Hltin301c v2 Comply With Infection Control Policies and Procedures in Health Work

Training Division
CHC30212 Certificate III in Aged Care
HLTIN301C
COMPLY WITH INFECTION CONTROL POLICIES AND PROCEDURES
Learning Materials
TABLE OF CONTENTS
Welcome ........................................................................................................................................................................4 Competency ...................................................................................................................................................................4 Assessment.....................................................................................................................................................................4 Essential knowledge: ......................................................................................................................................................6 Essential skills: ................................................................................................................................................................7 RANGE STATEMENT........................................................................................................................................................7 EVIDENCE GUIDE ............................................................................................................................................................9
GLOSSARY OF TERMS .......................................................................................... 11 FOLLOW INFECTION CONTROL GUIDELINES .................................................... 14

Demonstrate the application of standard precautions to prevent the spread of infection in accordance with organisation requirements ...........................................................................................................................................14 Demonstrate the application of additional precautions when standard precautions alone may not be sufficient to prevent transmission of infection ............................................................................................................15 Minimise contamination of materials, equipment and instruments by aerosols and splatter ....................................18
IDENTIFY AND RESPOND TO INFECTION RISKS .................................................... 20

Identify infection risks and implement an appropriate response within own role and responsibility .........................20 Document and report activities and tasks that put clients and/or other workers at risk ............................................23 Respond appropriately to situations that pose an infection risk in accordance with the policies and procedures of the organisation ....................................................................................................................................25 Follow procedures for risk control and risk containment for specific risks ..................................................................26 Follow protocols for care following exposure to blood or other body fluids as required ...........................................30 Place appropriate signs when and where appropriate ................................................................................................32 Remove spills in accordance with the policies and procedures of the organisation ...................................................34
MAINTAIN PERSONAL HYGIENE .......................................................................... 36

Maintain hand hygiene by washing hands before and after client contact and/or after any activity likely to cause contamination ....................................................................................................................................................36 Follow hand washing procedures .................................................................................................................................37 Implement hand care procedures ................................................................................................................................40 Cover cuts and abrasions with water-proof dressings and change as necessary ........................................................42
USE PERSONAL PROTECTIVE EQUIPMENT ....................................................... 43

Wear personal protective clothing and equipment that complies with Australian/New Zealand Standards, and is appropriate for the intended use ......................................................................................................................43 Change protective clothing and gowns/aprons daily, more frequently if soiled and where appropriate, after each client contact .......................................................................................................................................................43
LIMIT CONTAMINATION ......................................................................................... 45

Demarcate and maintain clean and contaminated zones in all aspects of health care work ......................................45 Confine records, materials and medicaments to a well-designated clean zone ..........................................................46
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HLTIN301C Version 2 (August 2012)
Confine contaminated instruments and equipment to a well-designated contaminated zone ..................................47
HANDLE, PACKAGE, LABEL, STORE, TRANSPORT AND DISPOSE OF CLINICAL AND OTHER WASTE .......................................................................................................... 54
Wear appropriate personal protective clothing and equipment in accordance with Workplace Health and Safetypolicies and procedures when handling waste ..................................................................................................54 Separate waste at the point where it has been generated and dispose of into waste containers that are colour coded and identified .........................................................................................................................................55 Store clinical or related waste in an area that is accessible only to authorised persons .............................................59 Handle, package, label, store, transport and dispose of waste appropriately to minimize potential for contact with the waste and to reduce the risk to the environment from accidental release ..................................................61 Dispose of waste safely in accordance with policies and procedures of the organisation and legislative requirements ................................................................................................................................................................63
CLEAN ENVIRONMENTAL SURFACES ................................................................ 65

Wear personal protective clothing and equipment during cleaning procedures.........................................................65 Remove all dust, dirt and physical debris from work surfaces .....................................................................................66 Clean all work surfaces with a neutral detergent and warm water solution before and after each session or when visible soiled .......................................................................................................................................................66 Decontaminate equipment requiring special processing in accordance with quality management systems to ensure full compliance with cleaning, disinfection and sterilisation protocols ...........................................................66
SUSTAINABILITY PRACTICES .............................................................................. 69

Definition ......................................................................................................................................................................69 Social ............................................................................................................................................................................69 Economic ......................................................................................................................................................................70 Workforce ....................................................................................................................................................................70 environmental ..............................................................................................................................................................71
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WELCOME Welcome to this unit of study. As you work through the learning guide and assessment, you will be developing knowledge about this unit of study. If you do not understand an activity, ask questions and discuss any queries with your trainer, mentor or supervisor. It is important that you develop skills in a work situation, or, in a simulated situation that approximates the workplace as closely as possible. We encourage you to contact us for assistance at any time. Simply call or email and CHARLTON BROWN will be able to assist you. COMPETENCY In order to be assessed as competent (C), you will need to provide evidence which demonstrates that you have the essential knowledge and skills to successfully complete the unit to the required standard. Competency is simply being able to demonstrate that you can do the task, not just once, but with confidence, repeatedly. Please read the beginning of this unit, it will tell you about the elements and the performance criteria you will be assessed against. It will also inform you of the knowledge and skills you require to successfully complete the unit. If you can already demonstrate such knowledge and skills you can undertake these skills you should talk to your trainer. Marking guide at the end of each unit you will find a marking guide. designed to assist you This is
ASSESSMENT
1.
2.
3.
Complete all the assessment tasks in the unit. You will find these at the end of the unit. Have your supervisor sign the statement of validation that you can undertake these skills in the workplace. Complete the Assessment Cover Sheet and sign all sections. Check the marking guide to ensure you have covered all elements of the assessment. The marking guide is used by the assessor to mark off your competency
The evidence you need to provide for an assessment of competence in this unit will be based on, but not limited to: Successful completion of assessment Verbal discussion and questioning by assessor Mentor / supervisor / workplace coach verification of skills Any other evidence you or your assessor have gathered Any other activities your assessor considers necessary You are required to submit your work in a neat, orderly, detailed and organized manner. Use references in all your work.
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ELEMENT
Elements define the essential outcomes of a unit of competency. 1. Follow infection control guidelines
PERFORMANCE CRITERIA
The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in bold italics are elaborated in the Range Statement. 1.1 Demonstrate the application of standard precautions to prevent the spread of infection in accordance with organisation requirements Demonstrate the application of additional precautions when standard precautions alone may not be sufficient to prevent transmission of infection Minimise contamination of materials, equipment and instruments by aerosols and splatter
1.2
1.3 2. Identify and respond to infection risks
2.1 Identify infection risks and implement an appropriate response within own role and responsibility 2.2 Document and report activities and tasks that put clients and/or other workers at risk 2.3 Respond appropriately to situations that pose an infection risk in accordance with the policies and procedures of the organisation 2.4 Follow procedures for risk control and risk containment for specific risks 2.5 Follow protocols for care following exposure to blood or other body fluids as required 2.6 Place appropriate signs when and where appropriate 2.7 Remove spills in accordance with the policies and procedures of the organisation 3.1 Maintain hand hygiene by washing hands before and after client contact and/or after any activity likely to cause contamination 3.2 Follow handwashing procedures 3.3 Implement hand care procedures 3.4 Cover cuts and abrasions with water-proof dressings and change as necessary 4.1 Wear personal protective clothing and equipment that complies with Australian/New Zealand Standards, and is appropriate for the intended use 4.2 Change protective clothing and gowns/aprons daily, more frequently if soiled and where appropriate, after each client contact 5.1 5.2 5.3 Demarcate and maintain clean and contaminated zones in all aspects of health care work Confine records, materials and medicaments to a welldesignated clean zone Confine contaminated instruments and equipment to a well-designated contaminated zone Wear appropriate personal protective clothing and equipment in accordance with Workplace Health and Safetypolicies and procedures when handling waste Separate waste at the point where it has been generated and dispose of into waste containers that are colour coded and identified Store clinical or related waste in an area that is accessible only to authorised persons Handle, package, label, store, transport and dispose of waste appropriately to minimize potential for contact with the waste and to reduce the risk to the
3. Maintain personal hygiene
4.
Use personal protective equipment
5.
Limit contamination
6.
Handle, package, label, store, transport and dispose of clinical and other waste
6.1
6.2
6.3 6.4
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ELEMENT
Elements define the essential outcomes of a unit of competency.
PERFORMANCE CRITERIA
The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in bold italics are elaborated in the Range Statement. environment from accidental release 6.5 Dispose of waste safely in accordance with policies and procedures of the organisation and legislative requirements 7.1 Wear personal protective clothing and equipment during cleaning procedures 7.2 Remove all dust, dirt and physical debris from work surfaces 7.3 Clean all work surfaces with a neutral detergent and warm water solution before and after each session or when visible soiled 7.4 Decontaminate equipment requiring special processing in accordance with quality management systems to ensure full compliance with cleaning, disinfection and sterilisation protocols 7.5 Dry all work surfaces before and after use 7.6 Replace surface covers where applicable 7.7 Maintain and store cleaning equipment
7. Clean environmental surfaces
ESSENTIAL KNOWLEDGE:
Basic microbiology including: - bacteria and bacterial spores - fungi - viruses Aspects of infectious diseases including: - pathogens - opportunistic organisms Disease transmission: - sources of infecting microorganisms including persons who are carriers, in the incubation phase of the disease or those who are acutely ill - paths of transmission including direct contact, aerosols and penetrating injuries - risk of acquisition Susceptible hosts including persons who are immune suppressed, have chronic diseases such as diabetes and the very young or very old Organisation requirements relating to immunisation, where applicable The organisations infection control policies and procedures Identification and management of infectious risks in the workplace Clean and sterile techniques Standard precautions Additional precautions Good personal hygiene practice including hand care Effective hand hygiene: - when hands must be washed - procedures for routine handwash - procedures for surgical handwash Personal protective equipment: - guidelines for wearing gowns and waterproof aprons - guidelines for wearing masks as required - guidelines for wearing protective glasses
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guidelines for glove use
Surface cleaning: - cleaning procedures at the start and end of the day - routine surface cleaning - managing a blood or body fluid spill Sharps handling and disposal techniques ESSENTIAL SKILLS: Ability to: Apply standard precautions: - consistently follow the procedure for washing and drying hands - consistently put into practice clean and sterile techniques - consistently use personal protective equipment - consistently limit contamination - consistently maintain clean surfaces and manage blood and body fluid spills - consistently protect materials, equipment and instruments from contamination until required for use - consistently ensure instruments used for invasive procedures are sterile at time of use (where appropriate) Apply additional precautions when standard precautions are not sufficient
RANGE STATEMENT The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Standard precautions include: Aseptic technique Personal hygiene practices especially washing and drying hands (e.g. before and after client contact) Use of personal protective equipment Techniques to limit contamination Surface cleaning and management of blood and body fluid spills Safe handling of sharps Safe disposal of sharps and other clinical waste
Appropriate reprocessing and storage of reusable instruments Additional precautions may include: Special ventilation requirements Additional use of personal protective equipment Dedicated equipment (e.g. to each client or as appropriate to work function)
Use of a special facility Minimising contamination may include but is not limited to: Protecting materials, equipment and instruments from contamination until required for use Ensuring instruments used for invasive procedures are sterile at time of use
Cleaning all environmental surfaces Infection risks may include but are not limited to Sharps injury Waste Discarded sharps Human waste and human tissues Related waste General waste Inhalation of aerosols
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Contact with blood and other body substances Personal contact with infectious materials, substances and/or clients Stock including food which has passed used-by dates
Animals, insects and vermin Procedures for risk control may include but are not limited to Eliminating a hazardous process Using personal protective equipment appropriately Changing a system of work to reduce a hazard. Isolating the hazard Using protective devices to decrease exposure Using safe handling techniques Following infection control policies and procedures
Procedures to minimise the risk of exposure to blood and body fluids Protocols for care following exposure to blood or other body fluids may include but are not limited to: Immediate care following: A sharps injury A splash of blood or other body fluids Post exposure care
Record keeping and notification Legal requirements for the notification of all work related occurrences of injury, disease or illness Hand hygiene procedures may include: Routine handwash Surgical handwash
Use of antiseptic wipes and alcohol based preparations in specific situations where waterless hand hygiene is acceptable Hand care may include but is not limited to: Suitable water-based hand creams that are registered on the Australian Register of Therapeutic Goods Using warm water for handwashing Drying hands thoroughly after handwashing
Wearing heavy-duty utility gloves when handling irritant chemicals Protective clothing and equipment may include but are not limited to Gowns and waterproof aprons that comply with Australian/New Zealand standards Examination gloves and surgical gloves that comply with current Australian/New Zealand standards Glasses, goggles or face-shields Surgical face masks that comply with current Australian/New Zealand standards Footwear to protect from dropped sharps and other contaminated items
Guidelines for latex allergic clients and staff Clean zone includes but is not limited to: Storage areas for materials, medicaments, equipment Sterile storage areas Administration areas Contaminated zone includes but is not limited to: Area used for items that have become contaminated during use Receiving area for contaminated instruments in the instrument reprocessing centre Waste may include but is not limited to: Clinical waste: discarded sharps human tissues
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laboratory waste any other waste as specified by the workplace
Related waste: - radiographic waste - chemical and amalgam waste - cytotoxic waste - pharmaceutical waste - radioactive waste
General waste Disposal of waste requirements may include: Disposal in accordance with: - Environment Protection (Waste Management) Policy - Environment Protection (Waste Management) Regulations - Australian and New Zealand standards
Organisation policies and procedures Cleaning procedures include but are not limited to Damp dusting benches, equipment and shelving Maintaining the interior of drawers and cupboards in a clean and tidy state Cleaning floors daily using a mop and water and detergent Storing cleaning equipment clean and dry Managing the removal of a small blood or body fluid spill
EVIDENCE GUIDE Observation of workplace performance is preferred for assessment of this unit The assessee must provide evidence of specified essential knowledge as well as skills The assessee must demonstrate compliance with the organisations infection control policy as it relates to specific job role Consistency of performance should be demonstrated over the required range of workplace situations: - consistent application of handwashing, personal hygiene and personal protection protocols - consistent application of clean and sterile techniques
consistent application of protocols to limit contamination Context of and specific resources for assessment: Assessment should replicate workplace conditions as far as possible Where, for reasons of safety, access to equipment and resources and space, assessment takes place away from the workplace, simulations should be used to represent workplace conditions as closely as possible Method of assessment Evidence of essential knowledge and understanding may be provided by: - traditional or online (computer-based) assessment - written assignments/projects Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice Questioning Staff and/or client feedback Supporting statement of supervisor Authenticated evidence of relevant work experience and/or formal/informal learning
Role play/simulation Access and equity considerations: All workers in the health industry should be aware of access and equity issues in relation to their own area of work
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All workers should develop their ability to work in a culturally diverse environment In recognition of particular health issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on health of Aboriginal and Torres Strait Islander people Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on health of Aboriginal and/or Torres Strait Islander clients and communities
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GLOSSARY OF TERMS ..........................................................................................

