Question

Lyn works in a PSG medical centre clinic as a Centre Manager. As couple of nurses were away on vacation, Lyn hired a family friend, Cristina, to assist with Centre daily jobs. Cristina was a medical assistant and a DA many years ago, but left work after a leg injury. Lyn only wanted Cristina to help out with sterilising and cleaning up after procedures, so everyone agreed that it should be fine. Cristina started her work at the centre and after few days, one morning she noticed some blood drops on the waiting room floor whilst on her way to the treatment room. She grabbed some tissues, wiped up the spill and threw the tissues in the nearest waiting room bin. Lyn saw her do this, but didn’t want to embarrass Christina, so once she left the room Lyn put on her gloves, wiped the floor with alkaline cleaning solution and changed the bin bag. She put the used bin bag in the biological waste bin in the treatment room, as Aaron, Mrs Watson’s grandson, was in for an immunisation and toddling around the waiting room, getting into everything. Later that day Christina was gloved up, wearing her goggles and apron, and doing the sterilising scrubbing. She was brushing some forceps when she heard a familiar voice - it was Karen, a dear old friend from high school, who had arrived for a procedure! Cristina rushed over and hugged her friend but thought she had better look busy but wanted to continue chatting, so she grabbed the brush, swished the forceps in the water, and then returned to Karen and scrubbed while they chatted. After that Cristina returned to the sink but she couldn’t find the blue cloth that Lyn had told her to dry the instruments with. She looked in the cupboards and found a blue hand towel which she used to dry the instruments. At the end of the day Christina empty all the bins. As she emptied the waiting room bin, she noticed a needle hanging in the corner; she carefully picked it up and put it in the general bin of the waiting area. She then moved on to the reception area and treatment room bins, and threw all the waste from these bins into the green Council bin. She advised that the bins were done, Lyn asked her about the key, but Christina said the bin wasn’t locked so she hadn’t needed a key. Answer the following questions:

a. List three examples where Christina has put herself or others at risk, and provide an appropriate response for addressing each risk.

Answer 1

The first example where christina had put others and herself at risk are when she just cleaned the blood on the floor with a dry tissue without wearing gloves.Glove is a personal protective equipment which has to bevworn whenever you anticipate a contact with blood or body fluids .A hand may have many cuts and bruises which may be not visible by our naked eyes but if those cuts comes in contact with blood or body fluids the person will be at risk if getting blood borne infection like Hepatitis B,HIV , Hepatitis C.A very small quantity of blood is needed for transmission of infection.She discarded the tissue in a general waste bin where a toddler was moving around and which would have come in contact to the toddler thus risking the baby to blood borne infections avoid this risk all health care institution should have a spill management protocol which lays down guidelines on cleaning in case of body fluid spill the protocol should in a glow chart format and laminated and displayed.All staffs should be trained in cleaning,use of Personal protective equipment and biomedical waste seggregation at the time of joining or induction irrespective of being a full time or part time worker.A regular training on job should be conducted to refresh and reinforce these protocols to the staff .

The second instance in which Christina risked others is when she was cleaning an instrument while chatting to her friend .The aerosols or the fluid while cleaning a used equipment can come in contact with the sclera of the eyes and lead to blood borne infection.In this case Christina was wearing all PPE goggles,gloves but her friend was standing without any of these.To avoid this risk equipment cleaning should be a dedicated room away from the general public and it should have a sign board of restricted entry.And the staffs should be trained on care to be followed while cleaning instruments.

The third instance in which she risked herself and others are when she saw the opened needle in one bin and through in the general bin .This could have led to herself or others getting needle stick injury which could risk the person to get blood borne infections.Thiscab be avoided by placing puncture proof sharp containers at the treatment room .or where needles are being used .There should stringent rules in biomedical waste seggregation with regular audits to sensitize staffs on proper seggregation.All stafs should be trained on these protocols during induction.There should be charts to display seggregation of waste for general public awareness for proper seggregation.Christina did not lock the green council bin which makes biomedical waste to be snuggled by raggpickers and recycled or reused .Thus can lead to serious infection.A supervisor should take regular rounds for seggregation and appropriate storage of waste.The hospital should also have protocol on post exposure prophylaxis in car if needle stick injury or body fluid exposure to prevent the risk of blood borne infections.