing in the
correct timeframe.
Transporting the Specimen
• Check samples and forms before they leave the phlebotomy area
• Before the samples leave the clinic they should be checked for errors:
o Are sample tubes labelled correctly?
o Are the forms completed correctly?
o Is there a form for every sample?
o Is there a sample for every form?
o Does the information on the form match that of the corresponding sample?
• This check is critical because once a sample leaves clinic it may be
impossible to correct certain errors
Collection of Urine Specimen
• Urine is formed and excreted by the kidneys
• The production and composition of urine depends on the glomerular
filtration, tubular selective reabsorption and tubular secretion
• A urine sample is easily collected and will provide useful information
about the metabolism status, kidney function and the urinary tract
state.
• A specimen can be examined macroscopically, biochemically and
microscopically to detect bleeding, infection, glucose, protein, cells
and the presence of micro-organisms
Type of Urine Samples
• For routine examination urine is collected in a clean leak-proof
container.
• For culture purposes midstream urine is collected in a sterile leak
proof container.

*Mid-stream urine is the portion of urine that does not contain the first
and last portions of the sample.
Procedure for Collecting Urine Specimen for Routine Examination

• Provide the patient with a clean container.

• Instruct the patient to collect about 20 ml of urine directly into the clean
container

• Receive the specimen from the patient. Adhere to infection prevention

and control standards

• Secure the lid of the container immediately

• Label container with patients name, age and address and send to the
laboratory for investigation with a filled in request form to perform the test.
Procedure for Collecting Midstream Urine
- Provide the patient with a clean container
- Instruct the patient to collect urine specimen in the following steps:
o Wash genital area
o Begin to urinate without collecting urine
o After a few ml have passed, collect urine in container (10-20 ml if
possible)
o Finish urinating without collecting
o Cover the container with its lid and send it to the clinician
- Receive the specimen from the patient. Adhere to IPC
- Label the container with patients name, age and address and send to
the laboratory for investigation with a filled in request form.
- Tests on urine specimens should be performed within one hour to
prevent the specimen from being contaminated due to bacterial
growth
Collection of sputum specimens
A sputum specimen is needed for identifying pathogens causing infection
in the respiratory tract

• The sputum is collected by coughing up, and is therefore

contaminated with a small number of commensal micro-organisms from
the upper respiratory tract and mouth

• The commensal micro-organism has to be differentiated from the

pathogens causing infection

• A sputum sample is best collected in the morning after waking up

• A clean container with a wide mouth is used to collect sputum

The health worker needs to instruct the patient to collect two sputum specimens
i. Spot collection
ii. Early morning sputum collection the next day

iii. Spot Collection (Immediate Specimen)

- Advise patient to rinse mouth
- Coach the patient from behind
- Instruct the patient to cough sputum into the container
*This exercise should take place in a well ventilated environment preferably
in the open air/outdoors
- Verify that sample should contains sputum and not saliva
- Send the specimen to the laboratory
- Send patient home with a container for a first morning sputum the next day
ii. Early Morning Sputum Collection (Next Day)
- Early morning sputum sample usually has the highest yield of Acid
Fast Bacilli
- Instruct the patient to produce early morning sputum just like it has
been done today on the spot collection
- Emphasize that the patient brings morning specimen to health unit
within 24 hours after producing the sample
Precautions during Collection of Sputum Specimen
- The patient who is coughing is of a greater danger to staff than the specimen
- When collecting and receiving the specimen be sure to adhere to infection
prevention and control standards
Instruct patient to cover their mouth when coughing
Do not collect sputum in the laboratory or clinic room
Do not stand in front of the patient during specimen collection
Use appropriate leak proof containers with a wide mouth
Label a clean sputum container (on the side and on the lid/cover) before
obtaining specimenCollect specimen in a well-ventilated area, preferably
outdoors in the sunlight
Ensure that no one stands in front of the patient while producing sputum
Ensure container is labelled and closed firmly with lid after the specimen is
collected
Wash your hands with antiseptic after collecting specimen
Storage of specimens for
different rapid tests
• Wherever possible, obtain a fresh specimen and take the specimen at
a time when it can be transported in a timely manner.
• For the most accurate results, specimens should be received by the
laboratory as soon as possible or at least within 24 hrs. After this
time, any dominant or more virulent micro-organisms will flourish and
weaker ones will die off, which can lead to inaccurate results.
• If delivery is delayed, the specimen should be placed ideally in a
‘specimen’ designated fridge.
• Regular cleaning of specimen refrigerator and temperature should be
documented.
Criteria of good specimen
• Patient’s full name [last name, first name]
• Patient’s Medical Record Number or Date of Birth
• Date of specimen collection
• Time of specimen collection [time sensitive specimens]
• Specimen description or anatomic site of the specimen [non-blood
body fluids, microbiology, cytology and surgical tissue specimens]
Sample rejection criteria
• Incorrect sample types received: Basic incorrect blood tube/other
sample.
• Samples without the appropriate preservative (e.g. acidified urine
samples).
• Samples that are received ambient, when a frozen sample is required.
• Samples that are received unprotected from light, when they are
required to be covered at the point of venepuncture.
• Samples in incorrect containers (e.g. cervical cytology must be a
ThinPrep vial; urine cytology must be in a uricyte container)
• Insufficient sample received
• No sample received
• Labelling or form issues (mislabelled/unlabelled/no forms/no clinical
information)
• Clotted/haemolysed/lipaemic/icteric samples
• Sample is broken or has leaked in transit.
• Transported incorrectly
• Inadequate fixative
• specimen too large for container
• Incorrect media.
• Specimen stability compromised (i.e. age of specimen, temperature
store
Explain different types of containers for sharps, infectious and non-
infectious material