Term
Additional precautions
Meaning
Infection control precautions that are applied in the known to have communicable disease or to be Precautions include isolation of the client and strict who care for the client must wash hands thoroughly, and use other equipment as necessary care of a client who is in an infectious state. control of visitors. Staff wear disposable gowns
Airborne transmission Asepsis Bacteria
Occurs by dissemination or either dust particles containing infectious agents or airborne droplet nuclei
Is defined as the absence of infectious agents that may produce disease

Single cell microscopic organisms with a nucleus that have the capacity to reproduce rapidly. Different kinds of bacteria tend to effect different organs and systems of the body, producing a range of infectious diseases. Term used rather than body fluid to emphasise the need for precautions to prevent contact with solid tissue and faeces as well as body fluids A disease that can be spread from person to person. The disease is caused by pathogens The process of becoming unclean and contaminated with microorganisms Refers to the removal of organic matter, including visible soils and germs, from surfaces and devices Includes waste which has the potential to cause injury, disease or public offence and includes: discarded sharps human tissue including material or solutions containing free flowing blood (excludes hair, teeth and nails) laboratory and associated waste directly involved in specimen processing
Body substance Communicable disease Contamination Cleaning Clinical waste
Contact transmission Disinfection
Refers to transmission of infectious agents through direct or indirect contact with a contaminated piece of equipment, skin-to-skin contact and a consumers environment Refers to a process that eliminates many of all pathogenic micro-organisms, except bacterial spores on devices and instruments and can be achieved by heat or chemical means Refers to the transmission of infectious agents through respiratory droplets generated from consumer secretions propelled through the air, by coughing, sneezing, talking and during procedures that generate aerosols such as suctioning. Close proximity, within one metre is required as droplets do not stay suspended in the air and generally travel short distances. Droplet transmission involves contact of the conjunctive or mucous membranes, of the nose, mouth or eyes, of a susceptible person.
Droplet transmission
Exposure
Defines as an injury that involves direct skin contact with blood or other body substances where the skin integrity is compromised or in which there is direct mucus membrane contact. The exposure may be due to needle stick or sharp instrument injury, or a splash, bite or scratch. Refers to an individual exposed to blood or body fluid Refers to invasive procedures where there is potential for direct contact between skin, usually the finger or thumb of a staff member and sharp surgical instruments, needles or sharp tissues in body cavities or in
Exposed person Exposure-prone procedures
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poorly visualised or confined body sites of a consumer. An exposure-prone procedure is one in which there is potentially a high risk of transmitting a blood borne disease between a staff member and a consumer during a medical or dental procedure. Fungi Tiny organisms, such as mould and yeasts that belong to the world of plants but contain no chlorophyll. They multiply by producing various kinds of spores. Some fungi infections appear on the skin such as tinea. Includes other waste that does not fall into the categories of clinical or related waste. It forms the bulk of waste generated an is no concern to public health such things as paper, plastic etc. Refers to the action of performing hand hygiene for the purpose of physically or mechanically removing dirt, organic matter or microorganisms. Is an essential step in hand cleansing and should be done in such a way that hand recontamination does not occur. A general term which applies to any action of hand cleaning. Anything with the potential to cause injury or disease In a health care setting, a hazard is defined as an agent (biological, chemical or physical) that has the potential to cause harm to people or the environment. In infection control, a hazard is either an infectious agent, or a mechanism that allows the transmission of an infectious agent. Are parasitic worms. Most worm infections are transmitted from person-to-person via faeces that contaminate food and water tapeworm, roundworm, and pinworm. A disease state resulting from the invasion and growth of microorganisms in the human body Microbes that cause infection in the human body (pathogens) belong to 1 of 5 major groups bacteria, viruses, fungi, protozoa and helminths. Infection is preceded by colonisation. There is natural latex which is produced from the sap of the commercial rubber tree, Hevea brasiliensis. Synthetic rubber is derived from petrochemicals. Latex sensitisation is related to proteins found in latex and not to chemical additives found in latex products Is a percutaneous injury with and sharps designed for use in the health care that may potentially transmit infectious agents, and particularly blood borne viruses. Sharps may or may not have been used on consumers
General waste
Hand cleansing
Hand drying Hand hygiene Hazard
Helminth
Infection
Latex
Needle stick injury
Notifiable disease Refers to a diseases or conditions that, by law, must be notified to the relevant State/ Territory Health department. Outbreak Is defined as the occurrence of an infection at a rate greater than that expected within a specific geographical area and over a define period of time. Workplace Health and Safety
WHS
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Pathogen Personal Protective Equipment (PPE) Protozoa
A microbe that is harmful and can cause an infection or a disease Refers to specialised clothing or equipment worn by staff alone, or in combination, to protect mucous membranes, skin, and clothing against recognised or unrecognised infectious material e.g. Gloves, gown or plastic apron and eye goggles or shield A single cell microbe from the animal kingdom. They are considered to be parasites that use nutrients from other living organisms to survive and can survive in the environment for a long period of time. They enter the body through contaminated water, insect bites and sexual intercourse. Cytotoxic waste Pharmaceutical waste Chemical waste Radioactive waste
Related waste
Reprocessing Reusable item Risk Sign Scabies Sharp/s
Refer to cleaning with or without disinfection or sterilization, so as to render the medical device or equipment safe to use. Refers to an item designated or intended by the manufacture to be suitable for reprocessing and reuse e.g. cleaning, disinfecting. The likelihood of injury or illness occurring. What you observe when caring for a client. Refers to a parasitic disease caused by a mite, Sarcoptes scabiei, which penetrate the cornflower layer of the skin Refers to any object or device capable of cutting or penetrating the skin, which may or may not be contaminated with blood and/ or body substances including needles, scalpel blades, wires, lancets, stitch cutters, glass and any other sharp object or instruments designed to perform penetrating procedures. Refers to a receptacle designed to the relevant Australian Standard, for the disposal of sharps. Refers to the individual whose blood or body fluids was inoculated into or splashed onto the affected person. The source individual may sometimes not be identifiable. Refers to a body substance either solid or liquid obtained from a consumer for the purpose of analysis. The aim of such analysis is to identify microorganisms that cause disease and to provide direction for appropriate treatment, if needed in a timely manner Refers to the minimum work practices required in all settings and situations to achieve a basic level of infection control are recommended for the treatment and care of all consumers. Precautions that prevent the spread of infection within a health care setting Refers to the process that destroys or eliminates all forms of microbial life. All objects to be sterilised must first be cleaned to remove all organic matter and other residue. What the client tells you if they are unwell. The term previously applied to work practices that required everyone to assume that all blood and body substances are potential infection, independent of perceived risk. Are microbes which are much smaller than bacteria, they have no cell structure and lack a rigid cell wall. Viruses can grow and reproduce only when there is a resident within a host cell. Viruses need the nutrients and parts of other cells to survive
Sharps container Source individual
Specimen
Standard precautions
Sterilization
Symptom Universal precautions Viruses
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FOLLOW INFECTION CONTROL GUIDELINES ..........................................................................................

Every person is potentially a source of infection and must be considered as such in order to protect staff, consumers and others from cross infection. Factors such as micro-organisms capable of causing infection, a favourable environment and a susceptible host will always exist in health care settings, including consumers homes. These factors however can be reduced but not necessarily eliminated.
DEMONSTRATE THE APPLICATION OF STANDARD PRECAUTIONS TO PREVENT THE SPREAD OF INFECTION IN ACCORDANCE WITH ORGANISATION REQUIREMENTS
Maintaining safe environment for people, residents/clients, families, visitors, and staff in a health care environment is a complex matter. There are many infectious agents present in the health care environment. Clients/residents might be infected with communicable diseases or have wound that carry infections. Care workers or visitors may also carry or be infected by diseases. It will be necessary to handle equipment, material and waste product that carry infection. Therefore, health care workers can be infected during the course of their duties and other people could be at risk while visiting and working in the health care setting. Health-care related infections are extremely serious and can be life threatening in some circumstances. Organisational infection control policy and procedures are designed to minimise transfer of infection in the health care setting by providing safe work practices for activities, including: Hygiene and hand washing procedures Cleaning and decontamination procedures for surfaces and equipment Correct use of chemical disinfectants and manufacturers specifications Correct use of Personal Protective Equipment (PPE) Handling and cleaning of contaminated linen Procedures for managing spills Safe handling and disposal of infectious wastes Safe handling and disposal of sharps Storage of processed equipment. Cleaning, disinfection and sterilisation process and documentation requirements
They will also contain Workplace Health and Safety (WHS) Regulation guidelines for: Accident reporting and management e.g. what to do in case of a needle stick injury Staff health issues e.g. vaccination requirements and health screening of health care workers All health care workers must know and follow current policies and procedures in the workplace. It is important to remember that: Infection control policy and procedure will vary between health care facilities. Policy and procedures is reviewed regularly and can change. It requires a team approach by all health care workers to be effective.
Standard precautions are recommended for the care and treatment of all patients, regardless of their perceived or confirmed infectious status, and in the handling of: Blood (including dried blood), All other body fluids, secretions and excretions (excluding sweat), regardless of whether they contain visible blood, Non-intact skin, Mucous membranes.
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The use of standard precautions is essential as the primary strategy for the successful minimisation of transmission of health care associated infection. This is because:
Infectious patients may not show any signs or symptoms of infection that may be detected in a routine history and medical assessment. A patients infectious status is often determined by laboratory tests that may not be completed in time to provide emergency care. Patients may be infectious before laboratory tests are positive or symptoms of disease are recognised (the window period of disease). People may be placed at risk of infection from those who are asymptomatic but infectious.
Standard Precautions
These are work practices required for the basic level of infection control, and are recommended for the treatment and care of all patients. They include: Hygienic practices, particularly washing and drying hands before and after patient contact. Use of protective barriers when necessary, which may include gloves, gowns, plastic aprons, masks, eye shields or goggles. Appropriate handling and disposal of sharps and other contaminated or clinical waste. Appropriate reprocessing of reusable equipment and instruments. Use of aseptic technique. Use of environmental controls.
The implementation of standard precautions benefits patients as well as Health Care Workers (HCW). The use of these standards minimises the risk of cross-infection from HCW to patient, from patient to HCW, and from patient to patient even in high-risk situations. It is recommended for the care and treatment of all patients, regardless of their perceived infectious status.
DEMONSTRATE THE APPLICATION OF ADDITIONAL PRECAUTIONS WHEN STANDARD PRECAUTIONS ALONE MAY NOT BE SUFFICIENT TO PREVENT TRANSMISSION OF INFECTION
Infection control polices follow a two-tiered approach to reduce the risk of infection transmission in the health care setting and are known as standard precautions and additional transmission-based precautions. Addition precautions must not be used alone and must always be used in addition to standard precautions. Always follow organisational infection control policies and practices correctly for standard and additional precautions in the workplace. Additional precautions should be applied in a health care setting for patients known or suspected to be infected or colonised with infectious agents that may not be contained with standard precautions alone and that could transmit infection by the following means: Airborne transmission of respiratory secretions (e.g. Pulmonary Tuberculosis, Chickenpox, Measles) Droplet transmission of respiratory secretions (e.g. rubella, pertussis (whooping cough), influenza) Contact with patients who may be disseminators of infectious agents of special concern (e.g. faecal contamination from carriers of Vancomycin-resistant enterococci). Inherent resistance to standard sterilisation procedures, or other disease specific means of transmission where standard precautions are not sufficient (e.g. patients with known or suspected CreutzfeldtJakob disease).
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Additional precautions should be tailored to the particular infectious agent involved and the mode of transmission, and may include one or any combination of the following: Allocation of a single room with ensuite facilities A dedicated toilet (to prevent transmission of infections that are transmitted primarily by contact with faecal material, such as for patients with infectious diarrhoea or gastroenteritis caused by enteric bacteria or viruses) Cohorting (room sharing by people with the same infection) if single rooms are not available Special ventilation requirements (e.g. Monitored negative air pressure in relation to surrounding areas) Additional use of personal protective (e.g. a well-fitted respiratory protection device for HCWs attending to patients in respiratory isolation, a 0.3-m particulate filter respiratory protection device 2 is recommended for Tuberculosis) Rostering of immune HCWs to care for certain classes of infectious patients (e.g. those with chickenpox) Dedicated patient equipment; and Restricted movement both of patients and HCWs.
At a glance, the following table outlines the general principles and work practices of standard and additional precautions:
Standard Precautions
Additional Transmission-Based Precautions Additional precautions should be tailed to the particular infections and its means of transmission. These might include:
Use of aseptic techniques Good personal hygiene practices particularly washing and drying hands before and after client/patient contact
Use of appropriate PPE may include gloves, fluid resistant gowns, plastic aprons, masks or face shields and eye protection Appropriate handling of disposable sharps and other infectious or contaminated waste Appropriate reprocessing of reusable equipment and instruments, including appropriate use of disinfectants Environmental controls including environmental cleaning and spills management Appropriate management of support services such as laundry and food services
Isolation of a client/patient in a single room or grouping of client/ patients with the same infection A dedicated toilet for infectious transmitted by contact with faecal material Special ventilation to prevent circulation of infection around the general health care setting Use of addition PPE e.g. respirator or mask Rostering of immune health care workers for certain classes of infection e.g. chickenpox Dedicated client/patient equipment Restricted movement of infectious client/ patient and health care workers Removal of gloves and gowns and hand washing before leaving the room Treatment of all wastes as clinical waste Reprocessing of all equipment after use and before use on next client/ patient Use of single use disposable equipment.
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An outline of the application of additional precautions for infections with respiratory (airborne or droplet) transmission or contact transmission:
Requirement Airborne transmission

Gloves None
Additional precautions types Droplet transmission

None
Contact transmission
For all manual contact with patient, associated devices and immediate environmental surfaces Use when HCWs clothing is in substantial contact with the patient (includes items in contact with the patient and their immediate environment) Protect face if splash likely
Impermeable apron/gown
None
None
Respirator or mask
Particulate filter personal respiratory device for tuberculosis only All others, surgical mask Protect face if splash likely None
Surgical mask
Goggles/face-shields Special handling of equipment
Protect face if splash likely None
Protect face if splash likely Single use or reprocess before reuse on next patient (includes all equipment in contact with patient) If possible, or cohort with patient with the same infection (e.g. methicillin-resistant Staphylococcus aureus) None Notify area receiving patient Remove gloves and gown, and wash hands before leaving patients room
Single room
Yes (or cohort patients with same infection) Door closed Essential for pulmonary tuberculosis Surgical mask*for patient Notify area receiving patient Encourage patients to cover nose and mouth when coughing or sneezing and to wash their hands after blowing nose. Provide one metre of separation between patients in ward accommodation.
mask refers to a fluid-repellent,
Yes (or cohort patients with same infection) Door closed None Surgical mask* for patient Notify area receiving patient Provide one metre of separation between patients in ward accommodation
Negative pressure Transport of patients Other
Surgical
paper
filter
mask
used
in
surgical
procedures
(see
AS
4381)http://www.health.qld.gov.au/EndoscopeReprocessing/module_1/1_1.asp
Employees and contractors must comply with instructions given for the protection of both own and others health and safety. This includes the correct use of safety and protective equipment. They should avail themselves of the relevant information and training programs. Employers and contractors are responsible for providing appropriate information, education and training, and ensuring that a safe work environment is developed and maintained.http://www.health.qld.gov.au/EndoscopeReprocessing/module_1/1_3a.asp When handling waste within a health care facility, it is necessary to carry or to have available and accessible, safety equipment, in case of spills or contamination. All mobile garbage bins and trolleys
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should include barriers and warning signs, spill kits, a first aid kit, fire extinguisher and appropriate waste containers. MINIMISE CONTAMINATION OF MATERIALS, EQUIPMENT AND INSTRUMENTS BY AEROSOLS AND SPLATTER To successfully control the transmission of infection in the health care setting it is necessary to: Identify potential infectious hazards Access the risk and route of transfer Implement control measure to minimise the risk of infection. A hazard in a health care setting is defined as an agent (biological, chemical or physical) that has the potential to cause harm to people or the environment. In regards to infection control, a hazard is either, an infectious agent, or a mechanism that allows the transmission of an infectious agent (e.g. invasive device). Identifying a hazard involves:
Identifying and documenting the activities and tasks that put patients, and, Health care workers (HCWS) at risk of infection (e.g. sharps injury); Identifying and documenting the infectious agent involved; Identifying and documenting the route of infection; and Obtaining evidence to confirm that the infection may be spread using this route (observational or experimental studies plus expert knowledge).
Risk assessment for the transfer of infectious diseases includes:
Hazard identification Hazard characterisation, which involves evaluating the infective dose of the infectious agent and a relationship between the dose received and the frequency/severity of the infection (doseresponse relationship) o o o o o Knowledge of infectious agents, epidemiology etc. Assessment of the health care establishment physical environment (Layout, facilities and practices), Assessment of current infection control procedures, Analysis of records of infection, Level of knowledge and/or training of patients and HCWs.
Exposure Assessment, which involves evaluating factors relating to hazard exposure to determine the dose of infectious agent received, which may be quantitative or qualitative (for example, for a sharps injury this would be the source of infection and the level of contamination) and assessing:
o Patient categories o HCW categories o Procedures (critical, semi-critical, non-critical) o Frequency of exposure.
Risk Characterisation, which involves integrating hazard and exposure information to give a qualitative estimate of risk (e.g. low risk) or, if data is available, a quantitative populationbased estimate (e.g. 1 in 1000).
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The purpose of risk management/control is to minimise peoples exposure to sources of infection, including blood or body fluids, in the health care setting. Depending on the nature of specific risks, risk management may be achieved by:
Eliminating the risk factors. Modifying procedures, protocols and work practices. Engineering controls. Implementing safe work practices. Monitoring HCW and patient compliance with infection control procedures. Providing HCWs with information about personal health conditions that may place them or patients at risk. Providing information/education and training to patients and HCWs. Using personal protective equipment appropriately.
In addition to AS/NZS 4360:1995, a framework for identifying hazards, assessing the risks and implementing risk management is provided by the hazard analysis critical control points (HACCP) approach (ANZFA 1996, Mortimore and Wallace 1998), which is based on the following principles: Determining critical control point plans required to control identified hazards. Specifying critical limits that determine whether a procedure is under control, at a particular control point. Establishing a monitoring system for critical limits. Implementing corrective action if critical limits are not met. Verifying that the system is operating according to specification.
These principles form a framework to link identifying specific hazards with critical control points. Implementing suitable procedures within this framework should provide effective control over the transmission of infectious agents in the health care setting. For example, the critical points for ensuring that reprocessed instruments are sterile may include cleaning the instruments before sterilisation, packing the sterilised units and validating the steam sterilisation process. Routine procedures are then required to ensure that each of these identified critical control points is adequately monitored (for example, see AS/NZS 41851). Using this approach, critical control pathways may be mapped for all activities where hazards have been identified. The higher the risk associated with the identified hazard, the more critical control points and/or the more rigorous the monitoring procedures that may be required. Health care establishments have a legal and ethical responsibility to provide health care workers with:
Risk assessment guidelines, A safe working environment, Effective workplace instruction and ongoing education about infection control procedures, Appropriate facilities and equipment, including workplace health services, Health screening programs.
Ongoing monitoring and evaluation of infection control procedures is also required.
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IDENTIFY AND RESPOND TO INFECTION RISKS ..........................................................................................

IDENTIFY INFECTION RISKS AND IMPLEMENT AN APPROPRIATE RESPONSE WITHIN OWN ROLE AND RESPONSIBILITY
In order to identify infection risk and why you are constantly cleaning, disinfecting and sterilising items, you need to know about micro-organisms and their way in infecting people.
What are micro-organisms?

