Chapter 4: Biosafety Practice in HIV

Rapid Testing Site

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 Chapter outline

• Overview of biosafety

• Biosafety practice in HIV rapid testing sites

• Disinfection and dispose of infectious materials

• Accident Management

• Summary

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 Enabling Objectives

By the end of this chapter participants will be able to

• Describe the importance of biosafety practice.

• Practice the biosafety requirements while blood specimens collecting and

HIV rapid testing.
• Use disinfection and waste disposal method

• Apply appropriate actions following accidental exposure to infectious

materials

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 4.1 Overview of biosafety

• Exercise
Activity 4.1. Self-Reflection

Instruction: Reflect your ideas on the following question

Question: What is meant by biosafety and biosecurity?
Time: 5 minutes

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 4.1 Overview of biosafety cont’d…

• Biosafety: refers to the use of specific practices, safety equipment, and facility
designed to ensure that workers, the community, and the environment are
protected from accidental exposure or unintentional release of infectious
agents, toxins, and other biological hazards.

• Biosecurity: Principles, technologies and practices that are implemented for

the protection, control and accountability of biological materials, skills and data
related to their handling.
 Biosecurity aims to prevent their unauthorized access, loss, theft, misuse,
diversion or release.

• Biohazard: An agent of biological origin that can produce deleterious effects

on humans.

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 4.1 Overview of biosafety cont’d…

Why is biosafety important?

• Performing HIV tests poses a potential health hazard to the tester and
specimen collector.

• Coming in contact with human blood or blood products is potentially

hazardous.

• Biosafety involves taking precautions to protect the tester, other staff,

clients and environment, and the community against infection.

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 4.1 Overview of biosafety cont’d…

What else needs protection?

• To protect other people from infection

• To protect the integrity of test products. Shield unused tests from any
contamination.

• It is also important to protect the environment from hazardous material.

• Avoid transferring contaminated materials into areas outside of the testing area.

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 4.1 Overview of biosafety cont’d…

• Universal or Standard Precautions

Every specimen should be treated as

infectious
Why?
• Because infectious agents may be present in a client’s blood.
• So we must follow safety practices in every step of the testing
process
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 4.2 Biosafety Practices in HIV Rapid Testing
Sites
Exercise

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 4.2.1 Safe Working Practices

• Safety practices are means to control chain of infection and safe working
practices are designed to:
• Reduce the risk of infection or injury to you, co-workers, and the community
• Protect the patient from infections
• Apply safety practices throughout the testing process
• Before Testing (Pre-analytical) phase
• Specimen collection
• Specimen preparation and transport
• Testing (Analytical) phase
• Testing
• After Testing (Post-analytical) phase
• Waste Disposal

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 4.2.2 Blood borne pathogens

• Blood borne pathogens: Pathogens present

in human blood that can lead to diseases e.g.,
HIV, Hepatitis B and C

• Risk of Exposure: An event during which an

individual comes in contact with biological
agents with the potential for infection.

• Exposure may occurs by

 needle sticks, cuts from other
contaminated sharps,
 contact of mucous membrane or broken
skin with contaminated blood etc

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 4.2.2 Blood borne pathogens cont’d…

• Contamination: The introduction of

pathogens or infectious material into or on
normally clean or sterile objects, spaces, or
surfaces.

• Contamination sources:
• Blood

• Body fluids

• Contaminated materials

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 4.2.3 Safety during blood specimen collection and testing

• Wash hands between testing each client

• Wear new gloves, and gown/ apron during HIV

testing

• If you have cuts or abrasions on your hands, cover

them with adhesive dressing.

• Handle specimen safely

• Discarded sharp in to puncture proof container

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 4.2.2 Safety during blood specimen collection & testing cont’d..

• Testing bench/table tops should be non-

porous covering, easy to clean, resistant
to chemicals chemical and disinfectants

• Disinfect work surfaces daily

• Keep work areas uncluttered and clean

• Always perform testing at designated

work station only

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 4.2.2 Safety during blood specimen collection & testing cont’d..

