BIOLOGICAL HAZARDS

Gnanambhikaiy Ganapathi, S.Ked 04084841820003

Pembimbing:
Prof. dr. Tan Malaka MOH, DRPH, Sp.OK
NIP : 194603311973071001

BAGIAN ILMU KESEHATAN MASYARAKAT-ILMU KEDOKTERAN KELUARGA

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
2019
 CHAPTER 1: INTRODUCTION

• WHO 1995 : Public health degree is influenced by 4 factors

 environmental factors
 behavioral factors
 health service factors
 heredity
• Environmental factors are the most influential on improving the level of public health.
• Healthy conditions  pollution free environment, the availability of clean water, adequate
environmental sanitation, healthy housing and settlements, health-minded regional planning, and
the realization of the lives of mutual helping people and maintaining national values
• Environmental conditions that are not sanitary  Increase in vectors and disturbing animals (rats,
cockroaches, flies)  result of disposal of waste that is not managed properly

• Data from the Ministry of Health  2,062 hospital units (December 2015).
•Until 2015, Indonesia had 9754 puskesmas units, 3396 puskesmas units inpatient care, 6356
puskesmas units that were non-hospitalized.
•Health Facilities Research : 71.7% of health centers in Indonesia have clean water facilities and
44.5% had sewerage channels with closed channels.
•64.6% of puskesmas have separated medical and non-medical waste. Only 26.8% of puskesmas
have incinerators (solid medical waste is still poor)
•Waste/solid waste produced by the health center (medical & non-medical waste)
•Public health centers (puskesmas) produce
•Medical and non-medical waste (solid and liquid forms)
•Medical waste in solid form in public health center : from the treatment room (for inpatient
health centers), general polyclinics, dental polyclinics, maternal and child / polyclinics,
laboratories and pharmacies
•Liquid waste usually comes from a public health centre laboratory : microorganisms, toxic
chemicals, and radioactivity
• Waste generated from medical efforts  biohazard category
• Wastes of viruses, bacteria and other harmful substances that must be destroyed by the road is
burned in temperatures above 1000 degrees Celsius
• World Health Organization (WHO,1995)  launched around 0.14 kg of medical waste per day in
Indonesian hospitals or around 400 tons per year

• Non-medical waste in the hospital and health center environment  office / administration,
service unit, nutrition unit / kitchen and yard

• Health care waste for high-income countries for all health service waste can reach 1.1 - 12.0 kg
per person per day and hazardous health service waste from 0.4 to 5.5 kg per person every day for
middle-income countries

• All health service waste shows the number 0.8 - 6.0 kg per person per day,hazardous health care
waste is 0.3 - 0.4 kg per person per day,low-income countries all health service waste produces 0.5
- 3.0 kg per person every day
• The results of the study of 100 hospitals in Java and Bali were serving inpatients shows that the
average waste production  3.2 kg per bed per day
• Production of waste (solid waste)  Domestic waste (76.8%) & Infectious waste (23.2%)
• Composition of medical waste  Cotton, verbets, gauze, syringes, masks, gloves, bottles, plastic
wrappers, and infusion bottles
• Biohazardous waste  Any waste containing infectious materials or potentially infectious
substances such as blood. Special concern are sharp wastes such as needles, blades, glass pipetts,
and other wastes that can cause injury during handling (Fred Hutchinson Cancer Research Center)
• Biological hazards  Infectious agents or products of such agents that cause human disease  US
Center for Disease Control and Prevention (CDC, 2009)

• Biohazards  coming from, or affecting, the community outside the workplace  potential for
infectious disease factors to be transmitted from person to person.

• Environmental biohazards (occupational hazards)  outdoor workers.

 DEFINITION
• Biohazardous waste arises from, but is not limited to, medical, nursing, home healthcare,
dental,veterinary, laboratory, pharmaceutical, teaching, podiatry, tattooing, body
piercing,emergency services, blood banks, mortuary, crime/trauma scene remediation and
other similar practices and/or any activity prescribed by a relevant regulatory authority.
 Types of biohazardous waste
•Human blood or body fluids, other than urine or •Materials or equipment containing, or reasonably

faeces (except from hospital/nursing home patients)
•Human tissue
•Sharp discarded objects or devices capable of
cutting or penetrating the skin (“sharps”) or the
container in which they are packaged
suspected of containing human blood or body fluids other
than urine or faeces (unless there is visible blood and/or
faecal waste is from hospital/nursing home patients)
•Faecal contaminated materials from hospital patients or
nursing home residents (or similar) but excluding nappies
from newborn or infant patients