A micro-organism (microbe) is a small (micro) living plant or animal (organism). It can only be seen by using a microscope. Micro-organisms are everywhere. They require a reservoir or host to live and grow in. Micro-organisms that cause infection are called pathogens. Micro-organisms that do not cause any harm are called non-pathogens which are necessary for the breakdown of food and the syntheses for some of the nutrients that the body needs. There are 4 main types of micro-organisms:
Name Bacteria Fungi
Information
These organisms multiply rapidly They consist of one cell and can cause infection in any body system. These organisms live on other plants or animals mushrooms, yeasts and moulds are common fungi. Fungi can infect the mouth, vagina, skin, feet and other body areas. These are single-celled organisms. They can infect the blood, brain, intestines and other body areas. They are very small microscopic organisms that grow in living cells. They cause many diseases, including the common cold, herpes, acquired immunodeficiency syndrome (AIDS) and hepatitis.
Protozoa Viruses
Bacteria
Bacteria are classified according to their microscopic appearances, shape, size and special characteristics. Diseases caused by Cocci include pneumonia, tonsillitis, bacterial heart disease, meningitis, sepsis and various skin diseases. Diseases caused by Bacilli include diphtheria, tuberculosis and tetanus. Bacteria have many different shapes, the two main types are: Cocci which are spherical and shaped like small beds Bacilli which are shaped like rods Characteristics of Bacteria: Aerobic bacteria: Need oxygen in order to live and grow. Anaerobic bacteria: Do not require oxygen in order to live and grow. Many bacteria in the mouth are anaerobic. Spores bacteria: More resistant to unfavourable environmental circumstances and can remain alive and potentially dangerous for long periods, then under favourable conditions regenerate, multiple and cause disease e.g. food poisoning. Capsule: A thick, jelly-like material that surrounds the surface of some bacteria cells. This enables them to resist attack form white blood cells and the bodys other defences. They are highly infective. Motility bacteria: Capable of movement. Fungi: Common types of fungi are mould and yeast. Common infections caused by mould are Tinea and Ringworm. Thrush is caused by yeast Candida Albicans.
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Viruses
Viruses need a special microscope to be able to see them. Viruses cannot survive long outside the living body and can only reproduce inside the cytoplasm of a living cell. Diseases which are caused by viruses include the common cold influenza, chickenpox, smallpox, measles, German measles, herpes simplex, infections, serum hepatitis (Hepatitis A & B) and AIDS
Infection
An infection is a disease state resulting from the invasion and growth of micro-organisms in the body. A local infection is in a body part such as conjunctivitis, which is an infection of the eye. A systemic infection involves the whole body like septicaemia and measles. Signs and symptoms of infection include: Fever Pain or tenderness Redness and swelling of a body part Loss of appetite Rash Diarrhoea Nausea Vomiting. Discharge or drainage from an affected part The chain of infection is a process that requires the following:
Source Susceptible host Reservoir
Portal of entry Mode of transmission
Portal of exit
Most micro-organisms do not move under their own power, unless they are in liquid. In general, they are carried from place to place in fluids or air currents and on objects. The source of infection is a pathogen, and the pathogen must have a reservoir where it can grow and multiply. If a person is acting as a reservoir for a pathogen, but does not have signs or symptoms of infection, they are known as a carrier. Carriers can pass on the pathogen to others. To leave the reservoir or the host, the pathogen needs a portal of exit. Exits can be respiratory, gastrointestinal, urinary and reproductive tract breaks in the skin and, most importantly blood and body fluids. The pathogen must enter the body of the new host through a portal of entry. Portals of entry and exist are the same. A susceptible host (a person at risk of infection) is needed for the microbe to grow and multiply. The major methods of transmission are: Airborne - infection by inhalation of organisms suspended in air on water droplets or dust particles. Droplet - occurs when micro-organisms are transmitted via a fine spray or aerosol that may result from coughing and sneezing. Close proximity within one meter is required as the
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droplets remain in the air until they reach a new host. Infection due to inhalation of respiratory pathogens suspended on liquid particles. Direct contact physical contact such as in kissing and sexual intercourse. Touching with hands is the most common way of transmitting pathogenic organisms from one place to another. Indirect contact is when micro-organisms can survive outside the body, and can easily transferred to the body by various means such as: o Contaminated food and water o Insects e.g. malaria o Instruments and needles o Household items o Floors. Self infection this occurs when infective micro-organisms that are normally found in the mouth or on the skin, get into the patients blood stream. Such as: o Fungal diseases o Herpes o Boils. Cross infection is where infection transmitted between patients infected with different pathogenic microorganisms.
Common Infections
The following information lists infectious diseases that are most commonly encountered within community health and residential aged care settings: Bacterial infectious diseases o Gastroenteritis o Staphylococcal Viral infectious diseases o Influenza Multi-resistant/ Antibiotic-resistant Organisms o Methicillin Resistant Staphylococcus Aureus (MRSA) o Multi-resistant gram negative bacteria (ESBL) Other infectious diseases o Scabies
There are numerous infections, refer to your workplace Infection Control policies and procedures for more information. When an infection risk has been identified, additional precautions may be required to manage the risk and reduce the spread of infection. Organisation infection control policy and procedures will set out the process for: Reporting identified infection risks Appropriate responses to be followed to manage a specific risk once indentified The process for monitoring risk management procedures when they have been put into place
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Good communication is required along with a team approach to ensure that infection control measures are effective. Report infection risk immediately you must report immediately all situations that pose an infection risk to the appropriate person in the workplace. Follow risk management procedures must be communicated to all staff and appropriate signage used where necessary. It is very important that all workers involved clearly understand and correctly follow the risk management procedures for them to be an effective control. Risk management monitoring procedures many be monitored to measure their effectiveness. It is important that workers have a clear understanding of the reporting requirements of risk management monitoring. Specific risks in the health care setting may involve: o Occupation exposure o Risk prone procedures o Diseases with high risk of transmission o Susceptible hosts.
Health care workers have an obligation to follow specific establishment infection control policies as part of their contract of employment. This includes reporting any known potential exposures to blood and/or body substances. Failure to follow infection control policies and procedures may be grounds for disciplinary action. Some States/Territories have statutory infection control requirements for HCWs. All health care workers should be aware of their requirements for immunisation against infectious diseases and maintain personal immunisation records. Health care workers who undertake exposure-prone procedures have a responsibility to know their infectious status with regard to blood borne viruses such as hepatitis B virus, hepatitis C virus and human immunodeficiency virus, and should be given relevant information about the tests available and encouraged to have voluntary testing. Health care workers with infections should seek appropriate medical care from a doctor qualified to manage infectious diseases. Where there is a risk of an health care workers transmitting infection to a patient or other health care workers (e.g. if the health care workers is infected with a blood borne virus, other transmissible infection or predisposing skin condition), the health care workers should be counselled about their work options and either rostered appropriately or provided with information and facilities to enable them to continue to provide safe care.
DOCUMENT AND REPORT ACTIVITIES AND TASKS THAT PUT CLIENTS AND/OR OTHER WORKERS AT RISK
Monitoring and surveillance
Each health care establishment must tailor its surveillance systems to maximise the use of all health care resources, given outcome priorities, population characteristics and institutional objectives. Establishments should clearly define the nature of intravascular device-associated infections, the documentation required and any action to be taken. Data collection should be tied to action in risk reduction, in process and systems improvement and in the achievement of desired outcomes for patient care. All organisational plans, including those specifically aimed at effective waste management, must be regularly monitored, evaluated and assessed. It means that the plans success should be observed and measured to ensure that it is achieving what it is intended to achieve.
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All staff that handle or supervise the handling of waste products in the organisation are responsible for monitoring the plan and for suggesting improvement opportunities as they are identified. Problems associated with the plan and its outcomes should be reported so that interventions can be put in place. Monitoring includes incident and accident reporting and recording. Your organisation will have specific reporting procedures that must be followed in care of an incident, accident illness related to waste management, or if any previously unrecognised hazards are identified. All employees should be aware of the reporting requirements and should be encourage to actively monitoring the procedures used in managing waste. Incident and accident reporting are essential for identifying the factors that cause waste handling injuries. Records need to be regularly analysed so that problem areas can be identified and decisions about development of new or updated injury prevention strategies can be made. These decisions can help to prevent future injuries. Where adjustments need to be made or changes/ improvements must be implemented, this should be done quickly and efficiently.
Record keeping
During an investigation of an infection outbreak or risk, it is critical that clear notes are kept detailing all steps taken during the investigation. These notes should include completed questionnaires, assessment of all potential risk factors, details of any control measures implemented and any other action taken including a summary of finding. Check your policy to ensure you know when to notify local government authorities. Local government will keep their own records for future reference, as the sporadic case may become part of a wider investigation. It is a duty of care requirement on the part of all workers to maintain appropriate records accurately and legibly. We are all required to complete infection control records for our designated work area in accordance with workplace requirements. These records are a legal requirement and we need to always ensure that we all contribute to the maintenance of records of incidents, workplace injuries and disease. These records also help to highlight when training may be needed, why and for what reason. Documentation and record keeping ensure: That controls and monitored for their effectiveness The procedures can be reviewed and updated The activities can be checked as having been implemented. When infection control hazards and incidents are reported immediately, it helps ensure prompt investigations, assessment and long and short-term control development. This then becomes part of the critical management cycle of ensuring hazards and risks are minimised. Immediate response documentation and record-keeping for a work area may include the following critical pieces of data: Time and date of incident How the incident occurred Who witnessed and reported the incident Injury description Who it was reported to. Every workplace has specific requirements for WHS records that will be outlined in your policy. Remember that documentation and record-keeping: Is a legal requirement Are requirements for Work Cover audits Auditors scrutinise the documentary evidence Records are admissible as evidence Records can be referred to in a testimony
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Accurate records are valuable in defending the employers liability.
RESPOND APPROPRIATELY TO SITUATIONS THAT POSE AN INFECTION RISK IN ACCORDANCE WITH THE POLICIES AND PROCEDURES OF THE ORGANISATION
All staff needs to be clear on their responsibilities and accountability and need to agree to ensure they understand what is expected of them and how to deal effectively with situations that pose and infection risk. An infection control policy should detail the arrangements for protecting the health of all clients, any visitors, all employees, management and the public. It should outline the responsibilities of everyone in the workplace and be supported by written procedures the step-by-step processes to be followed. All supervisors and team members are required to implement and supervise work practices that effectively deal with infection risks and hazardous events. Identified hazards might include: Sharps Glass Waste Human waste and human tissues Personal contact with infectious clients/ patients Animals, insects and vermin Stock, including food, which has passed its use-by-dates Incorrect concentration of disinfectants and chemicals Cleaning procedures Linen handling procedures Work flows Use of personal proactive clothing Food safety Personal hygiene
Everyday infections like common colds and stomach complaints can also be transferred between employees and clients. To implement a coordinated approach to infection control, health care establishments should have an infection control program in place that includes: Development of an annual strategic business plan for infection control; Preparation of a comprehensive procedures manual that specifies performance standards for routine work practices and procedures and including the following: o strategies to modify procedures and equipment associated with increased risk of workplace exposure to blood and/or body substances, and to ensure their appropriate management; o strategies to monitor the effectiveness of the infection control program and ongoing compliance with regulatory and licensing requirements; o o o strategies to monitor antibiotic resistance; strategies to monitor and manage critical incidents; contingency plans to manage outbreaks of health care associated infections and breakdowns in infection control practices; and
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Coordination by a suitably qualified health care worker, for example a registered nurse, clinical/medical microbiologist or infectious diseases physician (in smaller establishments this function may be combined with other tasks). Policies and procedures should be consistent with national minimum standards and infection control principles. Policies and procedures should be consistent with national minimum standards and infection control principles outlined in these and other relevant national and State/Territory guidelines. To promote ownership and compliance, policies and procedures should be developed in collaboration with all clinicians involved. They should also be practical, workable, necessary and sufficiently flexible to ensure their implementation.
Procedure information session

A team leader or designated person will need to present policies and procedures to staff so they know procedural requirements and can ask appropriate questions. Presentation can take the form of: Discussions at staff meetings Special policy presentation meetings Internet or intranet postings Email to all staff
Initially information is passed onto staff at induction/ orientation and during their primary training period. This information can also be communicated via formal or informal training, coaching or workplace mentoring. It can also be passed on in the form of written procedures, verbal or written instructions from supervisors or instructions from more experienced staff.
Training
To ensure that workers are trained, a period of supervision practise and training should be implemented. This will ensure that workers are well supported and given appropriate feedback. Monitoring of practice is everyones responsibility. It ensures that the monitoring of practice occurs to prevent and problems arising. All staff receives training to ensure their skills are kept up-to-date. It is an ongoing process to ensure that staffs are constantly skilled and knowledgeable in infection control.
FOLLOW PROCEDURES FOR RISK CONTROL AND RISK CONTAINMENT FOR SPECIFIC RISKS
All workers have a duty of care when it comes to ensuring safety, by complying with and monitoring work procedures to control infection risks. You will need to be aware of work procedures specific to your organisation that affect your work and that of your peers relating to: Aseptic techniques Cleaning agents Cleaning and schedules Cleaning equipment Confidentiality Contractor pertaining to controlling or influencing infection risks Employee training pertaining to controlling or influencing infection risks Food handling and food safety Handling, storage and disposal of all types of waste
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Hygiene in general Immunisation Infection control incident and hazard reporting Infection control risk management Linen production and handling Maintenance procedures Management of blood and body fluids spills Needle stick injuries Personal contact with infectious clients/ patients Personal protective clothing Single use of disposables Skin preparation procedures Standard and additional precautions Sterilising Storage requirements Work flows pertaining to controlling or influencing infection risks.
Part of your duty of care obligations; include the need to ensure that work procedures and instructions have clear instructions relating to the presenting issues to enable you to monitor work procedures to control infection risks and to ensure compliance. Infection control monitoring procedures may include: Observations Interviews Surveys and inspections Quality assurance activities Review of outcomes Data analysis
There are cases of infection caused illness that occur with no obvious association. It can be difficult to identify a source of infection from an investigation of a single case. Interviewing a number of sporadic cases may be useful in generating hypotheses about possible sources of infection amongst previously unassociated cases. This may lead to the identification of clusters or outbreaks of illness. The routine follow-up of sporadic cases of outbreaks of illness due to infection allows for: The prevention of further infections from the source The identification of cases amongst others and other close contacts of the affected source Identification of disease amongst risk groups such as food handlers, care workers Education and/or feedback to the appropriate health care professionals, and other contacts and premises The identification of promotional opportunities to inform and educate the community about preventing the spread of infectious disease
These key points should be considered when carrying out any investigation: 1. 2. 3. 4. 5. 6. 7. Does the illness or the infection pose a risk to others? Is this case part of an outbreak? Are there any other cases, perhaps asymptomatic or undiagnosed? Is there any evidence for a particular source of this illness? If so, who else is at risk and what is the susceptible population? Should this case be further investigated? If so, how? What is the public health significance of this case?
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Cleaning
Depending on the nature of the workplace, various procedures will be more specific the others. The dilution of cleaning products is an important part of infection control. If the dilution is too weak, the desired effect is not obtained. If too strong, it is not uneconomical, but also potentially dangerous for anyone coming in contact with the cleaned surface and/or the fumes from the chemical. For this reason it is important for all involved with cleaning products to have a sound knowledge of the product, as well as the correct dilution rates. Availability of Material Safety Data Sheets (MSDS) and the understanding of their use is an important safety procedure for many staff members, not just the cleaning staff.
Surface cleaning
Floors in hospitals and day-care facilities should be cleaned daily, or as necessary, with a vacuum cleaner fitted with a particulate-retaining filter, which should be changed in accordance with the manufacturers instructions (Ayliffe et al 1999). The exhaust air should be directed away from the floor to avoid dust dispersal. A ducted vacuum cleaning system can also be used, as long as safe venting of the exhaust air is ensured. Damp dusting is acceptable. Brooms disperse dust and bacteria into the air and should not be used in patient/clinical areas. Dust-retaining mops, which are specially treated or manufactured to attract and retain dust particles, do not increase airborne counts as much as ordinary brooms and remove more dust from surfaces (Ayliffe et al 1999). However, brooms and dust-retaining mops should not be used in clinical areas where there is a high risk of infection associated with dust (e.g. burns units).
Procedure for routine surface cleaning

Work surfaces should be cleaned and dried before and after each session or when visibly soiled. Spills should be cleaned up as soon as is practical A neutral detergent and warm water solution should be used for all routine and general cleaning. When a disinfectant is required for surface cleaning, the manufacturers recommendations for use and workplace health and safety instructions should be followed. Buckets should be emptied after use, washed with detergent and warm water and stored dry. Mops should be laundered or cleaned in detergent and warm water, then stored dry.
Wet areas
Toilets, sinks, washbasins, baths, shower cubicles, all fittings attached to ablution facilities and surrounding floor and wall areas should be cleaned at least daily, or more frequently as required. Additional cleaning may be required for particular rooms (e.g. rooms with patients requiring additional precautions). Cleaning methods should avoid generation of aerosols.
Walls and fittings

Walls, blinds and curtains should be cleaned regularly and when they are visibly soiled. Curtains should be changed regularly and as necessary. Carpets should be vacuumed daily.
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Maintenance of cleaning equipment