(refer to health care waste )

Session 8: Apply knowledge and skills of rapid
diagnostic test in detecting diseases
 Basic principles of rapid diagnostic tests in
detecting diseases
Definition of the terms
• Rapid tests: : Are serological tests that are used in preliminary medical screening or incase of
emergency diagnosis.
- They either detect antibody (Ab) or antigen (Ag) that an individual develops against the infection
or the viral protein i.e, the antigen of the pathogen.
- Are easy-to-use tests that provide quick results, usually in 20 minutes or less. Also known as rapid
diagnostic tests or RDTs
- Unlike most standard tests, which have to be sent to a lab, rapid tests are done and provide
results at the point of care

• Antibody: Is a glycoprotein which is produced in response to and counteract a particular antigen

OR
Is a substance that causes the body to make a specific immune response
- Each antibody can bind to only one specific antigen
• An antigen :Is a foreign substance that enters your body
OR
Is any substance that causes the body to make an immune response
against that substance.
- This can include bacteria, viruses, fungi, allergens, venom and other
various toxins
• Agglutination: Refers to the clumping of particles together, is an
antigen-antibody reaction that occurs when an antigen is mixed with
its corresponding antibody at a suitable pH and temperature

• Incubation period : Is the time between infection or contact with the

agent and the onset of symptoms or signs of infection. The incubation
period ends when the first signs or symptoms of the disease appear.
• Window period: The time between when a person is exposed to a
bacteria or virus and when a test can accurately detect organism.
- In most cases, people develop antibodies to HIV within 28 days of
infection
- During this time, people experience the so-called window period
when they may have no signs of HIV infection but may transmit HIV to
others.
• Reactive: A reactive result indicates that IgG antibodies to the virus
were present in your blood specimen. A reactive test result indicates
that signs of the condition being tested for are present

• Non- Reactive: indicates that signs of the condition being tested for
are not present
• Invalid: The control line does not appear unable to determine a
positive or negative result

• Serology: is the scientific study of presence of antibodies or other

substances in a blood sample

• Standard operating procedures : is a set of written instructions that

describes the step-by-step process that must be taken to properly
perform a routine activity OR In Healthcare, SOP is defined as a
written set of instructions that a healthcare worker should follow to
complete a job safely, with no adverse effect on personal health or
environment and in a manner that maximizes the probability of a
beneficial health outcome in an efficient manner.
Types of Rapid diagnostic tests
i/rapid antigen test
Ii/ rapid antibody test

