SEARO – CSR Training on Outbreak Investigation Laboratory specimen: collection, safe transport and biosafety Protect yourself and protect others Biosafety in specimen collection and transport

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Learning Objectives At the end of the presentation, participants should be able to: –Identify principles in biosafety –Practice hand hygiene –Identify protective equipment to use for different routes of infection –Describe safe disposal of some hazardous wastes

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Biosafety: protect the patient First Rule: single use equipment Disinfect Work in a clean, dedicated area

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Biosafety: protect yourself Use personal protective equipment –disposable gloves –laboratory coats / gown –mask –protective eyewear / face shields if procedure is likely to generate aerosols

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Personal Protection: Gloves Whenever possible, suitable gloves should be worn when handling biohazardous materials –not a substitute for regular and proper hand hygiene

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Personal Protection: Hand hygiene Alcohol based hand rubs are gold standard in health care settings (if hands not visibly soiled) Photos: WHO

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Personal Protection: Hand hygiene Alcohol based hand rubs must complement with hand washing with normal soap Photos: WHO

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Infection control precautions Precaution UseRequirementsDisease Example Contact Patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient's environment Gloves Gown Nipah, Ebola, chickenpox Droplet Barrier to stop infections spread by large (>5 microns), moist droplets produced by people when they cough, sneeze or speak Contact precautions Well-fitting mask Eye protection Influenza, SARS, parainfluenza Airborne Patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei Contact precautions Droplet precautions N95 mask Isolation room (In hospital) TB, Legionella, measles, chickenpox

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Biosafety: protect others, protect the environment –Package samples appropriately for transport –Decontaminate spills - 10% bleach –Disinfect working areas – 1% household bleach –Soak contaminated non-disposable equipment/ material – 1% household bleach for 5 minutes –Place waste in leak-proof bags –Ensure safe final management of waste –Protect cleaning personnel – coat, gloves

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Spill clean-up procedure Wear gloves and other PPEs as indicated Cover the spill with a cloth or paper towels Pour an appropriate disinfectant over the cloth Apply the disinfectant concentrically After about 30 min, clear away the materials. If with broken glass collect and deposit into a puncture- resistant container Clean and disinfect the area of the spillage Dispose of contaminated materials Report the incident

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Some chlorine products available in the market Chlorine product% available chlorine Bleaching powder35% Stabilized/tropical25% High-test hypochlorite70% Liquid laundry bleach5% Liquid laundry bleach7%

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Chlorine Dilution according to use Chlorine Product Household Bleach (5% active chlorine) Household Bleach (30% active chlorine) Calcium Hypochlorite powder or chlorine granules (70%) Disinfection of excreta, cadavers, body fluids 0.5% available chlorine solution Add 1 litre of bleach to 9 litres of water (1:10 solution) Add 16 grams (1 tablespoon) to 1 litre of water Dissolve 7 grams (1/2 tablespoon) in 1 litre of water Disinfection of gloved hands, bare hands/ skin, floors, clothing and equipment, bedding 0.05% available chlorine solution Add 100 ml of bleach to 9.9 litres of water Add 16 grams (1 tablespoon) to 10 litre of water Dissolve 7 grams (1/2 tablespoon) in 10 litre of water

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Disinfecting water using a 1% stock solution What you need: –(4 pcs) plastic water containers (>= 10-litre) –1% chlorine stock solution –(1 pc)) 5-ml syringe –Comparator or test strip –(40 litres) of water (10 litres in each container)

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Disinfecting water using a 1% stock solution Process of disinfection: –Prepare 1% chlorine stock solution –Fill the containers with 10 litres of water each –Using a syringe, add progressively greater doses of 1% chlorine solution e.g., 1 st container – 1 ml 2 nd container – 1.5 ml 3 rd container – 2 ml 4 th container – 5 ml –Let it stand for 30 minutes and measure residual free chlorine concentration with test trip –Choose the sample with 0.4 – 0.5 mg/litre of free residual chlorine