Cleaning items (including solutions, water, buckets, cleaning cloths and mop heads) should be changed routinely. They should also be changed immediately following the cleaning of blood or body substance spills, or after each session for contaminated areas such as operating rooms or isolation rooms. These items should be washed/cleaned in detergent and warm water, rinsed and stored dry between uses. Detachable mop heads should be laundered between uses.
Reporting infection risks is critical so that action is taken promptly to prevent the spread of
infection to others. You have a duty of care requirement to clients, peers and the public under the WHS Act and respective regulations. Developing and monitoring an infection reporting system is also part of this process. Various regulations require that an employer report certain work-related injuries and dangerous occurrences to monitoring authorities. An employer must also keep records of all work-related injuries under the regulations.
Dangerous occurrence
Regulation 3: What is a dangerous occurrence? Subsection 5(1) of the Act defines "dangerous occurrence" as "an occurrence, at a workplace, that is declared by the Regulations to be a dangerous occurrence for the purpose of the definition". The definition of "dangerous occurrence" is relevant to the application of sections 23, 28, 68 and 69 of the Act and is incorporated by reference into all these provisions. Regulation 3 defines "dangerous occurrence" as an occurrence which endangers the health and safety of an employee or an occurrence at a workplace that arises from workplace operations and endangers the health or safety of another person at or near a workplace. The regulation also sets out circumstances which will be taken to constitute a dangerous occurrence. The matters specified in detail relate to malfunctioning breathing apparatus damage to particular equipment; uncontrolled explosion, fire or release of dangerous substances: electrical short-circuit; collapse of an excavation or other parts of a workplace.
http://www.austlii.com/au/legis/cth/num_reg_es/ohaser1991n266667.html Referral to government authority

Cases for follow-up may also need to be referred to the local government area in which the affected people reside. The investigating officer may need to refer investigation of food premises, special care facilities, care centres etc, to other municipals, when a need for follow-up is indicated as part of their investigation, the matter that is referred to an the investigating officer.
Steps in investigation
You will need to familiarise yourself with the steps within the procedures of your organisation to ensure you are on track with this. The key principles to consider are: An infection outbreak or risk investigation must be conducted with care and tact and in a professional manner Ensure that confidentiality is maintained throughout the investigation process Work within the scope of your job role and perform your duties thoroughly
Interviewing others
Clarifying the nature and timing of the infection outbreak or risk symptoms and use the appropriate questionnaire to determine the following: Personal details of the source people of the infection outbreak or risk Clinical symptoms Occupation
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Travel patterns Environmental exposures Other risk factors Case finding Food history general and 4-day history
Identifying the risk factor

There are certain risk factors which indicate that further investigation is required and may present education opportunities. These risk factors can be broadly categorised as follows: Workplace Possible source Travel
FOLLOW PROTOCOLS FOR CARE FOLLOWING EXPOSURE TO BLOOD OR OTHER BODY FLUIDS AS REQUIRED
Protocol for care following exposure to blood or other body fluids will include but not limited to: Immediate care following: o A sharps injury o A splash of blood or other body fluids o Testing procedures Post exposure care Record-keeping and notification (where applicable)
WHS requirements for the notification of all work-related occurrences of injury, disease or illness Health care workers involved in a significant exposure should follow organisational protocols. All health care establishments must develop their own infection control protocols for communicable diseases, including clear written instructions on the appropriate action to take in the event of needle stick and other blood or body fluid incidents involving either patients or health care workers (HCWs), including: The physician, medical officer or other suitably qualified professional to be contacted; The laboratory that will process emergency specimens; The pharmacy that stocks prophylactic medication; and Procedures for investigating the circumstances of the incident and measures to prevent recurrence (this may include changes to work practices, changes to equipment, and/or training).
The protocols should also include details for prompt reporting, evaluation, counselling, treatment and follow-up of workplace exposures to blood borne viruses. Treatment should be available during all working hours, and on call after hours (e.g. through an on-call infectious diseases physician). HCWs should be educated to report workplace exposures immediately after they occur. Patients exposed to blood or other body fluids must be informed of the exposure by a designated professional, while confidentiality is maintained about the individual source of the blood. Baseline serum should be collected from the patient and expert counselling provided on the implications of the event. Post exposure prophylaxis and appropriate long-term follow-up should be offered where applicable. Patient refusal for testing and serum storage should be documented. In the event of seroconversion, all reasonable attempts should be made to confirm that the virus strain transmitted is identical in the patient and the source.
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Health care establishments should provide support and counselling, and advise that further counselling can be arranged with workplace health nurses, infection control nurses, infectious diseases physicians or HIV liaison officers at teaching hospitals or sexually transmitted disease clinics. People nominated to provide support to affected individuals should have an appropriate knowledge of factors involved in the transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and have counselling expertise. Where this is not possible (e.g. in rural and remote areas) a person with appropriate knowledge of disease transmission should counsel and support affected individuals. Note: It is most important that, in order to maintain the confidentiality of the exposed person and the source, individual records are maintained. Immediate care of the exposure site Contaminated clothing should be removed, and the injured area should be washed well with soap and water (an antiseptic could also be applied). Any affected mucous membranes should be flushed with large amounts of water. If the eyes are contaminated, they should be rinsed gently but thoroughly with water or normal saline, while kept open. Evaluation of the exposure The exposed person should be examined to confirm the nature of exposure and counselled about the possibility of transmission of blood borne disease. Evaluation and testing of the exposed person The exposed person should have a medical evaluation, including the collection of information about medications they are taking and underlying medical conditions or circumstances. All exposed people should be assessed to determine the risk of tetanus. Depending on the circumstances of the exposure, the following may need to be considered: Tetanus immunoglobulin; A course of adsorbed diphtheria tetanus vaccine adult formulation (Td vaccine); or TB booster.
The exposed person would normally be tested for HIV antibody, HCV antibody and antibody to HBV surface antigen (HBsAg) at the time of the injury, to establish their serostatus at the time of the exposure. Expert counselling on the implications of the event, PEP and appropriate long-term followup should be offered. Health care workers who do not wish to undergo testing at the time of the exposure may be offered the option to have blood collected and stored but not tested. Blood that is collected and stored for this purpose must be retained for a minimum period of 12 months. If the source person is found to be HIV, HBV and HCV negative, no further follow-up of the exposed person is generally necessary, unless there is reason to suspect the source person is seroconverting to one of these viruses, or was at high risk of blood borne viral infection at the time of the exposure. If the source is positive for one of these viruses, pregnancy testing should be offered to women of childbearing age who have been exposed and whose pregnancy status is unknown.
Ref: Australian Government Department of Health and Ageing Infection control guidelines 2004
It will be necessary to test the workers at 6 weeks, 12 weeks, and 6 months following blood/ bodily fluid exposure and should receive nucleic acid testing for the presence of HIV RNA 4-6 weeks after exposure. The same testing processes will apply if staff are exposed to blood and bodily fluids of HIV and HBSAG (Hepatitis B). Any exposures should be documented and the results of the testing procedure should also be documented.
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PLACE APPROPRIATE SIGNS WHEN AND WHERE APPROPRIATE

Signage plays an important role in communicating information in the health care setting. Signs can be used to: Communicate a potential risk or hazard Indicate special requirements of a clients/ patients care Identify restricted area It is important that signage is appropriate for the situation and that it easily communicates the correct information to readers. To be effective, signage should be placed in an appropriate position to be easily identified upon approach. Signage should be used immediately when an workplace health and safety risk has been identified and to maintain safety in the workplace.
Safety Signage
The communication of important information and safety warnings is essential in the workplace. The design of safety signage must ensure that information is easy to read, easy to understand (nonambiguous) and must be able to be interpreted the same way by people of all languages. That is why signs are created to an internationally recognised standard. Messages are conveyed using different colours, standard shapes and graphics depending on the purpose of the sign.
WARNING signs use these symbols and colours:
PROHIBITION signs use a red circle with a slash through it.
INFORMATION signs are always in blue rectangles.
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Examples of signs
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REMOVE SPILLS IN ACCORDANCE WITH THE POLICIES AND PROCEDURES OF THE ORGANISATION
General
Health care establishments should have management systems for dealing with blood and body substance spills, and procedural manuals should include protocols and emphasise ongoing education or training programs. The basic principles of blood and body substance spills management are: Standard precautions apply, including use of personal protective equipment as applicable Spills should be cleared up before the area is cleaned (adding cleaning liquids to spills increases the size of the spill and should be avoided); and Generation of aerosols from spilled material should be avoided.
Using these basic principles, the management of spills should be flexible enough to cope with different types of spills, taking into account the following factors: The nature of the spill (e.g. sputum, vomit, faeces, urine, blood or laboratory culture); The pathogens most likely to be involved in these different types of spills (e.g. stool samples may contain viruses, bacteria or protozoan pathogens; sputum may contain Mycobacterium tuberculosis); The size of the spill (spot, small or large spill); The type of surface (e.g. carpet or impervious flooring); The area involved (i.e. whether the spill occurs in a contained area such as a microbiology laboratory or in a public area such as a hospital ward or outpatient area); and Whether there is any likelihood of bare skin contact with the soiled surface.
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It is generally unnecessary to use sodium hypochlorite for managing spills but it may be used in specific circumstances. It is recognised, however, that some health care workers may feel more reassured that the risk of infection is reduced if sodium hypochlorite is used routinely. In that case, the practice need not be discouraged, but the health care workers should be made aware that there is no evidence of benefit from an infection control perspective. If a spill of tissue infected with CJD occurs (e.g. brain tissue), the contaminated item or surface should either be destroyed by incineration or cleaned with either sodium hydroxide or sodium hypochlorite according to the guidelines. Blood and body substance spills should be dealt with as soon as possible. In areas such as hospital wards, waiting rooms and patient treatment areas, blood and body substance spills should be dealt with as soon as possible. In operating rooms, or in circumstances where medical procedures are under way, spills should be attended to as soon as it is safe to do so. Spots or drops of blood or other small spills can easily be managed by wiping the area immediately with paper towelling and then cleaning with water and detergent. A hospital-grade disinfectant can be used on the spill area after pre-cleaning. Where large spills have occurred in a wet area, s uch as a bathroom or toilet area, the spill should be carefully washed off into the sewerage system and the area flushed with water and detergent. Large blood spills that have occurred in dry areas (such as a ward or a patient treatment area) should be contained and generation of aerosols should be avoided. Granular formulations that produce high available chlorine concentrations can contain the spilled material and are useful for preventing aerosols. A scraper and pan should be used to remove the absorbed material. The area of the spill should then be cleaned with a mop and bucket of water and detergent. The bucket and mop should be thoroughly cleaned after use and stored dry. Care should be taken to thoroughly clean and dry areas where there is any possibility of bare skin contact with the surface (e.g. on an examination couch). Cleaning equipment (spills kit) Standard cleaning equipment, including a mop and cleaning bucket plus cleaning agents, should be readily available for spills management and should be stored in an area known to all health care workers. This is particularly important in patient areas such as hospital wards or treatment areas. To facilitate the management of spills in areas where cleaning materials may not be readily available, a disposable spills kit could be used, with the following items: A large (10 L) reusable plastic container or bucket with fitted lid, containing the following items; Appropriate leak proof bags and containers for disposal of waste material; A designated, sturdy scraper and pan for spills (similar to a pooper scooper); About five sachets of a granular formulation containing 10,000 ppm available chlorine or equivalent (each sachet should contain sufficient granules to cover a 10cm diameter spill); Disposable rubber gloves suitable for cleaning (vinyl gloves are not recommended for handling blood); Eye protection (disposable or reusable); A plastic apron; and A respiratory protection device (for protection against inhalation of powder from the disinfectant granules, or aerosols, which may be generated from high-risk spills during the cleaning process).
With all spills management protocols, it is essential that the affected area is left clean and dry. Disposable items in the spills kit should be replaced after each use of the kit. Sodium hydroxide spills kits should be available for areas at risk for higher-risk CJD spills, such as neurosurgery units, mortuaries and laboratories. Consumables items in the spill kit should be replaces after each use. Non-disposable item should either be replaced or cleaned using approved cleaning and sanitising procedures.
Always follow your workplace policies and procedures.
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MAINTAIN PERSONAL HYGIENE ..........................................................................................

MAINTAIN HAND HYGIENE BY WASHING HANDS BEFORE AND AFTER CLIENT CONTACT AND/OR AFTER ANY ACTIVITY LIKELY TO CAUSE CONTAMINATION
Infection control in the health care setting is based on the principles of hygiene, cleanliness and sterility. Hand washing is generally considered the most important measure in preventing the spread of infection in health care establishments (Larson 1996). Health care workers (HCWs) must wash their hands before and after significant contact with any patient and after activities likely to cause contamination. Significant patient contact may include: Contact with, or physical examination of, a patient Emptying a drainage reservoir (catheter bag); and/or Undertaking venepuncture or delivery of an injection. Activities that can cause contamination include: Handling equipment or instruments soiled with blood or other body substances Direct contact with body secretions or excretions; and/or Going to the toilet.
Gloves are not a substitute for good hand washing.

The frequency, duration, and type of hand hygiene are dependent upon the nature, intensity, duration, and sequence of the work activity.
Staff should wash their hands immediately in the following situations:

Before Direct client contact Any care procedures emptying catheter bag, showering Starting work Applying gloves Preparing and handling food, eating or feeding clients Applying protective equipment, especially facial or eye protection. Direct client contact Any care procedures emptying catheter bag, showering Handling equipment soiled with blood or other body substance Contact with own mucous membrane blowing nose Contact with non-intact skin or abnormal skin conditions rashes Finishing work Removing gloves. Going to the toilet Removing protective equipment, especially facial or eye protection Smoking Touching animals/ pets Touching inanimate objects that are likely to be contaminated phone, bed, bed pan. Skin is visibly soiled or contaminated Between different procedures on the same person Contaminated or in contact with bodily substances In contact with mucous membrane.
After
When
Reference: For further information refer to World Health Organisations (WHO) your 5 moments of hand hygiene factsheet
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FOLLOW HAND WASHING PROCEDURES

Hand washing is the most important procedure in the prevention of the spread of infection in the health care setting. Hands must be washed before and after any significant contact with clients and after activities likely to cause contamination. Gloves are no substitute for good hand washing. If in doubt, wash your hands. There are certain procedures that require more thorough hand washing. Non-surgical procedures that involve contact with non-intact skin or involved surgical entry into tissue, cavities or organs require a more thorough hand washing technique to be performed.
Hand washing technique: Level Washing technique

Routine Hand wash

Duration
1015 seconds
Drying
Pat dry using paper towel, clean cloth or a fresh portion of a roller towel
When needed
Before eating and/or smoking After going to the toilet Before significant contact with patients (e.g. physical examination, emptying a drainage reservoir such as a catheter bag) Before injection or venepuncture Before and after routine use of gloves After handling any instruments or equipment soiled with blood or body substances Before any procedures that require aseptic technique (such as inserting intravenous catheters)
Remove jewellery Wet hands thoroughly and lather Vigorously using neutral pH liquid hand wash Rinse under running water Do not touch taps with clean hands if elbow or foot controls are not available, use paper towel to turn taps off
Aseptic procedures
Surgical wash
Remove jewellery Wash hands thoroughly using an antimicrobial skin cleaner Rinse carefully Do not touch taps with clean hands if elbow or foot controls are not available, use paper towel to turn taps off Remove jewellery Wash hands, nails and forearms thoroughly and apply an antimicrobial skin cleaner (containing 4% w/v chlorhexidine)b or detergent based povidone iodine containing 0.75% available iodine or an aqueous povidone iodine solution containing 1% available iodine Rinse carefully, keeping hands above the elbows No-touch techniques apply
1 minute
Pat dry using paper towel
First wash for the day 5 minutes; subsequent washes 3 minutes
Dry with sterile towels
Before any invasive surgical procedure
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IMPLEMENT HAND CARE PROCEDURES

Hand care is important because intact skin (with no cuts or abrasions) is a natural defence against infection. Any breaks or lesions of the skin are possible sources of entry for pathogens (Larson 1996). Rings and artificial nails should not be worn; nails should be short and clean as they contribute to increased bacterial counts (Larson 1996). Rings or artificial nails must not be worn when performing invasive procedures (e.g. where gloved hands are placed inside body cavities). Repeated hand washing and wearing of gloves can cause irritation or sensitivity, leading to dermatitis or allergic reactions. This can be minimised by early intervention, including assessment of hand washing technique and the use of suitable individual-use hand creams. To minimise chaffing of hands, use warm water and pat hands dry rather than rubbing them. Cuts and abrasions should be covered by water-resistant occlusive dressings that should be changed as necessary. Health care workers who have skin problems such as exudative lesions or weeping dermatitis must seek medical advice and must be removed from direct patient care until the condition resolves. Hand care products marketed in Australia that claim a therapeutic use are generally either listed (AUST L) or registered (AUST R) on the Australian Register of Therapeutic Goods and must display the AUST L or AUST R number, respectively, on the label. Registered products are assessed for safety, quality and efficacy. Listed products are reviewed for safety and quality. Labelling is part of this regulatory system, and should be checked to determine the products suitability, as some hand creams are not compatible with the use of chlorhexidine. Aqueous-based hand creams should be used before wearing gloves. Oil-based preparations should be avoided, as these may cause latex gloves to deteriorate.
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The following table basic information about hand washing, hand washing products and procedures:
Term
Hand hygiene Hand cleansing Hand washing Hand antisepsis Hand rubbing Term
Definition
A general term referring to any action of hand cleaning hand washing, antiseptic hand wash, antiseptic hand rub Action of performing hand hygiene for the purpose of physically or mechanically removing dirt, organic material or microorganisms Washing hands with plain or antimicrobial soap and water Reducing or inhibiting the growth of microorganisms by the application of an antiseptic hand rub or by performing an antiseptic hand wash Action of applying an alcohol-based (waterless) hand hygiene product Definition
Inherent hand Instinctive need to remove dirt from the skin when hands are visibly soiled, sticky or gritty. hygiene practice Likely to be established in the first ten years of life and to drive majority of community and health care workers hand hygiene behaviour throughout life. Elective hand Attitude to hand cleansing in more specific opportunities not encompassed in the inherent hygiene practice category and more frequently corresponding to some of the indications for hand hygiene during health care delivery. Hand drying Hand drying is an essential step in hand cleansing and should be done in wash a way that hand recontamination does not occur. Common hand drying methods include paper towels, cloth towels and hot-air dryers. Warm air-drying is not as effective at removing bacteria from washed hands as paper towels; they are also less practical because of longer time needed to achieve dry hands. Paper and cloth towels should be single use. An alcohol-containing preparation (lotion/ rinse, gel or foam) designed for application to the hands to reduce the growth of microorganisms. Such preparation may contain one of more types of alcohol with excipients (inactive substance used as a carrier for the active ingredients of a medication) other active ingredients, and humectants (emollients/ moisturisers propylene glyol. Soap (detergent) containing an antiseptic agent at a concentration which is sufficient to reduce or inhibit the growth of microorganisms An antimicrobial substance with reduces or inhibits the growth of microorganisms on living tissues - e.g. chlorhexidine gluconate, iodine Compounds that possess a cleaning action. They are composed of a hydrophilic and lipophilic part and can be divided into four groups: anionic, cationic, amphoteric and non-ionic. Although products used for hand washing or antiseptic hand wash in health care represent various types of detergents, the term soap will be used to refer to such detergents in this document. Detergents that do not contain antimicrobial agents or that contain very low concentrations of antimicrobial agents solely as preservatives. An antiseptic agent that does not require the use of exogenous water. After application, the individual rubs the hands together until the agent has dried. The term includes different types of hand rubs (liquid formulations, gels, foams, leaflets/ towelettes
Alcohol-based hand rub
Antimicrobial soap Antiseptic agent Detergent (surfactant)
Plain soap Waterless antiseptic agent
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COVER CUTS AND ABRASIONS WITH WATER-PROOF DRESSINGS AND CHANGE AS NECESSARY
Skin that is intact with no cuts or abrasions is a natural barrier to infection. Having skin that is open from either cuts or abrasions etc allows an entry point for infection / bacteria etc to enter into the body. Any breaks or lesions of the skin are possible sources for infection that can be passed on to others. This might be through direct contact or as a result of sores/ wound/ lesions coming into contact with other substances.
Waterproof coverings.
Keep open-skin areas covered at all times