• Restrict or limit access when working

• Keeping specimen in secure area
• Keep emergency eye wash units
• Allocate specific site and chair/table for
testing
• Never eat, drink or smoke at
the test site
• Keep food out of the testing site refrigerator

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 4.3 Disinfection and waste disposal

Activity 4.3. Think/Pair/share

Instruction: Review the above Picture
4.3 with your neighboring trainee for
5 minutes and share the discussion
ideas within 4 minutes. Total time: 9
minutes
What did you observe from the
picture on the left?
What did you observe from the
picture on the right?

Picture 4.3: waste containers

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 4.3 Disinfection and waste disposal cont’d…

Answer What did you observe from the picture on

What did you observe from the picture
on the left? the right?
 It is an open container with a mixture of blood, • The container is made of thick plastic.
sharps and other contaminated waste. • This is appropriate for disposing of
 It has no lid.
 It has no label to warn people of biohazardous waste. sharps
 It is placed on the floor and prone to spill.
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 4.3.1 Disinfection

• Disinfection is a process to eliminate viable biological agents from items or

surfaces for further safe handling or use.
• Use disinfectant that active against the HIV/ agent being handled and is left in
contact for the appropriate time.
• Remember, disinfection:
Kills germs and pathogens
Keeps work surface clean
Prevents cross-contamination and
 Reduces risks of infection

• Decontaminate work surfaces with a suitable disinfectant

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 4.3.1 Disinfection cont’d…

• Procedures for preparation of disinfectant from 5% sodium hypochlorite

household bleach stock
• For spills, you should use a 10% bleach solution.
• The larger the spill, the longer the contact time with the 10% bleach solution.
• For general disinfection purposes such as wiping down all surfaces at the end of
the day, use a 1% solution.

Spills General Disinfection

10% 1%
(1 part + 9 parts) (1 part + 99 parts)

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 4.3.1 Disinfection cont’d…

• Procedures for preparation of disinfectant from 5% sodium hypochlorite

household bleach stock

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 4.3.2 Waste collection and disposal

• About 15% of the waste produced by health-care providers is

hazardous. The remaining 85% non-hazardous.

• Any waste material contaminated by biological agents during

performing of HIV rapid testing must be correctly managed.

• Waste should be segregated based on the nature of the wastes in to

infectious, non-infectious and sharp.

• Always seal contaminated waste

• Discard specimens for disposal in leak-proof containers with tops

appropriately secured before disposal
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 4.3.2 Waste disposal cont’d…

• The red plastic container on the right is suitable for sharp objects. It also has a
lid.
• Plastic bags must be securely tied once filled. This is appropriate for disposing
of contaminated waste such as used gauze.
• Contaminated waste should be kept
separate from office waste.
• Plastic bags must be securely tied once
filled; appropriate for disposing of
contaminated waste such as used
gauze

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 4.3.2 Waste disposal cont’d…

• Below, the image of the right illustrates improper disposal of objects. And on
the left, sharps are mixed with non-sharp items and the opening is exposed,
posing a potential hazard.

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 Guidance for Handling Sharps

• Sharp is any device or object that is a puncture or wound hazard because of

its pointed ends or edges.
• Sharps can include needles, syringes with attached needles, blades, scalpels
or broken glass

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 Guidance for Handling Sharps Cont’d…

• Do Not break, bend, re-sheath or reuse

lancets, syringes or needles

• Do Not shake sharps containers to create

space

• Must dispose of sharps after each test

• Must place sharps in sharps boxes

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 Guidance for Handling Sharp Cont’d…

• Place sharps container near your

workspace

• Do not drop sharps on the floor or

in the office waste bin

• Seal and remove when box is ¾

full

• Incinerate all waste

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 Incineration of waste

• It is the burning of contaminated waste to destroy and

kill micro-organisms.

• Contaminated waste should be burned to completion

• Incineration is usually the most practical way for safe

destruction of waste.