RAPID ANTIBODY TEST

This is the test that detects the presence of a patient-generated
antibody that is produced in response to a certain infection.
• Generally, IgG and IgM antibody isotypes are detected in this test.
• IgM is an initial antibody that is produced against the infection
whereas the IgG antibody appears later during the infection.
• These antibodies are present in the blood sample when a person has
an infection and gives a positive test result.
• The sample (blood, plasma, or serum) is taken and added to the well of the test card.
• About 10 mM dilution buffered saline is also added.
• Due to the capillary action, the mixture flows down to the test pad.
• Once the sample hits the conjugation pad, the antibodies present in the sample binds
to the antigen which is already present in the conjugation pad with conjugated gold
nanoparticles.
• Then the formed conjugate complex passes to the nitrocellulose membrane and
comes in contact with the three test lines: M, G, and control.
• M test line is for the recognition of the human IgM antibody and gives a visible
colored line only if the body produces this antibody against a certain infection.
• G test line for the recognition of the human IgG antibody in response to an infection
and produces a visible colored line when binds and forms IgG antibody/antigen/gold
nanoparticle complexes.
• The control line remains at the end and a colored line should always appear in this
region to make sure that the proper volume of the sample has been added.
• The excess sample will flow to the absorption pad.
• The results will be visible within 10 minutes.
RAPID ANTIGEN TEST
This is the test that detects the presence of specific antigen which
indicates the current infection
• This test is commonly used for the detection of respiratory pathogens
like the influenza virus, respiratory syncytial virus (RSV), and
coronavirus.
Principle of rapid diagnostic test
RDT is a qualitative and semi-quantitative – that works on the basis of
immunochromatographic action like lateral flow or agglutination that
forms the antigen-antibody complexes with the specific antigen of the
pathogen from the given sample
- Dipstick, microfluidics, and cassette formats are often used with a
sample on the test card along with certain reagents that provide a
result within half an hour.
 Importance of using rapid diagnostic test in
detecting diseases
• Are easy to use
• Require less time(Its test duration requires 10 minutes to 2 hours
only)
• Are inexpensive
• Less labor
• Intensive training or professional workers to use the rapid test kit is
not required as it has a simple procedure that can be followed easily.
• Little or no special equipment required
Session 9: Utilize principles of antigen rapid diagnostic
test in detecting diseases
Rapid antigen test; This is the test that detects the presence of specific
antigen which indicates the current infection

Common rapid antigen tests used in detecting diseases

• COVID-19 testing-related rapid tests
• Rapid strep tests (for streptococcal antigens)
• Rapid influenza diagnostic tests (RIDTs) (for influenza virus antigens)
• Malaria antigen detection tests (for Plasmodium antigens)
Principle of rapid antigen test
RDT is a qualitative and semi-quantitative – that works on the basis of
immunochromatographic action like lateral flow or agglutination that
forms the antigen-antibody complexes with the specific antigen of the
pathogen from the given sample
- Dipstick, microfluidics, and cassette formats are often used with a
sample on the test card along with certain reagents that provide a
result within half an hour.
• Explain the purpose of using rapid antigen test in detecting disease
- has quickly identified people with infection eg. COVID-19
- informing infection prevention and control measures thus preventing
transmission.
Perform rapid test for malaria according to procedures
• With malaria RDTs, the dye-labelled antibody first binds to a parasite
antigen, and the resultant complex is captured on the strip by a band
of bound antibody, forming a visible line (T - test line) in the results
window
• A control line (C- control line) gives information on the integrity of
the antibody-dye conjugate, but does not confirm the ability to detect
parasite antigen

*perform finger pricking procedure

Interpret malaria rapid diagnostic test results
False results in relation to Malaria rapid diagnostic test
• false-negative results are known to occur for a variety of reasons
- operator error
- poor storage conditions
- pfhrp2/3 gene deletions
- poor performance of specific RDT brands and lots
- low-parasite density infections
• False positive results may observed in patients with rheumatoid factor
(RF), hepatitis C, toxoplasmosis, human African trypanosomiasis,
dengue, leishmaniasis, Chagas disease, and schistosomiasis
Session 10: Utilize principles of antibody rapid
diagnostic test in detecting disease
Rapid antibody test
This is the test that detects the presence of a patient-generated
antibody that is produced in response to a certain infection.
Serum

• Mention common rapid antibody tests used in detecting diseases

-HIV test
-H.Pylori
-Hepatitis B and C
-Syphilis
-Pregnancy
Principle of rapid antibody test

RDT is a qualitative and semi-quantitative – that works on the basis of

immunochromatographic action like lateral flow or agglutination that
forms the antigen-antibody complexes with the presence of a patient-
generated antibody that is produced in response to a certain infection
- Dipstick, microfluidics, and cassette formats are often used with a
sample on the test card along with certain reagents that provide a
result within half an hour.
Perform HIV rapid testing according to guidelines and procedures
• HIV rapid test: An immunochromatographic technique which is used
to detect HIV antibodies in blood. Specimens for this technique
include whole blood, serum and plasma

• When performing HIV rapid test three blood samples must be

available; known HIV positive sample, known HIV negative sample
and a sample of unknown HIV status.
HIV Rapid Tests are Divided into Two Major Groups
• Antibody methods (to detect HIV)
o HIV Rapid tests
o Enzyme Linked Immunosorbent Assay (ELISA)
o Western Blot (confirmatory test if available)