It is necessary for all health care workers with cuts, abrasions, wounds on any exposed part of the body to keep the area covered with a waterproof occlusive (waterproof and impenetrable) dressing at all times while on duty. If necessary, the worker should also cover the wound with a disposable, waterproof glove if hands are affected. Dressing need to be changed as required. This is required to assist with healing or immediately if the dressing becomes soiled, lost or wet to prevent contamination. If the break or lesion is on an area that cannot be covered or is caused by weeping dermatitis, the health care worker should seek medical advice. Temporary placement in another work area away from direct client contact care may be required.
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USE PERSONAL PROTECTIVE EQUIPMENT ..........................................................................................

WEAR PERSONAL PROTECTIVE CLOTHING AND EQUIPMENT THAT COMPLIES WITH AUSTRALIAN/NEW ZEALAND STANDARDS, AND IS APPROPRIATE FOR THE INTENDED USE
Key points
All health care establishments should provide personal protective clothing and equipment that complies with relevant Australian standards and is appropriate for the intended use. All equipment should be readily available. Health care workers (HCWs) should wear gloves whenever there is a risk of exposure to blood or body substances. The type of gloves worn must be appropriate to the task. Wearing gloves must not replace hand washing. Gloves may have defects that are not immediately obvious or they may become damaged with use and become a hazard for Health care workers. Health care workers should wear protective eyewear or face-shields during procedures where there is potential for splashing, splattering or spraying of blood or body substances. Health care workers should wear suitable masks during procedures where there is potential for splashing, splattering or spraying of blood or body substances, or where there is potential for airborne infection. Health care workers should wear gowns and plastic aprons to protect their clothing and skin from contamination.
Protective clothing and equipment

The use of protective clothing (gowns or plastic aprons), worn over uniforms, protects HCWs from exposure to blood or body substances. Protective clothing and equipment that complies with relevant Australian standards should be readily available and accessible in each health care establishment. It may include: examination gloves (AS/NZS 40111) and surgical gloves (AS/NZS 41792); eye and/or facial protection (glasses, goggles or face-shields); surgical face masks (AS 43813) and respirators (AS/NZS 17164) designed for protection against respiratory pathogens (P2 particulate respirator; AS/NZS 17155);
1 AS/NZS 4011 (1997) and Amendment 1 (1998) Single-use examination gloves 2 AS/NZS 4179 (1997) Single-use sterile surgical rubber gloves Specifications. 3 AS 4381 (1996) and Amendment 1 (1997) Surgical face masks. 4 AS/NZS 1716 (1994: Amended 1996) Respiratory protective devices. 5 AS/NZS
Specifications.
1715 (1994) Selection, use and maintenance of respiratory protective devices.
CHANGE PROTECTIVE CLOTHING AND GOWNS/APRONS DAILY, MORE FREQUENTLY IF SOILED AND WHERE APPROPRIATE, AFTER EACH CLIENT CONTACT
Removal of Gloves Technique
1. Use the following pictures as a guide to help you remove gloves safely 2. Avoid touching the outside of the gloves. Only touch the inside 3. Wash hands after removing and disposing of gloves in a sealable bag
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1. Grasp one glove at wrist and pull down to knuckles
2. Grasp other glove at wrist and pull down to knuckles
3. Grasp wrist end of one glove and Pull it off completely
4. Remove other glove in a similar way, touching only the inside of glove
5. Dispose of gloves in a sealable plastic bag
6. Wash hands after removing and disposing of gloves
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LIMIT CONTAMINATION ..........................................................................................

DEMARCATE AND MAINTAIN CLEAN AND CONTAMINATED ZONES IN ALL ASPECTS OF HEALTH CARE WORK
Work flow should always be from clean to dirty zones. An important practice in infection control is to reduce the likelihood of spreading infections into clean areas is to follow a one-way work flow. Oneway work flows prevent infectious agents from dirty zones form being brought into clean zones.
Clean areas might be sterile areas or simply areas which are maintained in a manner that preludes infection.
Area Work areas
Description Work areas in the health care setting may be designed to assist one-way work flow with restrictions to prevent infection being transferred from dirty to less clean areas through to cleaner or sterile areas. Which require anything within a defined area to be sterile, such as operating rooms For storage of clean equipment, or instruments after reprocessing That are clean but might contain contaminants after a client had been treated Used for the storage of wastes, dirty linen and used equipment until it is disposed of or sent for reprocessing.
Special purpose areas Sterile zones Clean zones Treatment zones Contaminated zones
Care must be always taken to avoid contamination transferring into cleaner work areas. Work areas should be organised and set up to ensure safe, effective and efficient handling of waste in accordance with workplace requirements and relevant legislation. Workstations in the health care environment need to be set up so that there is minimal handling of waste and the least possible chance of contamination or associated problems
Waste minimisation
A fundamental principle of any waste management strategy is to minimise waste generation. It is important to categorise waste so it is easily identified making segregation cost effective. To increase efficiency and effectiveness, work areas need to be established so that waste handlers can practise and single stage segregation at the source. This will require several waste containers to be places in an area for waste. This is then a safer and more effective method then sorting through the waste at a later stage.
Radioactive waste
Only authorised persons are allowed to handle radioactive material and radiation apparatus. It requires a licence to handle this form of waste.
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Improving waste management

Assessment of the current system needs to be done prior to any form of introducing or modifying systems as the current one just may be working well. Regular audits undertaken to monitor any implementation of waste management plan and evaluate its success. An effective audit team should: Be multidisciplinary with at least one representative from major areas of the organisation Have authorise access to all departments and staff Examine the current waste management system in detail
When implementing changes to waste segregation at a workstation, be sure to consult the people who will use the area. They will know best what changes are likely to work. Standard Operating Procedures (SOP) Health care establishments must ensure that safe work practices are developed and maintained. Approved work practices should be documented and promoted so that all staff knows what is expected. Induction and ongoing training, plus updated information should be provided to all employees. This includes training that relates to waste management and legislation and environmental protection. Standard Operating Procedures (SOP) should: Specify the health care establishments waste management plan, Specify approved waste handling procedures and segregation procedures, Detail appropriate training required for people who generate and handle waste, Specify PPE required for waste handling tasks, Identify key managers instrumental in the implementation of the waste management plan, Outline spill management strategy, Specify appropriately trained personnel for spill management on site, Identify first aid resources and specify the protocol for needle stick injury treatment, Encourage waste minimisation. Waste management policies and procedures should be documented in manuals and in the waste management plan. SOPs can be written to expressly identify the handling and disposal methods to be used. There must be readily accessible to all staff and should be reviewed and updated regularly.
CONFINE RECORDS, MATERIALS AND MEDICAMENTS TO A WELLDESIGNATED CLEAN ZONE

Records, materials and supplies for use, medicaments etc must all be stored in clean, hygienic and appropriate storage. Hard copy records must be kept in properly protected folders and stored in suitable storage cabinets. The folders must be kept clean and free from contact with infectious substances, that is, they should not come in contact with blood or body fluids. They should only be handled by staff whose hands are clean. Supplies (including clean bed linen, towels, gowns etc) materials for use in treating clients and medicaments must all be held in a clean zone. They should be carefully handled and not come into contact with, for example dirty linen or any used or waste material. They should be sorted on shelves in a dry, properly organised storage space. Some medicaments might require temperature controlled storage.
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CONFINE CONTAMINATED INSTRUMENTS AND EQUIPMENT TO A WELLDESIGNATED CONTAMINATED ZONE

Just as clean items are kept and stored in a designated clean area, any infected instruments and equipment must be stored or held in a designated contaminate zone. Once cleaned and sterilised they can then be transferred back into the clean area. It is important that health care workers are aware of common infections risks that present in their immediate workplace and the health care setting in general. You need to understand how infection is spread in a heal care setting. Spread of infection in the health care setting The spread of infection in the health care environment involves 3 factors: A source of infection A host A pathway to the host Infection can pass between (either to or from) the following: Client / patient Health care workers Instruments and equipment The health care environment Showing the transmission of infection in the health care setting
Patient
Health care environment
Health care worker
Instrument and equipment
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The risk of contracting a health care associated infection will depend on the: Burden of infection or the ability to cause disease and the number of infectious agents present Susceptibility of the host to infection The type of infectious hazard
Key points
Management of clinical and related waste must conform to relevant State/ Territory regulations, Australian Standard AS/NZS 3816 (1998) and NHMRC National Guidelines for Waste Management in the Health Care Industry (NHMRC 1999b). Waste should be segregated at the point of generation, using appropriately colour-coded and labelled containers. Health care workers should wear gloves and protective clothing when handling clinical and related waste bags and containers. HCWs involved in the handling of such waste should be trained in the correct procedures.
Definition of waste
Providing a satisfactory and standard definition of clinical and related wastes has traditionally been a difficult issue for health care establishments. Terms such as hospital waste, clinical waste, infectious waste, medical or biomedical waste and biohazardous waste have been used synonymously, and often inappropriately, in many situations. In the waste management guidelines (NHMRC 1999b), health industry wastes are defined as all types of wastes (clinical, related and general) arising from medical, nursing, dental, veterinary, pharmaceutical or similar practices, and wastes produced in hospitals or other establishments during the investigation or treatment of patients in research projects. Clinical waste includes the following categories: discarded sharps; laboratory and associated waste directly associated with specimen processing; human tissues, including material or solutions containing free-flowing blood; and animal tissue or carcases used in research Related waste includes: cytotoxic waste pharmaceutical waste chemical waste radioactive waste General waste includes other wastes that do not fall into the above categories. It forms the bulk of waste generated by health care establishments and is of no more public health risk or concern than household waste. Bags or containers should not be overfilled, which will cause difficulty closing or sealing the bags or containers and will increase the risk of rupturing when handled or transported. Bags should never be compacted by hand. Waste should be effectively segregated according to its category, at the point of generation, using appropriately colour-coded and labelled containers according to AS/NZS 3816. The waste should be bagged, packaged or containerised and must be clearly marked with an adequate description of the contents. There are three main categories: Clinical waste must be placed in yellow containers bearing the international black biohazard symbol and clearly marked clinical waste. Cytotoxic waste must be placed in purple containers bearing the telophase symbol, and marked cytotoxic waste.
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Radioactive waste must be placed in red containers with the black international radiation symbol and marked radioactive waste.
Wastes that have not been segregated must be treated as that portion of the waste representing the highest risk. Clinical and related wastes should be segregated in line with the licence requirements of the final disposal facility. Most clinical and related wastes are nonhazardous and can be disposed of in the general waste stream. Waste segregation allows for supervised landfill for the bulk of clinical and related wastes.
Clinical waste
Any wastes can be classified as clinical by the relevant health care establishment or government authority. All clinical waste should be treated appropriately, contained and transported carefully. Microbiological cultures should be rendered safe by a validated steam sterilisation process, monitored in accordance with AS/NZS 4187,2 before they leave the control of laboratory health care workers. Clinical waste may be disposed of by incineration or landfill. Where landfill disposal of clinical and related wastes is intended, identifiable body parts, pharmaceuticals, cytotoxic and radioactive wastes should be excluded at source, and the landfill site must be confirmed as suitable. Standard precautions should apply when handling clinical wastes. Standard precautions should apply when handling clinical wastes. All waste should be handled with care to avoid injuries from concealed sharps (which may not have been placed in sharps containers). Gloves and protective clothing should be worn when handling clinical waste bags and containers. Staff involved in the handling of such waste should be properly trained, including in the management of clinical waste spills. Where possible, manual handling of waste should be avoided. Clinical waste must be placed in appropriate leak-resistant bags or containers. These should not be overfilled, and must not be compacted by hand. Trolleys used for transport of infectious or other hazardous waste should be clearly labelled as such, and used only for waste transport. They should be cleaned daily, never overfilled, and fitted with drip trays to contain leaks or spills.
Symbol
None
Waste
General
Container colour
Black, white buff, green,
Disposal
Landfill Consider recycling (Confidential waste to be shredded or incinerated) Licensed contractor (for disposal by approved technologies) Incineration Incineration or validated steam sterilisation, then supervised landfill Sewer: local regulations must to be followed Licensed contractor Incineration: 1100C (NHMRC 1999b) Licensed contractor Monitor before disposal by incineration or supervised landfill Dilute isotopes may be disposed of via sewerage system in accordance with relevant guidelines
Clinical waste sharps Nonsharps Liquid Cytotoxic Purple Yellow, container Yellow bag rigid
Radioactive
Red
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Types of Personal protective equipment

Type Gloves Sterile Product When to wear Wear when likely to have contact with sterile body cavity or tissue of a client under normal circumstances. Recommendations for use Select correct size and types Always check for holes Remove carefully to avoid contamination of hands or other surfaces Are not to be washed and reused Discarded after use Select correct size and type Need not to be worn for subcutaneous, intramuscular injections unless exposure to blood is anticipated Remove carefully to avoid contamination of hands or other surfaces Are not to be washed and reused Discarded after use
Refer to AS/NZS 4179-1997: Single-use sterile surgical rubber gloves - Specification
Non-sterile Medical
Wear for all procedures involving direct or perceived contact with nonintact skin, mucous membranes and blood or body substances While handling items or surfaces that have come into contact with blood or body substances
Refer to AS/NZS 4011-1997: Single-use examination gloves - Specification
General purpose/ utility
Wear for cleaning and during manual decontamination of used instruments and equipment
Select correct size and type Allocate to individual staff members May be reused wash in detergent after use and stored dry Replace if torn, cracked, peeling or showing signs of deterioration While in use, they are to be cleaned between each clients room and when moving from one work area to another
Heavy duty
Wear to reduce the risk of cuts, Select correct size and type punctures, or lacerations. Clean and store dry between use Wear to reduce the risk of injury Replace if torn, cracked, peeling or showing signs of deterioration from chemical or thermal burns. Refer to AS/NZS 2161.2-2005: Workplace protective gloves General
requirements
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Type Facial protection Surgical mask
Product
When to wear Wear in areas where droplet infection of the client is a concern. Can be worn for extended periods. Wear when the staff member has a cold
Recommendations for use
Wear and fit according to manufacturers instructions Not to be touched by hands while being worn Cover the nose and mouth. Secure correctly behind the ears with tape fastenings Can be worn for extended periods Remove as soon as practicable after they become moist or soiled Be removed and discarded as soon as practicable after use Wear and fit according to manufacturers instructions Not to be touched by hands while being worn Check fit incorrectly fitted mask will not provide the intended level of protection
Refer to AS/4381-1996 Surgical Face Masks
Particulate Respirator/ (P2 / N95)
Wear to protect from droplet infection from active pulmonary tuberculosis clients.
Refer to AS/NZS 1716-2009: Respiratory Protective Devices and AS/NZS 1715-2009 Selection use and maintenance of respiratory protective equipment
Respirator
Wear when there are noxious fumes, harmful dusts, sprays, vapours and mists.
Has built in filtration system Cover the nose and mouth Secure behind the ears by stapes
Protective Eyewear Safety spectacles
Wear when there is the risk of eye injury from splashing Wear during aerosol generating procedures
May look like normal glasses or may have side shields. Cannot wear glasses underneath. Clean after use Must be optically clear, anti-fog, distortion-free and close fitting Must be worn and fitted in accordance with manufactures instructions Should be removed and decontaminated between clients Either reusable after cleaning or single-use
Refer to AS 1336-1997 Recommended practices for workplace eye protection
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Type Goggles
Product
When to wear