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Preparation of 1%, 0.5% and 0.05% chlorine stock solution Chemical product % Available chlorine 1% chlorine For disinfecting: Water (to come up with 0.4—0.5 mg/ l of free residual chlorine) 0.5% chlorine For disinfecting: Cadavers Body fluids 0.05% chlorine For disinfecting: Gloved hands, bare hands and skin Floors Clothing and equipment, beddings Required amount Approximate measurements Required amount Approximate measurements Required amount Approximate measurements Bleaching powder (Chlorine of lime) 3530 g2 tablespoons16 g1 tablespoon16 g1 tablespoon Stabilized/tropical2540 g3 tablespoons20 g 1 ½ tablespoons 20 g 1 ½ tablespoons High-test hypochlorite (HTH or Calcium hypochlorite) 7014 g1 tablespoon7 g½ tablespoon7 g½ tablespoon Liquid laundry bleach5200 ml 1 teacup or 6 oz tin 100 ml ½ teacup or 3 oz tin 100 ml ½ teacup or 3 oz tin Liquid laundry bleach7145 ml10 tablespoons73 ml5 tablespoons73 ml5 tablespoons Javelle water1 500 ml 2 ½ teacups or 15 oz 500 ml 2 ½ teacups or 15 oz Total amount of stock solution1 litre 10 litres Mix the required amount of one of the given chemical products with clean water, making up to the total amount of stock solution (1 litre, 10 litres) in an airtight, opaque and non-metallic container.

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Some tips Handle the dry product with care. Avoid shaking and exposure to high temperatures or flames. Avoid direct contact with the chemical product. Use clean water in preparing the stock solution. Use non-metallic containers in preparing and storing the solution. Prepare and store stock solution in a well ventilated area. Avoid inhaling vapours and dust when opening or handling the containers. Solutions must be prepared daily and protected from heat, light and moisture.

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Dispose sharp material in bio-hazard sharps containers If no sharps container: improvise one and collect sharps immediately to prevent needle-stick injury Have first aid kit readily accessible Do not reuse contaminated equipment

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Items Requiring Disposal Infectious blood, body fluids, leftover biological samples Disposable needles and syringes * Disposable or non- reusable protective clothing * Disposable or non- reusable gloves Used laboratory supplies * Used disinfectants * Incineration recommended

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Building an Incinerator 1.Cut out one end of a 220 liter drum 2.Cut out 3 half-moon openings 3.Cut 4 side holes and insert metal rods to form an X 4.Cut away half of other end of drum to form lid 5.Insert first end cut as a waste platform

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation How to burn waste in an Incinerator 1.Place waste on platform inside of the drum 2.Soak waste in one liter of fuel 3.Light the fire carefully 4.Watch the fire and frequently mix the waste with the metal bars to be sure all of the waste is burned 5.When the fire has gone out, empty the ashes into a pit Note: You must replace the incinerator if large holes burn through the sides.

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Disposal Using a Pit Can be used for disposal of: –Liquids, if no isolation latrine or toilet is available –All other flammable items such as clothing Building a Pit: –Locate pit far from foot traffic flow –Dig 2 meters deep, wide enough to hold all contaminated waste material

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation How to Burn Waste in a Pit 1.Place disinfected waste in the pit 2.Pour fuel over waste 3.Carefully start fire 4.Observe burning process 5.Repeat fire if waste remains after burning 6.Cover ashes with soil 7.Bury a nearly full pit with ½ meter of soil 8.Dig a new pit for more waste

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation Disposal Safety Precautions Use safe handling practices for infectious material Locate disposal site on health facility grounds, away from traffic flow and public view Maintain disposal site security by roping off, posting signs, and stationing a guard Do not leave unburned waste in an incinerator or pit

Laboratory specimen: biosafety in specimen collection and transport SEARO – CSR Training on Outbreak Investigation