•A diagnostic specimen •Sanitary waste except from a domestic premise unless the
generator is known to have or suspected of having a
•A laboratory culture
communicable disease
•Tissue, carcasses or other waste arising from
•Waste from patients known to have, or suspected of
animals used for laboratory investigation or for
having a communicable disease or derived from a
medical or veterinary research other than prescribed activity
psychological testing
 Occupational Hazards

OSHA (Occupational Safety and Health Administration,1991)

•Safety Hazards – The most common type of biohazards and will be present in the most working
environment. The causes for this could lead to major injuries and even death. Some examples spill on
the floor & moving parts that a worker can accidentally touch, etc.
•Physical Hazard – The factors which are present in the environment that can harm living organisms
without necessarily touching it. This includes exposure to UV rays, radiation (microwaves, EMF)
•Chemical Hazard – In a workplace, when a worker is exposed to any chemical preparation. This could
lead to some serious illness or breathing problems. This hazard may include vapors and fumes from
solvents, pesticides, flammable materials like gasoline, solvents.
• Work Organization Hazard – Hazardous that can cause stress which can include short term or
long term stress. An example could be any workplace violence or lack of social support,
sexual harassment.

• Ergonomic Hazard – This occurs when the body is put under strain due to working
conditions. A short-term effect could lead to health issues like sore muscles and long-term
exposure to lead to serious illnesses.

• Biological Hazard – Anything of biological origin that can cause harm to humans or living
organism. Like Bacteria and viruses, insect bites and blood spills include biological hazards.