Wear if required when using potentially dangerous equipment. Wear when handling dangerous substances such as chemicals Wear instead of safety spectacles if you wear glasses
Have a larger area of coverage May wear glasses underneath Clean after use
Refer to AS 1337-1992: Eye protectors for workplace eye protection
Gowns/ Aprons Fabric / paper
Wear to protect self from infectious client. Wear to protect client from possible exposure to microorganisms.
Has ties at the neck and at the waist Both sets of ties need to be tied securely Discard paper gown after use Wash fabric gown. If infectious, place in correct linen bag and secure Change between clients Not to be worn as a general item of clothing in corridors etc
Refer to AS 3789.3-1994 Textiles for health care facilities and institutions Apparel for operating theatre staff
Plastic
Wear to reduce contact with blood, bodily secretions, excretions, disinfectants, chemicals, including entering as isolation room for contact precautions

Has ties at the neck and at the waist Both sets of ties need to be tied up Clean and store dry between uses Change between clients and different work areas Not to be worn as a general item of clothing in corridors etc Cover shoe completely and tie securely Made from polypropolene Discard after use
Foot wear Shoe covers
Wear to protect from contamination when entering an area of infection Wear to prevent contamination from spreading
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Type Enclosed nonslip
Product
When to wear
Wear at all times to reduce contact with Upper section of footwear should cover all of the upper foot and be made blood, bodily secretions, excretions, of waterproof material. Soles should be made of a substance that reduces disinfectants, chemicals. the chance of slipping. Shoes should be flat, with a heel of not more than 2.5 cm. In accordance with health and safety staff must wear enclosed footwear at all times to protect themselves from injury or contact with sharp objects Wear to protect from splashes, drips, Footwear with a steel toecap, a heavy duty upper and rubber soles. and the dropping or rolling of heavy objects.
Protective footwear
Head protection Hairnet/ cover
Wear to prevent contamination from Hair should be tied up and completely tucked into cover. falling hair, especially in food preparation, handling and servery areas
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HANDLE, PACKAGE, LABEL, STORE, TRANSPORT AND DISPOSE OF CLINICAL AND OTHER WASTE ..........................................................................................
WEAR APPROPRIATE PERSONAL PROTECTIVE CLOTHING AND EQUIPMENT IN ACCORDANCE WITH WORKPLACE HEALTH AND SAFETY POLICIES AND PROCEDURES WHEN HANDLING WASTE
Your employer is obliged, by law, to provide and maintain in optimum condition, any PPE that are necessary. Employees are obliged by law to use this equipment properly and at the appropriate times. They are also obliged to ensure that the equipment is correctly maintained and stored.
Common types of Personal protective equipment

Hard hat Hood Safety line Body harness Goggles Gloves Finger cots Face shield Safety shoes Rubber boots Lab coat Aprons - rubber Coveralls Protective suits Ear plugs/ muffs Hand protection/ metal glove Air-purifying respirator Air-supply respirator Anti-contamination clothes Shoe covers/ booties
Failure to properly select, maintain, and use the PPE required specific work activities can result in injury or infection. Injuries when handling waste can vary greatly in severity (minor to severe) and types e.g. chemical or thermal burns, eye damage, and systemic infection The particular type of protective clothing required varies according to the nature of the procedure, the equipment used and the skill of the operator, and is a matter for individual professional judgment or establishment policies based on local workplace health and safety (WHS) legislation. Professional organisations may also provide advice on the level of protection required. Respirators Respirators are used to prevent in halation of toxic or otherwise hazardous materials and in limited cases, to provide oxygen in an oxygen-deficient atmosphere. No respirator with a tight-fitting face piece should be issued to be used by a worker who has facial hair or other facial conditions that interferes with the fit, seal or function of the respirator. The respirator should fit comfortably and seal properly. Respirators should be re-fitted every 12 months or if the user loses or gains 10 per cent of their bodyweight. An industrial hygienist or health physicist should select the appropriate respiratory protection equipment. Selection will be dependent on risk assessment results and on sound research as to the best types and fit of respiratory protection. Chemical, radiological and biohazards protection clothing including gloves, aprons and coveralls. A variety of body protection can be used to prevent exposure to hazardous chemicals, radioactive materials, and biological agents, infectious and physical hazards. This equipment protects the individual form exposure or injury and in many instances prevents the spread of contamination to adjacent areas. Personal protective garments should always be considered as combustible unless otherwise specified.
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Disposable protective gear, including latex gloves and paper coveralls should be used for only one shift. Contaminated disposable equipment must be considered hazardous and must be disposed of dependent on the contamination. Non-disposable protective gear must be cleaned and disinfected or sanitised according to manufactures specifications. It should then be appropriately stored, ready for future use. Clothing that protects against liquid chemicals must be carefully selected. Chemicals can degrade some types of plastics and rubbers or might insidiously permeate the material without evidence of degradation. Clothing must be appropriately sized to protect the worker and to reduce any discomfort. Protective clothing must be cleaned, sanitised and stored properly to avoid deterioration, damage, or exposure to hazardous chemicals. Cleaning and sanitisation will prevent passing on of bacterial, viral or other infectious diseases to subsequent users. Face and eye protection Face and eye protection shall be provided where chemical splashes, flying particles, or mucous membrane exposure to a biological agent presents a hazard. The minimum type of eye protection is a pair of safety glasses. Increased protection against flying particles is provided when safety glasses have side shields. For employees who routinely wear safety glasses, it is recommended that they obtain high quality fitted glasses. Goggles are preferred form of eye protection. They should be used instead of safety spectacles, face shields or a combination of safety spectacles and face shields when caustics and hydrofluoric acid are involved in operation, high concentrations of acids are used; when temperatures are elevated; or when work generates splash, dust, mist, or aerosols. Face shields should be used as supplemental protection for the skin of the face, but when used without safety eyewear is not considered to be adequate eye protection. Special eye protection is required when workers are exposed to bright light, lasers, or ultraviolet light. Foot protection safety boots, toe and metatarsal guards Feet are vulnerable to injury from falling or rolling heavy objects, sharp protrusions and chemicals or infectious substances on walking surfaces, and electrical shock. Foot protection will reduce these hazards. Safety shoes or boots protect the feet. They should be made of materials that protect against chemical splashes and penetrations by sharp objects. Some will provide additional protection against highvoltage electricity and twisted ankles. Rubber boots that are designed to be worn over safety shoes, in lieu of safety shoes provide increased protection from chemicals and water and some protections to the lower part of the leg. They should be worn when dealing with any chemical, clinical or medical wastes that might spill or splash, including body wastes, blood etc. They can also be purpose built with strengthened uppers, thick soles and steel caps for maximum penetration.
SEPARATE WASTE AT THE POINT WHERE IT HAS BEEN GENERATED AND DISPOSE OF INTO WASTE CONTAINERS THAT ARE COLOUR CODED AND IDENTIFIED
Waste should be effectively segregated according to its category, at the point of generation, using appropriately colour-coded and labelled containers according to AS/NZS 3816. The waste should be bagged, packaged or containerised and must be clearly marked with an adequate description of the contents.
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There are three main categories: Clinical waste must be placed in yellow containers bearing the international black biohazard symbol and clearly marked clinical waste. Cytotoxic waste must be placed in purple containers bearing the telophase symbol, and marked cytotoxic waste. Radioactive waste must be placed in red containers with the black international radiation symbol and marked radioactive waste. Wastes that have not been segregated must be treated as that portion of the waste representing the highest risk. Clinical and related wastes should be segregated in line with the licence requirements of the final disposal facility. Most clinical and related wastes are nonhazardous and can be disposed of in the general waste stream. Waste segregation allows for supervised landfill for the bulk of clinical and related wastes. The underlying principles in any waste segregation program are: To reduce the volume of hazardous waste destined for special treatment or expensive offsite disposal To maintain safety standards during handling, transportation and treatment To eliminate the need for waste segregation to occur at disposal sites To facilitate the recycling process
Categories of healthcare waste: Health care risk waste

Potentially Infectious Waste 1. General 2. Laboratory Waste 3. Biological 4. Sharps 5. Radioactive Waste Blood and items visibly soiled with blood Contaminated waste from patients with transmissible infectious diseases Incontinence wear/nappies from patients with known or suspected enteric pathogens Items contaminated with body fluids other than faeces, urine or breast milk Other healthcare infectious waste Specimens and potentially infectious waste from pathology departments Microbiological cultures (liquid or solid media in which organisms have been artificially cultivated) Other laboratory waste Anatomical waste and identifiable body parts Any object which has been used in the diagnosis, treatment or prevention of disease that is likely to cause a puncture wound or cut to the skin
Includes materials in excess of authorised clearance levels, classified as radioactive under the General control of Radioactive Substances Order, 1993 (S.I. No. 151 of 1993) Discarded hazardous chemicals, reagents and medicines Includes normal household and catering waste, all non-infectious waste, non-toxic, non-radioactive waste and non-chemical waste Includes shredded waste documents of a confidential nature Assessed as non-infectious, i.e. not contaminated with blood or hazardous body fluids, e.g. plastic bottles, plastic packaging, etc.
6. Toxic Waste Non-risk waste 7. Domestic waste 8. Confidential material 9. Medical equipment 10. Potentially offensive material
Assessed as non-infectious, i.e. not contaminated with blood or hazardous body fluids, e.g. nappies/incontinence wear, stoma bags, etc. Adapted from; Segregation packaging and storage guidelines for healthcare risk waste 3rd Edition, April 2004
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Healthcare Waste - Basic Segregation and Packaging Schematic
HEALTHCARE WASTE (HCRW) First stage segregation NON-RISK WASTE HCRW
Second stage segregation
Yellow bag
Yellow box
Yellow Sharps box
Yellow box Purple lid
Yellow Sharps box Purple lid
Yellow box Black lid
Disinfection Treatment Plant
Incineration
Municipal / commercial waste disposal
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SEGREGATION OF HEALTHCARE WASTE - typical contents

YELLOW BAG
All Blood-Stained or Contaminated Items including:Dressings, swabs, bandages, personal protective equipment (gowns, aprons, gloves) Suction Catheters, Tubing and Wound Drains Incontinence Waste from known or Suspected Enteric Infections NB. Bags must not be used for sharp or breakable items nor for liquids DO NOT OVERFILL. Bag must be securely closed with cable tie or tape when 2/3 full maximum
YELLOW RIGID BIN OR BOX WITH YELLOW LID

Blood and Blood Administration Sets Placentas (In Placentabins) Body Fluids (but not in bulk) Disposable Suction Liners Redivac Drains Histology Waste Non-Cultured Laboratory Waste (including autoclaved microbiological cultures) Sputum Containers from Known or Suspected TB Cases DO NOT OVERFILL. Box must be securely Closed when at Maximum 3/4 full or, at manufacturers fill line
YELLOW SHARPS BIN OR BOX

Used Sharp Materials such as: Needles Syringes Scalpels Sharp Tips of I.V. Sets Contaminated Slides Blood-Stained or Contaminated Glass Stitch Cutters Guide Wires/ Trochars Razors DO NOT OVERFILL NOT FOR LIQUIDS Box must be securely closed when at maximum 3/4 full or, at manufacturers fill line
YELLOW RIGID BIN OR BOX WITH PURPLE LID

Non-Sharps Cytotoxic Waste Pharmaceutical Waste and Discarded Chemicals and Medicines ( only small quantities left over after administration to patients)
YELLOW SHARPS BIN OR BOX WITH PURPLE LID Needles, Syringes, Sharp Instruments and Broken Glass that have been used for the administration of Cytotoxic Drugs
YELLOW RIGID BIN OR BOX WITH BLACK LID Non-Autoclaved Microbiological Cultures (but only in conjunction with additional packaging and liners see notes on Laboratory Waste) Large Anatomical Body Parts Waste Containing Bse/Tse Related Blood or Tissue DO NOT OVERFILL Box must be securely closed when at maximum 3/4 full or, at manufacturers fill line
DO NOT OVERFILL Box must be securely closed when at maximum 3/4 full or, at manufacturers fill line
DO NOT OVERFILL NOT FOR LIQUIDS Box must be securely closed when at maximum 3/4 full or, at manufacturers fill line
Note: Dangerous Goods Regulations require the use of inner liners or receptacles with UN packaging for higher risk wastes or free liquids. Refer to guidelines for more detail.
BLACK BAG* FOR NON-RISK WASTE