• DNA PCR tests

o Useful in infant (<18 months) diagnosis
o The national protocol for PCR outlines the details of PCR testing
o PCR can only be done at well-equipped laboratories at referral
hospital
Materials and Supplies
It is important to be prepared with all the supplies and materials that are needed for
HIV testing. These include:
o Gloves
o Aprons or laboratory coats
o Timer, clock, or wrist watch with minute hand
o Transfer pipettes, pipette tips
o HIV rapid testing kits
o Alcohol
o Cotton Gauze / wool
o Sterile lancets and syringes
o Safety box/ sharps bin or disinfectant jar for lancets
o Marker pen for marking or labelling
o Paper towels for bench coating, cleaning, and hand washing
o Antiseptic for hand washing
o Leak-proof bag for containing or moving labelled biohazard waste for
incineration
o Disinfectant e.g. Jik, Clorox
o Bandages or plasters
Perform Syphilis rapid testing according to guidelines and procedures

• This is a qualitative rapid membrane immune-chromatographic test

which can detect antibodies to T. pallidum by whole blood
(fingerstick), serum, or plasma in about 10 minutes.
• he WHO STI guideline recommends screening all pregnant women
for syphilis during the first antenatal care visit. Remarks: This
recommendation applies to all settings, including settings with high or
low prevalence of syphilis.
• A single injection of long-acting Benzathine penicillin G can cure the
early stages of syphilis. This includes primary, secondary, or early
latent syphilis. CDC recommends three doses of long-acting
Benzathine penicillin G at weekly intervals for late latent syphilis or
latent syphilis of unknown duration.
Test procedure
• Use test kit immediately after opening
• Using a dropper provided transfer 1 drops of the serum or plasma or 2
drops of the whole blood samples to the sample well on the cassette
• Add 1 drop of buffer
• Read results at 5 minutes. Results read after 20 minutes are
considered invalid.
Perform H. Pylori rapid testing according to procedures
• The H. pylori Rapid Test Device (Whole Blood/Serum/Plasma) is a
rapid chromatographic immunoassay for the qualitative detection of
antibodies to H. pylori in whole blood, serum, or plasma
to aid in the diagnosis of H. pylori infection in adults 18 years of age
and older.
• H. pylori is a small, spiral-shaped bacterium that lives in the surface of
the stomach and duodenum

• It is implicated in the etiology of a variety of gastrointestinal diseases,

including duodenal and gastric ulcer, non-ulcer dyspepsia and active
and chronic gastritis.
• Both invasive and non-invasive methods are
used to diagnose H. pylori infection in patients with symptoms of
gastrointestinal disease

• The H. pylori Rapid Test Device (Whole Blood/Serum/Plasma) is a

simple test that utilizes a combination of H. Pylori antigen coated
particles and anti-human IgG to qualitatively and selectively
detect H. pylori antibodies in whole blood, serum, or plasma in just
minutes.
Procedures
Allow the test, specimen, buffer, and/or controls to reach room
temperature (15-30°C) prior to testing.
• Bring the pouch to room temperature before opening it. Remove the
test device from the sealed
pouch and use it as soon as possible.
• Place the test device on a clean and level surface.
• For Serum or Plasma or whole blood specimens: Hold the dropper
vertically and transfer 2 drops of serum or
plasma (approximately 50 μL) to the specimen well (S) of the test
device, then add 1 drop of buffer to the specimen well (S).
• Start the timer
• Wait for the colored line(s) to appear. Read results at 10 minutes. Do
not interpret the result after 15 minutes
Interpretation of results
• POSITIVE:Two lines appear. One colored line should be in the control line
region (C) and another apparent colored line should be in the test line
region (T)

*NOTE: The intensity of the color in the test line region (T) will vary
depending on the concentration of H. pylori antibodies in the specimen.
Therefore, any shade of color in the test line region (T) should be considered
positive.
• NEGATIVE: One colored line appears in the control line region (C). No line
appears in the test line region (T).
• INVALID: Control line fails to appear. Insufficient specimen volume or
incorrect procedural techniques are the most likely reasons for control line
failure. Review the procedure and repeat the test with a new test. If the
problem persists, discontinue using the test kit immediately and contact
your local distributor
Perform Hepatitis B rapid testing according to guidelines and
procedures

• HBV Rapid test qualitatively detects for the presence of Hepatitis B

surface antibody in human serum or plasma samples.

• This test applies lateral flow immuno-chromatography and is for

professional in vitro diagnostic use.
Test Procedure
• Ensure specimen and test kits are brought to room temperature
before testing.
• Open the foil wrapped pouch and remove the cassette. Place the
cassette on a flat, clean surface. Use test immediately after opening.
• Using a dropper provided transfer 3 drops of the serum or plasma
(approx. 75 μl) to the sample well on the cassette. Avoid trapping air
bubbles.
• Read results at 15 minutes.
• Results read after 20 minutes are considered invalid. Dispose of the
cassette safely after testing.
HCV Rapid test qualitatively detects for the presence of Hepatitis C surface antibody in human serum or
plasma samples.
The end
The end
The end