Biological Hazards and Infection Prevention and Control in Healthcare Settings: A Critical Review of Principles, Practices, Challenges, and Emerging Strategies

Abstract

Biological hazards still remain a risk to the patients, HCWs, laboratory personnel, support personnel, visitors, community and the environment. Health care institutions handle blood, body fluids, respiratory secretions, clinical samples, contaminated materials, sharps and infectious waste routinely and thus become exposed to different forms of biological hazards. This article reviews the characteristics and sources of biological hazards, major exposures and routes of transmission, key infection prevention and control (IPC) strategies, occupational exposures, and challenges in implementing such strategies with special focus on low- and middle-income countries, Nepal and South Asia. A critical narrative review of articles from peer-reviewed journals and guidelines on biological hazards, health care-associated infections (HAIs), infection prevention and control, biosafety, hand hygiene, personal protective equipment (PPE), health care waste management, occupational exposure, antimicrobial resistance (AMR), and health system preparedness for the last five years was conducted. The review presents evidence that biological risk management requires an integrated approach of using standard precautions, PPE specific for risk, hand hygiene, cleanliness of the environment, safe injections, sterilization of equipment, biosafety in the laboratory setting, safe disposal of medical waste, monitoring, education, occupational health and safety, and antimicrobial stewardship. Implementation is impeded due to inadequate infrastructure, workforce, supply, monitoring, and gaps between policy and practice. Biological risk management should be part of institution's governance, occupational health, quality improvement, environmental health, AMR programs, emergency preparedness, and health system resilience rather than a separate infection control intervention. This review combines a clinical, occupational, laboratory, environmental, organizational, and health system perspective into a risk management framework with emphasis on implications for resource-constrained healthcare systems, including Nepal and South Asia.