Incontinence Wear (from Non-Infectious Patients) Oxygen Face Masks Empty Urinary Drainage Bags Clear Tubing (E.G. Oxygen, Urinary Catheters, Ventilator, I.V. N.G.) Enteric Feeding Bags Giving Sets With Tips Removed All Other Household Non-Recyclable Waste
Note: All bags and containers must have an individual tracing tag or label. + Containers, marking and labels for healthcare risk waste must conform to ADR requirements. * Some Waste Authorities may require healthcare non-risk waste to be packaged in clear, or otherwise identified plastic bags.
DO NOT OVERFILL
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Effective Segregation Effective segregation can be best achieved through: Providing education and training programs for all personnel who generate waste Providing MSDS for identification of material composition Establishing identifiable colour coding, labelling and containment Incorporating quick and efficient waste disposal methods into client/ patient care procedures Using methods that ensure the easy, safe and proper segregation of clinical and related wastes at eh earliest possible stage, preferably art the point of generation Providing a suitable storage area at the point of waste generation Developing systems with realistic goals and targets and an effective dialogue between waste generators and waste handlers/ disposal contractors that ensure mutual awareness of the facilities segregation protocols.
STORE CLINICAL OR RELATED WASTE IN AN AREA THAT IS ACCESSIBLE ONLY TO AUTHORISED PERSONS Most waste storage areas will be restricted to authorised personnel only. Storing clinical waste The Regulation has specific requirements for storing clinical waste before it is transported off-site for treatment. These requirements have been introduced to prevent harm to humans, avoid contamination of soil and surface waters, and to assist in ensuring correct disposal. Premises generating and storing their own clinical waste do not require a development approval for waste storage under the Integrated Planning Act 1997. However, those premises storing clinical waste received from generators off-site must obtain a development approval and become a registered operator for the activity. Clinical and related waste must be: bagged and stored in rigid-walled, leak-proof secondary containers, preferably in a bundled area with an impervious surface (e.g. concrete); stored in bags and containers coloured yellow, and marked with the biohazard symbol and the words CLINICAL WASTE; kept so as not to cause environmental nuisance (e.g. by refrigerating potentially odorous materials); and kept in an area not accessible to unauthorised people or animals.
Sharps Sharps produced by premises generating clinical or related waste must be placed into a rigid-walled, puncture-resistant container that meets the relevant Australian Standard for the type of container, and is the appropriate colour for the type of sharp. For example, if the sharps waste is contaminated with a cytotoxic drug, the container should be purple. If it is contaminated with blood, the container should be yellow. If the sharps waste is contaminated with blood and a cytotoxic drug, the container used should be the colour of the highest level waste present this being the cytotoxic drug (the container should be purple). Sharps discarded in other areas (e.g. public toilets, hotels, shopping centres, restaurants, parks, or skin penetration premises) must be placed into rigid-walled containers and should be disposed in accordance with local government requirements. Once the sharps container has been sealed and secured, it can be placed directly into a secondary container for transportation. There is no requirement to first place the sharps container into a plastic bag before disposal into a secondary container, as they are already contained.
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Clinical waste Clinical waste must be placed in yellow bags and containers identified with the Biohazard symbol and the words CLINICAL WASTE marked prominently and permanently in black. Cytotoxic waste Cytotoxic wastes require careful handling and containment. All cytotoxic waste must be placed into purple bags and containers that are identified with the cell in telophase symbol and the wording CYTOTOXIC WASTE in white. Radioactive waste Radioactive waste must be placed into red bags and containers that are marked with the radiation warning symbol and the words RADIOACTIVE WASTE in black. The Radiation Safety Act 1999 contains requirements for the management of radioactive substances. The lid of the secondary container should be capable of being secured once the waste has been deposited. Once sealed, neither the primary nor secondary container should be opened on-site, unless for the purposes of conducting a waste assessment or audit.
What is not clinical waste? In certain cases, clinical waste need not be managed in accordance with the provisions of the Regulation. These circumstances include clinical waste generated in the home (except hypodermic needles) or as a result of emergency first aid given by members of the public (not including ambulance attendants, police, doctors or nurses in the course of their work), by beauty care or ear/body piercing establishments, by animal bathing services or facilities having animals, by some medical practitioners, and in first aid rooms. Internal movement and transporting of clinical or related waste internal movement Internal movement is the movement of containerised clinical or related waste from its source to the storage, treatment or collection point. Waste should be moved around premises in rigid-walled, puncture resistant containers. A rigid-walled container is one that has hard, unbending sides and is resistant to splitting, breaking and puncturing. The container must not allow liquids to leak or soak through. A mobile garbage bin is an example of a rigid walled container suitable for the transportation of clinical or related waste. The movement of loose waste or waste carried in plastic bags should be avoided or, where necessary, limited to short distances, light waste loads and low risk wastes. Good waste management practice involves minimising exposure to the waste. To facilitate this, all movement of wastes throughout the premises should be planned to avoid peak activity times, such as visiting hours, meal times and change of shifts. Clinical or related wastes should not be moved through public areas or general staff thoroughfares. Trolleys and bins should not be overfilled, to avoid potential spillage. The practice of double-bagging waste should be carefully considered before it is sed. Double-bagging means using two bags to contain one waste load. It potentially doubles the thickness of the plastic skin and gives added strength. Double-bagging may be used in situations where heavy loads of waste are moved from generation areas to bins. However, care must be taken when placing a bag containing waste into an empty bag so that the contents are not spilled, or staff do not come in contact with the waste. The risks associated with this double handling may reduce the value of double-bagging. Waste disposal chutes Many facilities are equipped with waste disposal chutes. These are generally hollow steel tunnels that allow movement of waste bags from waste generating areas to a collection point. Waste chutes must not be used for moving clinical or related wastes because of the risk of the bag breaking and waste spilling. In such instances, staff are collecting the waste at the bottom of the chute run the risk of unnecessary exposure to infection. It is also likely that the waste chute may become contaminated.
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Accident prevention Emergency services need to know about the type and amount of dangerous goods stored on the premises, especially in the event of an accident. An emergency management plan might include: Evacuation procedure for the workers Standard procedures for contacting emergency services Emergency contact lists, including after hours telephone numbers Emergency equipment MSDS location Site-containment measures Areas where waste might be stored need to be suitably sited, lockable, hygienic, appropriately sign-posted and kept secure at all times. Security Storage areas should be checked daily to ensure that they are not left unlocked or damaged in any way. Depending on security level implemented different levels of access and authorised personnel may enter the areas. Hygiene Waste storage areas need to maintain a high level of cleanliness to avoid cross-contamination or spills and leakages. Visual inspections need to be carried out daily as a security check. If there is any spills then emergency clean up is required. All staff using the facility should be aware of any possible problems in storage containers and should be able to identify if there is a problem or not. Periodically, all storage containers should be removed and a thorough clean of the area should be carried out. When performing this task, workers are required to wear full safety clothing and equipment in case of a spillage or outbreak in the area.
HANDLE, PACKAGE, LABEL, STORE, TRANSPORT AND DISPOSE OF WASTE APPROPRIATELY TO MINIMIZE POTENTIAL FOR CONTACT WITH THE WASTE AND TO REDUCE THE RISK TO THE ENVIRONMENT FROM ACCIDENTAL RELEASE
Container Colour Yellow (vivid yellow Y13) Label Colour Black
Waste Clinical
Symbol Biohazard Symbol
Labelling Clinical Waste
Cytotoxic
Lilac (lilac p23)
White
Cell in Telophase
Cytotoxic Waste
General Radioactive Red (scarlet r12) Black Radioactive Symbol Radioactive Waste
1 It is an offence under section 67 of the Waste Regulation to use equipment that does not comply with the design rules where applicable.
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Different types of waste require different types of disposal. Examples of waste disposal techniques include: Incineration
Incineration is the term used to describe the process of combustion carried out in a multiple-chambered incinerator that has mechanisms for close monitoring and controls. Incinerator residues can generally be disposed of in landfills. Where incineration is used, the following issues should be addressed.
Emissions standards
Depending on the type of waste incinerate, gaseous emission might involve toxic gases such as hydrogen chloride etc and fumes. Regular maintenance of any incinerator is therefore essential to efficient operations.
Ash disposal
A well-designed and operated incinerator will destroy and infectious and toxic waste by exposing it to a sufficiently high temperature for a sufficient time, with sufficient oxygen to burn organic matter, leaving a biologically inert ash with not combustible residue. The removal and handling of ash is done under regulations to ensure safety.
Landfill
Landfill is a traditional disposal method used for common waste. There are specific and/ or segregation landfill sites for the disposal of clinical wastes.
Sewerage
Sewage disposal of certain liquid wastes to the sewer might be acceptable because the associated potential hazards are reduced through dilution and dispersals within the sewerage system. Disposal to sewer must meet Workplace Health and Safety guidelines.
Microwave
The microwave process usually involves the grinding and shredding of waste material to optimise radiation and exposure. Microwaving is suitable for the bulk of clinical and related wastes, excluding body parts or pharmaceuticals including cytotoxics and radioactive wastes.
Chemical disinfection
Chemical disinfecting which includes physical maceration (shredding or grinding) is a suitable treatment for small amounts of clinical and related wastes. This treatment usually involves and initial grinding/ shredding of the waste, which is then soaked in a liquid disinfectant. Agents used include sodium hypochlorite and hydrogen peroxide and lime. Chemical disinfection is not a suitable treatment method for human body parts or pharmaceuticals including cytotoxics and radioactive wastes.
Off-site transportation
Transporting wastes from a generating premise to a storage, treatment or disposal facility away from the premises is off-site transportation. If clinical or related waste is transported in loads of 250kg or more, or for fee or reward, licensing (in the form of a registration certificate2) is required for environmentally relevant activity (ERA) 83 under the Environmental Protection Regulation 1998. This is a requirement regardless of whether the waste is being transported by the person who generated the waste or by a commercial operator. The Code of environmental compliance for certain aspects* of regulated waste transport (ERA 83) contains conditions that must be complied with for road transport aspects of ERA 83 (see the information sheet Carrying out an ERA subject to a code of environmental compliance for information on the requirements when a code of environmental compliance applies)3. Other forms of transport of regulated waste are required to have a development approval in addition to the registration certificate. Even if a vehicle does not require licensing to undertake the activity, certain requirements should be met to provide safe transportation of clinical or related waste4. All waste must be transported in rigid-walled, puncture resistant containers. The container used must have a lid that is capable of being secured during transportation. Plastic bags alone may not be strong enough to ensure the safe handling and transportation of these wastes. It is important to ensure that any reusable containers are in good condition and are not split, cracked or damaged in any way. It is preferable that any vehicle used for the transportation of clinical or related waste should be used solely for that purpose. The transport vehicle should be designed to protect the driver, public and environment from contact with the waste during transportation and in the event of an accident. The driver area should be separated from the waste transport area to minimise risk of exposure. The vehicle should be easy to load, unload and clean.
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The waste transport compartment should be fitted with container restraints or a method of securing containers. Restraining containers during transportation will ensure that containers do not fall during transporting and create risk of contact when unloading. It also prevents containers from being damaged.
DISPOSE OF WASTE SAFELY IN ACCORDANCE WITH POLICIES PROCEDURES OF THE ORGANISATION AND LEGISLATIVE REQUIREMENTS
AND
There are national guidelines in place to control waste generated by the health industry. All health organisations should have a structured waste management plan, supported by SOPs and/ or company worksheets. This plan should be known about and the procedures involved should be understood by all personnel who work with waste products. Health care industry guidelines aim to: Enhance and protect public health and safety Provide a safer working environment Minimise waste generation Minimise the environmental impact of waste treatment and disposal Facilitate compliance with regulatory requirements.
You need to know what waste you are handling in a health care environment to ensure that the proper precautions are taken. Procedures for waste management should outline: Classification Segregation Safe packaging Labelling Storage Transport Disposal.
Organisational policies and procedures need to be kept up-to-date regards waste management, this might include: Different types of waste Protective measure or precautions to be followed Who is authorised to handle the waste How waste should be segregated and labelled How waste should be disposed of Where the waste should be picked up from.
General waste constitutes the bulk of waste generated by health care facilities and is no more a public health risk or concern then domestic or household waste. Clinical waste is waste that has the potential to cause disease, including, for example, the following: Animal waste Discarded sharps Human tissue waste Laboratory waste.
Discarded sharps are objects with sharp points or cutting edges such as used hypodermic or other medical needles, scalpel blades, lancets, scissors and broken laboratory glass.
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Any hypodermic needles generated in any situation must always be disposed of in rigid-walled, punctureresistant containers, and all possible care should be taken to safely dispose of any other waste. Any sharps discarded at premises that generate clinical or related waste must be disposed of into an Australian Standards compliant container. Human tissue waste includes blood and blood components such as plasma, material heavily contaminated with blood, human tissue removed during medical procedures and some other bodily fluids. Laboratory waste means a specimen or culture discarded in the course of dental, medical or veterinary practice or research. This includes wastes contaminated by genetically manipulated material or imported biological material. Laboratory waste also includes cultures and stocks of infectious agents. Animal waste is any discarded material including carcasses, body parts, blood or bedding from animals contaminated with an agent infectious to humans. Dead animals at the side of the road or animals put down due to old age or injury do not have to be disposed of as clinical waste. Related waste is waste made up of, or contaminated with, chemicals, cytotoxic drugs, human body parts, pharmaceutical products or radioactive substances. Cytotoxic drugs are drugs known to have carcinogenic, mutagenic or teratogenic potential. Pharmaceutical products are restricted drugs under the Health (Drugs and Poisons) Regulation 1996. These listing criteria provide a consistent frame of reference for waste streams: 1. The waste typically contains harmful chemicals, and other factors indicate that it could pose a threat to human health and the environment in the absence of special regulation toxic waste 2. The waste contains such dangerous chemicals that it could pose a threat to human health and the environment even when properly managed hazardous wastes 3. The waste typically exhibits one of the four characteristics of hazardous waste described in the hazardous waste identification regulations ignitability, corrosivity, reactivity, toxicity 4. If there is a cause to believe that, for some reason the wast typically fits within the statutory definition of hazardous waste. To decide if a waste should be listed as toxic waste it must be determined whether it typically contains harmful chemicals constituents. A hazard code can be applied to listed wastes: 1. Toxic waste (T) 2. Acute Hazardous Waste (H) 3. Ignitable Waste (I) 4. Corrosive Waste (C) 5. Reactive Waste (R) 6. Toxicity Characteristic Waste (E). The hazard codes assigned to the listed wastes affect the regulations that apply to handling the waste. General information required on a waste label includes: The area/ group the material originated from The name of the material or classification A date of generation Specific details covered in the chemical, biological, and radioactive waste sections.
Depending on the workplace, labels might be pre-generated or they may be designed to be written on. Different work environments may also have different labelling required for the transport of waste.
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Pharmaceutical waste
Pharmaceutical waste, excluding cytotoxics might arise from: Pharmaceutical that have passed their recommended shelf life Pharmaceuticals discarded due to off-specification batches or contaminated packaging Pharmaceuticals returned by clients/ patients or discarded by the public Pharmaceuticals that are no longer required by the facility Waste generated during the manufacture and administration of pharmaceutical.
Non-hazardous materials such as normal saline or dextrin need not be considered as pharmaceutical wastes. Excess stock of pharmaceuticals, either current or expired can be returned to the relevant authority or collection centre for appropriate disposal or distribution. The disposal method depends upon the chemical composition of the material. Whilst the disposal of drugs and their metabolic by-products to sewer via the urine and faeces of clients/ patients undergoing treatment is unavoidable, the following general Principles should be observed: Pharmaceutical wastes should be placed in non-reactive containers Wherever possible, this waste should be incinerated, it should not be sent for landfill Where practicable, non-flammable liquids should be absorbed by surplus absorbent sawdust enclosed in either a wet bag or a plastic bag and then incinerated Pharmaceutical waste can be disposed of a clinical waste if both are incinerated.
General waste
General waste is any waste not classified as being within any of the categories of the clinical and related waste streams. It represents the significant majority of all health industry wastes. This category includes: Incontinence pads Drained dialysis wastes Sanitary wastes Disposable nappies Office wastes Intravenous drip equipment as long as no hazardous materials uses. All sharps are to be removed.
CLEAN ENVIRONMENTAL SURFACES ................................................................................................

WEAR PERSONAL PROTECTIVE CLOTHING AND EQUIPMENT DURING CLEANING PROCEDURES
Wear personal protective clothing and equipment during cleaning procedures, remove dust, dirt and physical debris from work surfaces and clean all work surfaces with a neutral detergent and warm water solution before and after session or when visibly soiled. During cleaning procedures PPE is just as important as is the procedure followed to handle and manage waste. Glove, aprons, respirators, masks, eye production etc must all be work as needed.
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REMOVE ALL DUST, DIRT AND PHYSICAL DEBRIS FROM WORK SURFACES
Cleaning is the process of removing dust, dirt, debris and grime from various surfaces or from equipment. If you use chemical products in the cleaning process, particularly caustic cleaning products, it might be necessary to wear gloves, eye protection, masks and strong rubber aprons. Cleaning is usually undertaken before any sanitising or sterilising procedures can occur. Wipe surfaces clean of all lose debris, scraps, etc. Large items should be disposed of according to organisational and legal requirements, that is, anything that constitutes clinical waste should be placed in the appropriate containers. Dust or damp-dust benches, equipment and shelving. They can then be wiped over with hot water and detergent.
CLEAN ALL WORK SURFACES WITH A NEUTRAL DETERGENT AND WARM WATER SOLUTION BEFORE AND AFTER EACH SESSION OR WHEN VISIBLE SOILED
Dependent on their use and the materials with which they come into contact, benches and shelves might require sensitisation. Spray-on sanitisers that will rapidly air dry are the most appropriate. Maintain the interior of drawers and cupboards in a clean and tidy state. Wipe and clean regularly. Floors must be cleaned at least daily. They should be thoroughly swept then mopped using clean mop and hot water, detergent and sanitising agent. Signs need to be place appropriately when cleaning. After washing floors should be fried to prevent accidents, slips or falls. General waste bins must be emptied, cleaned and re-lined. Once the cleaning has been completed, cleaning equipment must be cleaned, dried and stored in the correct places.
DECONTAMINATE EQUIPMENT REQUIRING SPECIAL PROCESSING IN ACCORDANCE WITH QUALITY MANAGEMENT SYSTEMS TO ENSURE FULL COMPLIANCE WITH CLEANING, DISINFECTION AND STERILISATION PROTOCOLS
Any area where waste is going to be stored needs to be equipped with a cleaning station which contains all the equipment necessary to clean spills and prevent contamination. Equipment used to clean infectious or contaminated waste will need to be either classed as waste itself or disposed of in the same ways as the waste with which it is contaminated or it might be disinfected to ensure that cross-contamination does not occur. In order to grow and multiply, bacteria require warmth, moisture, food, correct PH balance and oxygen. To kill bacteria and prevent the spread of infection, it is necessary to remove at least one of these conditions. Moulds and yeasts which can cause infection can generally be killed with heat or with their spores. Most viruses will succumb to cleaning and sterilisation process also. Chervils, heat (stems) and radiation (irradiation) can be used.
Autoclaving
Autoclaving can be used to sterile metal, materials and rigid plastics. Autoclaving is the heating of infectious waste by steam under pressure. The effectiveness depends on the temperature, pressure, exposure time and the ability of steam to penetrate the container. Trained staffs are required to operate an autoclave. Ventilation may be required depending on items being autoclaved.
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Cleaning stations examples of basic checklist for maintaining a cleaning area Equipment: Mop Bucket Sand Gloves Fire extinguisher Boots Goggles Disinfectant Barriers Face mask Check all products to ensure to be in working order.
Dry all work surfaces before and after use

All work surfaces should be dried prior to reuse. Air drying it optimal, yet paper towel or cloths can be used to dry the area. Equipment should always be stored in a manner that ensures a safe work environment. Equipment should be positioned in storage to minimise the risk of injury. Free access to work areas must be maintained at all times and equipment not in use should be removed for cleaning and then stored appropriately.
Classification of instruments and equipment

Equipment and instruments are classified into 3 categories of processing and storage based on the degree of infection risk in their intended use. All items must be stored in a way that maintains their level of processing. 1. Critical
a) Intended for use in entry or penetration into sterile tissue, cavity or blood stream. b) Sterility must be maintained. c) Unpackaged items must be used immediately. d) Packaging of wrapped items must not be crushed, bent, compressed or punctured. e) Items must be handled with care. f) If packaging is damaged or allowed to become wet it must be considered un-sterilised and sent
for reprocessing. 2. Semi-critical a) Intended for use in contact with no intact skin
b)
Store to protect from environmental contamination
3. Non-critical a) Intended for use in contact with intact skin b) Store in a clean dry place It is important for all health care workers involved in the use, processing or storage of equipment and instruments to know and follow establishment policy and procedure.
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Disposing of cleaning equipment

If equipment is used to clean waste which cannot be sterilized, is should then be classed as waste itself; this means that cloths, sponges, mop heads or containment equipment should be disposed of in the same way as the waste substance. Different types of disposal include: Incineration Landfill Sewerage Microwave Chemical disinfection. As technologies are continually being updated and developed, facilities should be open minded with respect to their waste disposal options. When disposing of waste and cleaning equipment, paperwork should be used to provide evidence of checklist actions.
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SUSTAINABILITY PRACTICES ................................................................................................