Not only workplaces like hospitals that deal with biohazards materials like surgical gloves, and
medical sharps have to be concerned about biohazards but even those who are working with
waste management, manufacturing or law enforcement are also at the risk of toxic exposure.
 Biological Hazards in Healthcare Settings
• Laboratory workers are exposed to biological hazards during collecting or processing biological
materials
• Physicians and nurses are especially exposed when they perform surgical or invasive procedures,
when they treat wounds, or when they take body fluid samples.
• Nurses and nurse assistants take care of patients incapable of looking after themselves or when
doctors make clinical examinations.
• Disinfecting, cleaning, transporting contaminated equipment, or working in contaminated areas can
also expose nurse assistants or other hospital workers to biological hazards in healthcare settings
• Transmission of infection  bloodborne, droplet, airborne, fecal-oral, and contact routes
• Hepatitis B, C, and D viruses or human immunodeficiency virus (HIV)  Percutaneous sharp injury
with a contaminated needle or other sharp object
• Other possible routes of transmission  Accidental exposure to blood or other organic fluids
through a worker’s broken skin or mucous membranes
• Ebola virus is a very serious biological hazard transmitted by direct or indirect contact with
organic fluids of infected patients
• Healthcare workers from Europe or North America who had worked with patients from countries
where the infection is endemic or during epidemics
• Airborne-transmitted infections  Measles, tuberculosis, chickenpox, and severe acute respiratory
syndrome
• Microscopic droplets or droplet nuclei coughing, sneezing, and talking from patients with
respiratory tuberculosis  can remain suspended in the air for long periods and be dragged by air
currents
• Increased exposure to tracheobronchial secretions  inducing sputum, secretion aspiration,
bronchoscopies, autopsies, sputum testing, extubating/intubating, and oral care
• Prevention measures and medical monitoring of occupational tuberculosis avoiding its progression
to active tuberculosis  tuberculin skin test and interferon gamma release assays)
• Rubella, measles, mumps, and varicella  can be prevented through vaccination
• Those working with immunocompromised patients (infectious diseases, hematology, oncology,
and posttransplant wards) & pediatric departments  use of a chirurgical mask can reduce the risk
of transmission (meningitis, influenza, and other respiratory infections are spread through contact
of infected respiratory secretions with healthcare workers’ mucosae)
• Flu infection prevention  Vaccination
• Salmonella spp., Shigella spp., Campylobacter jejuni/coli, Yersinia enterocolitica,
enteropathogenic Escherichia coli, enterohemorrhagic Escherichia coli, rotaviruses, Clostridium
difficile, and Vibrio cholerae  Transmitted to healthcare workers by the fecal-oral route
• Scabies agent or herpes simplex virus 1 or 2  Transmitted by contact
• Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter
baumannii, Pseudomonas aeruginosa, and Enterobacter spp
 Transmitted by contact but usually do not cause infection in healthy people
 Can cause pneumonia or infecting wounds
• Vehicle for nosocomial dissemination
 Biological Hazards: Bloodborne Pathogens
• Microorganisms which transmit disease by contact with blood
• Contact may be direct, such as needlesticks or splashes of blood containing fluids to the mucous membranes
or open wounds, or indirect, such as when surfaces contaminated with blood come in contact with someone’s
mucous membranes or abraded skin
• The most common bloodborne risks to health care workers are Hepatitis B (HBV), Hepatitis C (HCV), and
Human Immunodeficiency Virus (HIV) infections
• World Health Organization (WHO) 2003  approximately 16,000 HCV infections, 66,000 HBV infections,
and 1,000 HIV infections occured every year worldwide from needlestick injuries (NSIs)
• Side effects of drugs used in post-exposure prophylaxis, as well as psychological fear and the uncertainty of
acquiring the infection
• Intensive care units, operating rooms, emergency rooms, inpatient units, and transport teams, as well as home
care
• At risk  physicians, surgeons,nurses,nursing assistants,laboratory staff,technicians,students,service
employees (laundry, dietary, environmental services and maintenance),personnel involved in handling
biomedical waste
• OSHA’s Bloodborne Pathogen Standard  written exposure control plan (ECP), the use of engineering
controls (safe needles, sharps containers, needleless systems), personal protective equipment (PPE), hepatitis
vaccinations, training, and post exposure evaluation and follow-up
 Biological Hazards : Medical Waste
• Incineration was the most common method of medical waste treatment, both in the U.S. and worldwide  until the
late 1990s
• Although effective and inexpensive, burning medical waste emits pollutants  dioxins, furans, hydrochloric acid,
sulfur dioxide, nitrogen oxides, lead, mercury, and cadmium
• Common treatment alternatives to incineration  steam autoclave, microwave, and chemical disinfection
• Many countries do not have resources to construct properly made incinerators (high investment cost) & do not use
the proper fuel to burn the waste at high enough temperature  higher pollution emissions
• Medical waste, hazardous waste, recyclable materials, and general trash  separated into color-coded puncture-
resistant bins and plastic bags
• Accidental treatment in autoclaves or incinerators of hazardous chemical waste  dangerous levels of toxic air and
water emissions
• Supercritical carbon dioxide (SF-CO2)  used to sterilize medical and other infectious material at the point of
generation rather than after segregation, which would allow the sterilized waste to be segregated, reused, or
landfilled by non-skilled workers.
• SF-CO2  low toxicity and negligible environmental impacts, and shows promise as a viable alternative to
incinerators and other costly alternative treatment technologies for medical waste
 Noise
• Noise constitutes an increasing problem in hospitals and clinics as elsewhere
• Health workers likely to be exposed to high noise levels produced by certain of the machines they work
with include traumatologists, orthopaedic surgeons, and ear, nose, and throat specialists
• The harmfulness of noise depends not only on the characteristics of the noise itself (its intensity and
cadence) and those of the place in which the noise is experienced but also on the susceptibility of the
exposed subject
• Many cases of acoustic trauma having been reported in which the noise level was not particularly high.
• It should also be remembered that quite soft noises of certain types may be extremely unpleasant and
their continual repetition may constitute a long term psychic health hazard
• In the United States the recommended maximum noise levels for hospital wards are 45 dB (A) during
the day and 35 dB (A) at night
• Hospital rooms should be suitably sound proofed, noisy faults in taps, cisterns, trolleys, and so on
should be repaired as quickly as possible
 Ergonomics : Musculoskeletal Disorders

•A survey at a public hospital in Bangkok reported that 61.5 % of nurses experienced pain and/or muscle strain of the
lower back due to differences in job requirements across healthcare jobs
•Nurses are expected to lift and move heavy objects  debilitated, unconscious, or obese patients
•Factors related to back pain  bending the body for two hours continually per shift, lifting patients without
assistance, and improper posture during work
•Major causes of muscular pain  individual behaviors such as improper posture during heavy lifting, long duration
of work activities, and the lack of muscular exercise
•A study conducted at Murtala Mohammad Specialist Hospital (MMSH), Kano, North-West Nigeria  200 (66.67%)
of the LBP cases believed that their low back pain (LBP) was related to their work while 40 (13.33%) and 60
(20.00%) associated their back pain with domestic and previous trauma respectively
•Out of the 116 nurses with moderate LBP, 53 reported that it prevented from going to work while the remaining 63
only reported restriction in daily activities. 54 (18%) thought it was severe, preventing them from going to work
•Strong association between musculoskeletal disorders and work related factors and work pressure
•Predominantly found among nurses where 66.67% related their LBP to their occupational hazard  poor working
and incorrect lifting postures has been implicated as causative factors in LBP
 Prevention & Personal Protection