• It protects the environment and must be supervised.

• Care should be taken in transporting wastes

incineration.
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 Burial waste disposal

• Access to the disposal site should be restricted

• Burial site must be lined with material of low permeability

• Selected site should be 50 meters away from any water source

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 4.4 Accident Management
Exercise
Activity 4.4. Self-Reflection

Instruction: Reflect your ideas on the following question

Question: what is the common accident happened during
specimen collection and/or testing.
Time: 7 minutes

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 4.4 Accident Management Cont’d…

There are three types of accidents that may happen:

• Potential Injury, i.e., needle-pricks, falls
• Environmental, i.e., splashes or spills
• Equipment damage

In case of an accident,
• You should report to your supervisor immediately.
• Assess the situation and act accordingly.
• Record the accident using appropriate forms, and continue to monitor
the situation.

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 4.4 Accident Management Cont’d…
What can cause needle stick injury?
• Lack of concentration
• Inexperience
• Lack of concern for others
• Improper disposal of sharps

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 Spill/Splash Management

• Spill (Splash) can result in biological hazard exposures and contaminations

• Depending on the size, location, concentration and/or volume of the spill,

different protocols may be necessary.

• Procedures for cleaning and decontaminating spills should be available

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 Spill/Splash Management Cont’d…

Follow these steps in case of a spill or splash:

 Wear clean disposable gloves

 Immediately and thoroughly wash any skin splashed with blood

• Large spills- Cover with paper towels and soak with 10% household bleach
and allow to stand for at least 15 minutes

• Small spill - Wipe with paper towel soaked in 10% bleach for 5 minutes

 Discard contaminated towels in infectious waste containers

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 Post-Exposure Prophylaxis

• Post- Post-Exposure Prophylaxis (PEP), also known as post-exposure

prevention, is any preventive medical treatment started after exposure to a
pathogen in order to prevent the infection from occurring.
• It is short-term antiretroviral treatment to reduce the likelihood of HIV
infection after potential exposure
• Risk of HIV infection after a needle stick or cut exposure to HIV-infected
blood is estimated to be 0.3% .
• Stated in another way, 99.7% of needle stick/cut exposures do not lead to
infection.
• Treatment immediately after exposure to HIV can reduce risk of infection by
about 80%.

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 Post-Exposure Prophylaxis Cont’d…

Steps to manage potential HIV exposed person

• Treat the exposure site /Immediate measures

• Percutaneous injury or injury to non-intact skin:

Wash the exposed site with soap and water as soon as possible, without
scrubbing.
Avoid using antiseptics.
Allow free bleeding but do not squeeze the wound.

• Exposed mucous membranes: Irrigate copiously with clean water or saline

• Report the exposure to the PEP focal person or the ART clinician in the facility
immediately for the PEP managment

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 Summary

• Performing HIV tests poses a potential health hazard to the tester and
specimen collector
• Every specimen should be treated as infectious.
• Safe working practices are designed to reduce the risk of infection or injury
to you, co-workers, and the community.
• Wear appropriate PPE during testing and waste handling
• Use appropriate disinfectant active against the HIV and left in contact for
the appropriate time,
• Waste should be segregated based on the nature of the waste
• Procedures for cleaning and decontaminating spills should be available

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 References

• Kojima K, Bennett A, Blacksell S, Heisz M, Makison Booth C, McKinney M,

Summermatter K. Laboratory biosafety manual. 4th Edition. World Health
Organization. 2020.

• Centers for Disease Control and Prevention (CDC) National Institutes of

Health. Biosafety in microbiological and biomedical laboratories. CDC 2020.

• World Health Organization (WHO). Consolidated Guidelines on HIV

Prevention, Testing, Treatment, Service Delivery and Monitoring:
Recommendations for a Public Health Approach. WHO 2021.

• The Federal Ministry of Health Ethiopia National Consolidated Guidelines for

Comprehensive HIV Prevention, Care and Treatment. August 2018.
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 Thank you
Any Question?

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