Increasingly more Australian women and men are working. There has been an increase of women working, of around 10 percent in 20 years to 1.8 million working leading to significant implications for how we live, work and care. This is occurring against the background of changing family shape, with only 40 per cent now 'traditional' nuclear families of two parents sharing biological children. With a third of marriages in 2001 predicted to end in divorce, and big increases in sole parent households, work and care arrangements have to accommodate many kinds of transitions over the life course. It is against this background that demands for childcare have grown. (Barbara Pocock, 2011 ECA website) While much attention focuses on the effects of work on the ability to care for children, combining care and work in the future is increasingly going to be about aged care, with a quarter of our population predicted to be over 65 by 2036. Work is generally associated with positive wellbeing and social inclusion outcomes for both men and women. Having a job is, overall, a good thing but only in the right circumstances. Giving up more household hours to work affects people's capacity to do other important things to care for each other; exercise; spend time with neighbours, friends and families; and undertake formal or informal voluntary work. (Barbara Pocock, 2011 ECA website)
DEFINITION
Sustainable development is a perspective or a vision rather than a definition and provides room for many different starting points. One of the most well known and widely used definitions of sustainable development comes from the Brundtland Commission report Our common future from 1987 in which it defines sustainable development as development that meets the need of the present without compromising the ability of future generations to meet their own needs. The message from the United Nations is that we must ensure that basic human needs may be satisfied for all human beings without damaging the life sustaining system of our planet. A clear common message in the perspectives and definitions gathered from different international contexts is that the time line encompasses several generations and that there is always a global perspective. Individual involvement and responsibility are also integral parts of the concept of sustainable development. The key principle is that economic, social and environmental conditions and processes are integrated into a whole, but also includes opportunities to approach this whole from all different directions.
SOCIAL
The Oxford Dictionary defines sustainable as capable of being upheld, maintainable and to sustain as to keep a person, community etc from failing or giving way; to keep in being; to maintain at a proper level; to support life in; to support life, nature etc with needs. Considering this, really we are looking at holistic approach to sustaining everyone on a social level. Some groups see social sustainability about maintaining populations or matching population to the resources available to sustain life. At present, this is a debate within the community. It has been referred to as the Human Carrying Capacity number of people that a land can support (Brown, Hansen, Liverman and Meredith in Forum for Global Stability Toward Definition in 1987) http://www.environment.arizona.edu/files/env/profiles/liverman/brown-hanson-liverman-and-merideth-1987em.pdf. This debate has been going on for decades and will continue to be part of the current social climate for the foreseeable future. The World Bank Social website states the social sustainability is generally, societies that are inclusive, cohesive, and that have accountable institutions are best able to support lasting development outcomes.
A sustainable society is a society whose long-term prospects for continuing to exist are good. Such a society would be characterized by an emphasis on preserving the environment, developing strong peaceful relationships between people and nations, and an emphasis on equitable distribution of wealth. d Coop America, Coop America Quarterly, No. 37, Summer 1995, p 46.
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As you can see, social sustainability is really at a governmental level but it will affect our daily work lives especially in aged care. Now consider that the younger population will have to support and increasing ageing population which will put strain on the economy and the physical care of the aged. People are having fewer children as the planet will not be able to support large families which will in turn reduce the workforce. These are points to consider when looking at social sustainability. I am sure that you can think of more. Eng
ECONOMIC
There are many constraints in aged care linked the funding. According to the Department of Health and Ageing, expenditure on health and residential aged care as a percentage of Gross Domestic Product is projected to rise from 9.3 per cent in 2002-03 to 12.4 per cent of GDP by 2032-33. The scope of peoples universal entitlement to health care funded by public monies should be debated over time to ensure that it is realistic, affordable and fair and will deliver the best health outcomes. Health care priorities should be decided with consideration of the clinical, economic and community perspectives. In Australia, as around the world, people are living longer and therefore there is increasing economic and social strain on the population and in turn, governments to ensure that all people are cared for. According to the Department of Health and Ageing, the current overall balance of taxation, private health insurance and out of pocket, contributions are appropriate and should be maintained over the next decade. The current scope and structure of safety net arrangements needs to be reviewed to cover a broader range of health costs in a simple and integrated way that continues to protect people from unaffordable out-of-pocket costs. Incentives for improved outcomes and efficiency should be strengthened in health care funding arrangements should involve a mix of: activity-based funding; payments for care of people over a period of time; and reward payments for good performance and timeliness of care. A fit-for-purpose approach to funding models should be applied. This may involve changing the scope of payments available to include more than the existing fee-for-service model currently used. The Department of Health and Ageing discusses the need to support system changes and enhance efficiencies, priority areas for new capital investments including: establishment of Comprehensive Primary Health Care Centres; expansion of sub-acute services; investments to support expansion of clinical education across service settings; e-health including person-controlled electronic health records and data systems; targeted investments in hospitals to support reshaping of roles; and to enable capital to be raised through both government and private sectors.
WORKFORCE
The aged care workforce includes the management or delivery of aged care in any setting. As well as staff who provide hands-on care, the aged care workforce includes a range of skilled professionals such as allied health professionals, general and specialist medical practitioners, pharmacists and ancillary staff involved with facilities and services. A number of reports demonstrate concern about the current aged care workforce its size, skill mix, and availability. The recruitment and retention challenge facing aged care would rise if the overall Australian labour market became much tighter. But in that, they would not be alone. As the aged care workforce ages, the gap between workforce supply and demand is projected to increase13 as demand increases without a similar increase in supply. In the supply of registered nurses, there is an acknowledged shortage of nurses worldwide. The aged care workforce is predominantly female, and has a strong part-time and actualised structure. Workplace stress, increased injuries and high workplace health and safety risks are reported. Wage disparity compared with other sectors is a factor for many workers in aged care. http://www.health.gov.au/internet/main/publishing.nsf/Content/90A1E255138D80CACA256FE3001715E3/$File/na cws.pdf To ensure that there is enough care staff the government has undertaken strategies to ensure a sustainable workforce including:
specification of workforce categories within each model (e.g. registered nurse, enrolled nurse, assistant in nursing, care workers, other employees, allied health) and best means for utilisation in different contexts of care; mapping of current and future skills, roles and duties in a range of contexts; variations in work roles, job descriptions and role boundaries of workers in these contexts;
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prediction of met and unmet demand for skilled staff across categories, leakages or retention of staff to the system would be an issue for consideration also; level of consistency needed regarding nomenclature and job descriptions; and projected change in demographics of all residents (disability, dependency, dementia, ethnicity) and impact of this on projected workforce skills required.
As you can see, it is very complex to ensure that there is enough people to care for the aged in our community.
ENVIRONMENTAL
The healthcare sector is finding waste management issues to be increasingly important. Disposing of healthcare waste can have high costs and environmental implications. According to the Waste Management Guideline established by the Department of Human Services in Victoria, there are several strategies and containment measures that will assist us to understand what our obligations and requirements may include (http://www.capital.dhs.vic.gov.au/WasteManagementGuideline/) please see container information listed below. Waste management includes a variety of different aspects of working every day. Below are some areas of consideration as discussed by Queensland Department of Health (http://www.resourcesmart.vic.gov.au/for_government/waste_and_recycling_2376.html) as shown below.
Pests and disease

Food waste attracts pests and vermin, like feral pigs and rats. These pests and vermin can start or spread disease in the community. Piles of old garden waste and pieces of old furniture left in yards can shelter vermin and help them to breed. Dengue fever can be spread by mosquitoes that breed in anything that can hold water, like inside old car tyres, litter and even old palm fronds lying on the ground!
Poison and pollution

Illegally dumped pesticides, motor oil and other chemicals can contaminate land, creeks, and water supplies. People drinking or swimming in polluted water can get sick. Councils are required by law to clean up land contaminated with chemicals that they dispose of. Chemical clean-ups can be very expensive.
Human waste and diseases

It is very important to keep human waste out of water supplies. Human waste (faeces, poo, kuma, urine, wee) contains diseases that make people sick. Human waste can get into the local water supplies from leaking septic tanks, releasing contaminated water from sewerage treatment plants, dirty nappies, leaking sewerage pipes and people using local creeks as a toilet.
Injury and disease

People can get diseases like tetanus and leptospirosis if they cut or scratch themselves on pieces of metal, nails or glass. Children can be seriously hurt by playing with old car batteries or household cleaners that they find lying around.
Litter
Litter can be a problem in any community. Broken bottles and tins, for example, can cause injury if people do not put them into bins. Mosquitoes and other vectors can breed in water trapped in old tyres and bottles. People are more likely to drop litter in places that already have litter lying around. If they see litter on the ground, they may think it is OK for them to also throw their litter on to the ground. Without providing ways for people to stop littering, the whole community can be affected because they do not want to live in a dirty town.
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This hierarchy lists ways of managing waste problems. The best option is to avoid creating waste in the first place. The worst option is to bury waste at a rubbish tip. Option Avoid creating waste Re-use waste Recycle waste Recover energy from waste Dispose of waste safely Example Ask suppliers not to package the goods they provide, where appropriate If goods have to be packaged, ask the supplier to take back the packaging Use packaging for storage Burn waste in a legal incinerator to heat water for council or community use Bury waste in a council landfill/rubbish tip
Containment of materials http://www.capital.dhs.vic.gov.au/WasteManagementGuideline/

All areas All areas of a facility must provide designated containment requirements of the following attributes: waste containers such as skips, wheelie bins, bucket bins, sharps containers, cages for storing the following, but not limited to: rubbish (general waste) recycling (full and partial commingled) confidential paper waste redundant (hard waste) materials for re-use sharps waste clinical waste related wastes materials such as cardboard must be appropriately compacted or baled waste container colours should be aligned with Australian standard AS 4123.7 and ANZCWMIG Industry code of practice for the management of clinical and related waste 5th edition 2007.
Types of containers
All areas Waste containers (skips, wheelie bins, bucket bins, sharps containers, cardboard compactors, rubbish compactors) should meet Australian standards. For more information about clinical and related waste containers, refer to Industry code of practice for the management of clinical and related waste 5th edition 2007. Designing Waste Storage Areas Space Sufficient space in the facility areas must be provided for waste containers and equipment as well as waste likely to generate on the premises between collection periods. When designing waste storage areas in healthcare facilities, designation of the following locations needs to be considered. Ward/department disposal areas There is a requirement for sufficient space to be designated within the ward/department disposal area for waste containers and waste generated between collection periods. Central bulk disposal areas There is a requirement in the central bulk disposal areas to provide separate designated areas for: clean, empty or used waste containers secure areas temperature-controlled areas caged storage areas
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Location of Waste Containers

All areas There is a requirement for all disposal areas to be well located for: convenient disposal for users sited away from food preparation and general storage areas and from routes used by the public safe and efficient movement across the healthcare facility and from disposal area to disposal area such as ward/department disposal area to central bulk disposal area safe and efficient accessibility for collection contractors central bulk central storage areas would be located and designed out of public view from the road, patient and public areas, public walkways, near car parking or adjacent to neighbouring residential/ commercial/educational properties waste/recycling contained in cages, secure or temperature-controlled areas must be placed in a location where collection trucks, or collection person/s permit easy, convenient and safe access.
Design Aspects of Waste Storage Areas

Ward/department disposal areas point of production There is a requirement in the ward/departments for secure disposal area sufficient in size to allow for waste to be separated. The ward/department disposal area should provide adequate for space for: containment of waste containers such as wheelie bins for adequate separation of rubbish, recycling and reusable materials including rubbish, recyclable materials, confidential paper, clinical waste and sharps waste during and between collection periods movement of waste materials including manual handling Central bulk disposal areas Central bulk disposal areas for should support the following attributes when planning waste storage areas. It should be noted that central storage areas should be sited away from food preparation, storage areas and walkways used by the public. Clean, empty or used waste container area should be adequately sized to provide enough space for: containment of a variety of empty and used waste containers including wheelie bins, sharps containers and skips for rubbish, recycling, re-use materials including rubbish, recycling, confidential paper and other paper during and between collection periods (this space needs to accommodate all items which are collected from one central location by the waste contractor) equipment including compactors and bailers easy accessibility for cleaning adequate ventilation to prevent build up of odours clear signage and labelling on all door and entrances spill response kit. Secure areas should provide enough space for some clinical waste materials such as sharps and cytotoxic waste that require storage in secure areas. These areas should be adequately sized to provide enough space for: containment of used containers including sharps containers and pails for cytotoxic waste to be stored until collection easy accessibility for movement of waste containers easy access for cleaning visual screening from public areas adequate ventilation to prevent build up of odours clear signage and labelling on all door and entrances spill response kit Temperature-controlled areas are required for storing some materials such as clinical waste, clinical waste for incineration only or some related wastes to be stored in a temperature-controlled area. Food waste must also be chilled if not collected within three days of generation. Where waste storage area is temperature controlled, the temperature should be maintained at or below 5-7C. These areas should be adequately sized to provide enough space for: adequate ventilation to prevent build-up of odours clear signage and labelling on all door and entrances spill response kit.
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Caged storage areas are required for storage of larger items or materials with inherent value such as mattresses, electronic equipment, desks, chairs and office equipment for example. These items must be stored in a caged storage area to reduce the risk of WHS issues arising. These areas should be adequately sized to provide enough space for: adequate ventilation to prevent build up of odours clear signage and labelling on all door and entrances spill response kit. Other design attributes to consider in central bulk storage areas include the following: Bin servicing or repair areas should be adequately sized to provide enough space for: containment areas for damaged or new waste containers adequate space for service staff to work with containers to remove and replace wheels and lids safely and without obstruction or OHS issues. Bin washing facilities must include taps. In addition: the floor surface should be washable with smooth surface and must drain to sewer the concrete floor graded and drained to sewer the area must be undercover to prevent rainwater from entering wash water wash areas are required where waste containers are the responsibility of the facility discharging of wash water must be stated as acceptable on the facilities Trade Waste Agreement. There is a requirement for all waste disposal areas to consider accessibility and movement of waste containers. Design shall allow for adequate vehicle access, manoeuvring and loading into collection vehicles as well as visual screening from public areas. Noise Noise affecting staff, patient, visitors, public and surrounding properties should be considered when choosing location of all waste storage areas. Lighting Sufficient lighting must be provided. Ventilation and odours There should be adequate ventilation to prevent build up of odours. All disposal areas must have their own extraction ventilation system. Mechanical exhaust systems shall comply with AS1668 and not cause any inconveniences, noise or odour problems. Water supply and hydraulics A floor waste basket trap connected to the sewer is required within central waste containment areas. A tap facility should also be provided.
Supporting information and references

Australian Dangerous Goods Code for Transportation by Road or Rail. Australian Standard AS 4031:1992. Non-reusable containers for the collection of sharp medical items used in health care areas. Australian Standard AS 3816:1998. Management of Clinical or related Wastes. Australian/New Zealand Standard AS/NZS 4261:1994. Reusable containers for the collection of sharp items used in human and animal medical applications. Australian and New Zealand Clinical Waste Management Industry Group, 2000. Industry Code of Practice for the Management of Clinical or related Wastes. National Health and Medical Research Council, 1999. National guidelines for waste management in the health care industry. (http://www.health.gov.au:80/hfs/nhmrc/publications/pdf/eh11.pdf, accessed 22 October 2001) Other Environmental Protection Agency (EPA) information sheets in this series include: Clinical or related waste treatment and disposal; Defining clinical waste; Determining whether waste is clinical waste;
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Managing sanitary hygiene waste; Managing clinical or related waste; and Managing clinical or related waste in scheduled areas. For copies of these information sheets on clinical or related waste, visit the website at www.env.qld.gov.au or contact the Ecoaccess Customer Service Unit on 1300 368 326.
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CHARLTON BROWN
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Hltin301c v2 Comply With Infection Control Policies and Procedures in Health Work

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Training Division

CHC30212 Certificate III in Aged Care

COMPLY WITH INFECTION CONTROL POLICIES AND PROCEDURES

GLOSSARY OF TERMS .......................................................................................... 11 FOLLOW INFECTION CONTROL GUIDELINES .................................................... 14

IDENTIFY AND RESPOND TO INFECTION RISKS .................................................... 20

MAINTAIN PERSONAL HYGIENE .......................................................................... 36

USE PERSONAL PROTECTIVE EQUIPMENT ....................................................... 43

LIMIT CONTAMINATION ......................................................................................... 45

HLTIN301C Version 2 (August 2012)

Confine contaminated instruments and equipment to a well-designated contaminated zone ..................................47

CLEAN ENVIRONMENTAL SURFACES ................................................................ 65

SUSTAINABILITY PRACTICES .............................................................................. 69

HLTIN301C Version 2 (August 2012)

HLTIN301C Version 2 (August 2012)

1.3 2. Identify and respond to infection risks

3. Maintain personal hygiene

Use personal protective equipment

HLTIN301C Version 2 (August 2012)

7. Clean environmental surfaces

HLTIN301C Version 2 (August 2012)

guidelines for glove use

HLTIN301C Version 2 (August 2012)

HLTIN301C Version 2 (August 2012)

laboratory waste any other waste as specified by the workplace

HLTIN301C Version 2 (August 2012)

HLTIN301C Version 2 (August 2012)

GLOSSARY OF TERMS ..........................................................................................

Airborne transmission Asepsis Bacteria

Is defined as the absence of infectious agents that may produce disease

Body substance Communicable disease Contamination Cleaning Clinical waste

Contact transmission Disinfection

Exposed person Exposure-prone procedures

HLTIN301C Version 2 (August 2012)

Hand drying Hand hygiene Hazard

Needle stick injury

HLTIN301C Version 2 (August 2012)

Pathogen Personal Protective Equipment (PPE) Protozoa

Reprocessing Reusable item Risk Sign Scabies Sharp/s

Sharps container Source individual

Symptom Universal precautions Viruses

HLTIN301C Version 2 (August 2012)

FOLLOW INFECTION CONTROL GUIDELINES ..........................................................................................

HLTIN301C Version 2 (August 2012)

HLTIN301C Version 2 (August 2012)

HLTIN301C Version 2 (August 2012)

Requirement Airborne transmission

Additional precautions types Droplet transmission

Goggles/face-shields Special handling of equipment

Protect face if splash likely None

Negative pressure Transport of patients Other

HLTIN301C Version 2 (August 2012)

Risk assessment for the transfer of infectious diseases includes:

HLTIN301C Version 2 (August 2012)

Ongoing monitoring and evaluation of infection control procedures is also required.

HLTIN301C Version 2 (August 2012)

IDENTIFY AND RESPOND TO INFECTION RISKS ..........................................................................................

What are micro-organisms?

Name Bacteria Fungi

HLTIN301C Version 2 (August 2012)

Source Susceptible host Reservoir

Portal of entry Mode of transmission

HLTIN301C Version 2 (August 2012)

HLTIN301C Version 2 (August 2012)