• Elimination of the source of contamination is fundamental to the prevention and control of

biological hazards
• Improvement of ventilation,partial isolation of the contamination source, installation of negative
pressure and separate ventilation and airconditioning system (in medical wards for infectious
diseases) and the use of ultraviolet lamps can help contain the spread of contaminants
• If the contact with biological hazards cannot be prevented, employees must use personal protective
equipment and adhere strictly to the practice of personal hygiene  masks, gloves, protective
clothing, eye shields, face shields and shoe covers
• Surgical masks  barrier protection against large respiratory droplets

• N95 or higher level respirators  filters out particulates and liquid droplets in small particle size,
therefore providing protection from inhaling aerosols and microorganisms that are airborne
• No oil mists or fumes as in a hospital setting  respirators of the N-series with filter efficiency of
95% (Type N-95), 99% (Type N-99) or 99.97% (Type N-100) are suitable

• Environment where there are significant amounts of oil mists  R95, R99 or R100 respirators
(R:oil resistance) or P95, P99 or P100 respirators (P:oil proof) should be used

• Powered Air Purifying Respirator, PAPR  electric blower to bring the air through the filter to the
user, making it more comfortable to wear
• Air-supplying respirators  Clean air is supplied by air compressor or high-pressure cylinder
through a hose

• Adequate training is required for using the PAPR and the air-supplying respirators to ensure their
correct and safe use

• Respirator should fit the wearer for a good face seal and the user must perform the seal check to
ensure that the respirator is worn correctly for the required protection
• Protective clothing  protective coverall (with attached hood), gown, apron, head and shoe
covers
• Should be waterproof or impervious to liquids to protect the body from contamination by
blood, droplets or other body fluids and prevent these contaminants from getting into the body
through open wounds or contaminating the worker's own clothing, thus reducing the chance of
spreading of pathogen and cross-infection
• Protective clothing is disposable in most cases though some can be reused after sterilization
• Safety goggles/glasses and face shields  protect the eyes from contacting pathogen-carrying
blood, droplets or other body fluids which may then enter the body through the mucosa 
Glasses without side shields can only protect the front from liquid splash
• Gloves protect the hands from contacting blood, droplets, body fluids and other body tissue of
the infected,or pathogen-contaminated objects and can avoid infection when touching the eyes,
mouth or nose afterwards,can also protect open wounds from contamination by pathogen
• Contaminated gloves should be disposed of in special rubbish bag marked with "Biological
hazard" warning and label. Fasten the bag and place it in a designated location for special
disposal.
•Shoe covers prevent pathogens from being carried outside the workplace
•Shoe covers are usually disposable after use
•Boot covers offer further protection  prevent contaminants from getting into the boots
•Shoe covers should be water resistant and skid proof
•Sterilization  process using ultra heat or high pressure to eliminate bacteria, or using biocide to eliminate
microorganisms, including spores in bacteria
•A complete sterilization process  disinfecting the contaminated premises and thorough cleaning of any
residual toxic substances, to ensure that employees would not be harmed through exposure in the risk area.
•Most common sterilizing and antiseptic agents  liquid bleach and rubbing alcohol
•Hands must be washed thoroughly after taking off any personal protective equipment.
•Simplest and most basic method to avoid infection  Washing hands with liquid soap
•Wash hands before and after work
•Wash hands immediately before and after wearing protective clothing, uniforms or gloves  reduce the
possibility of infection
 CONCLUSION

• Several US Occupational Safety and Health Administration (OSHA) regulations include

provisions on biological hazards.
• Hepatitis B vaccine vaccination and blood-borne pathogens
• Biological hazards are also covered in regulations with a broader scope (those on hazard
communication, the specifications for accident prevention signs and tags, and the regulation on
training curriculum guidelines).
• The recognition and avoidance of hazards relating to animal, insect or plant life is addressed in
other OSHA regulations concerning specific work setting  the regulation on
telecommunications, the one on temporary labour camps and the one on pulpwood logging (the
latter including guidelines concerning snake-bite first-aid kits).
• One of the most comprehensive standards regulating biological hazards in the workplace is
European Directive No. 90/679.
• Biological agents  micro-organisms, including those which have been genetically modified, cell
cultures and human endoparasites
• Able to provoke any infection, allergy or toxicity & classifies biological agents into four groups
according to their level of risk of infection.
• The Directive covers the determination and assessment of risks and employers’ obligations in
terms of the replacement or reduction of risks (through engineering control measures, industrial
hygiene, collective and personal protection measures and so on),information(for workers, workers’
representatives and the competent authorities), health surveillance, vaccination and record-
keeping.

• The Annexes provide detailed information on containment measures for different containment
levels according to the nature of the activities, the assessment of risk to workers and the nature of
the biological agent concerned.
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THANK YOU