While the health risks associated with fluid waste have been known for decades, it wasn’t until the introduction of AIDS into our society that infection control practices and an awareness of the vulnerability to healthcare workers, including custodians, to exposure of bloodborne pathogens, including Heptatities B, became a major concern.
Today, a myriad of regulations govern workers’ exposure to fluid waste and bloodborne pathogens. Still, companies need to have a plan in place.
These plans should include worker training and education, as well as the specifics of how to protect one’s self, disinfect and dispose of the waste.
- Base education programs on practical situations faced by workers in the performance of their specific duties. Content should include:
- General information about infection prevention and control (stressing the importance of hand washing)
- Information about bloodborne pathogen transmission
- Assessed risk of exposure
- Preventing exposure tips
- Immunizations (HBV vaccine)
- Specific policies and procedures for individual work areas, including protocols following an exposure
- Resources for further assistance
Workers need to know how to apply preventive techniques in routine practice and in unusual situations. Time must be given for workers to question, absorb and apply the information. It’s critical that educational programs enable workers to express and work through their concerns about caring for individuals with a bloodborne infection. Records of participation should be maintained as needed to satisfy legal requirements.
Specifically emphasized in the educational programming are the risks that exist in the workplace. The factors involved with exposure include:
- The infectious agent (bloodborne pathogen)
- Transportation of the agent (either through body fluids or aerosol means)
- The host of agent
A very common and neglected issue in prevention of transmission is proper disinfection and personal protective equipment for the worker’s hands.
Many of the microbial inhabitants of the hands are capable of colonizing and infecting wounds, cuts, and other susceptible sites. The single most effective means of preventing the transmission of infection is conscientious hand washing.
New technologies should be introduced promptly to replace less effective or less safe practices if evaluation indicates benefit.
Emphasis should be on:
- Reduction of exposure to needles or other sharp items
- Reduction of exposure of cuts or mucous membranes to blood and fluids capable of transmitting bloodborne pathogens
- Decreased contamination of working environments
- Redesign of reusable instruments to enable effective cleaning and disinfection
- Implementation of safety devices based on level of risk of various types of exposure incidents.
Personal protective equipment serves as a barrier against direct contact with bloodborne pathogens. Protective equipment includes:
- Eye protection
- Face shields
- Protective footwear
Of course, when selecting gloves for workers, make sure those who will wear them and those who will come in contact with them are not allergic to latex, if that is the type chosen.
One study concluded that among surgical personnel, the use of face shields, waterproof gowns and waterproof boots could have prevented more than half of the observed cutaneous exposures involving sites other than the hand.
Usage of the proper disinfectant during waste clean up can prevent exposure to risk and infections from occurring both during the actual cleaning procedure and afterwards from residual microbial activity from incubation.
As with the matter of reaction with the personal protective equipment, there are many other factors to consider when using a disinfectant material, such as actual fluid containment and health risk issues.
When deciding on what product or material to consider for body fluid clean up and disposal, compare the products available. Of foremost consideration is the actual killing agent that is included and used for the product. Most commonly, products available have an aldehyde, phenol or chlorine killing agent.
The various disinfectants have a wide range of antimicrobial activity, and not all will kill what they come in contact with. In addition, reaction to the personal protective equipment, and surrounding surface area that has been exposed to the bloodborne pathogen must be also taken into consideration.
What the product does to the residual waste once treated is highly important and not to be disregarded. Is it simply absorbed on a granular material or polymer, where it can still be in a fluid state, or is it solidified, as in a cementatious reaction, where no visible liquid is available either visually or while handling of the waste? The spilled material should be in a solid form that will not be moldable, pliable or release the fluids back out while handling, either during transportation or from landfill burial.
When a spill of infectious waste occurs, prepacked spill kits for employees should be at the ready.
- Evacuate the scene of the accident in order to control the risk exposure of outside people to the materials and reduce the spread of infection
- If people are physically exposed to the material, remove all clothing that becomes contaminated because fluids can seep through the cloth to come into contact with skin
- Contaminated laundry should be handled as little as possible, and it should be placed in an appropriately labeled bag or container until it is decontaminated, disposed of, or laundered
- Put on all personal protective equipment (PPE), including doubling of gloves, and make sure no exposed skin areas occur
- Containment of the spill is of the utmost importance, from both an airborne issue as well as spreading of the fluid
- Apply the solidification powder to form a perimeter around the spill and contain it. This will allow for the chemical treatment to enact while the threat of exposure has been reduced
- With proper tools, remove sharps that may have been formed by the spillage and breakage of the holding material
- Place the materials within a lined, thick walled container to reduce the risk of puncture. Be alert not to create aerosols while collecting the debris.
At this point, the treated fluid waste should have solid properties that will allow for collection of the spill. Remember that a true solidifier will continue to set up even after placed in the disposal bag. Apply any additional powder to the spill to collect and treat any remaining fluid.
Wiping down of the affected area with wipes will require the same attention as the spill powder, in regard to killing agents and potential reaction with the personal equipment.
The US Centers for Disease Control (CDC) recommends that a 5.25 percent bleach diluted to a concentration of 0.05 percent is useable for the decontamination of a blood spill. To avoid causing aerosols, do not apply the liquid solution directly to the spilled area, rather apply to the cloth and wipe, and work into the area. Allow several minutes for disinfection, and repeat procedure.
Upon completion of the clean up and collection of the spilled materials, meticulous attention to the removal and collection of the soiled disposable personal protective equipment (PPE) must be followed:
- Remove the gown/ protective apron, followed by the outer layer of gloves
- Remove the facemask and goggles with the unsoiled gloves
Once all used PPE, spill control equipment, and other potentially contaminated items are in the red bag, add a mixture of cementatious encapsulation powder to the waste container, as so no fluid will be released, and all materials are encased in a solid mass and seal bag securely for disposal.
Wash your hands with a non-abrasive, preferably germicidal, soap and inspect for any possible exposure. If your skin or mucous membranes come into contact with another person's blood/body fluids, flush with water into the sanitary sewer system as soon as possible. Immediately contact the medical office if you are involved with any blood or body fluid exposure incident.
Mark Ceasar is an executive with OMNI, a division of AJAX Floor. OMNI manufactures spill control products for the hazardous and biohazardous waste clean-up markets.