Procedure - Management of Blood Spills

---

Purpose
1.	Process
1.1	Routine cleaning of facilities and surfaces in health centres in high and low security facilities
2.	Spills management in health services areas in high and low security facilities
3.	Small blood spills
4.	Large blood spills in a 'wet' area e.g. a bathroom or toilet area
5.	Large blood spills in 'dry' areas
6.	Standard cleaning equipment

Purpose

To control and prevent the transmission of infectious diseases.

1. Process

1.1 Routine cleaning of facilities and surfaces in health centres in high and low security facilities

Standard precautions must be implemented when cleaning surfaces and facilities. Staff and prisoners must wear suitable gloves and other protective clothing appropriate for the task. Protective eyewear must be worn where splashing is likely to occur.

Toilets, sinks, washbasins, baths, shower areas, and surrounding areas should be cleaned regularly or as required. Bedpans and urinals should be cleaned with an abrasive cleaner, rinsed in warm water then dried and stored appropriately. Cleaning methods for these items should avoid generation of aerosols.

Although environmental surfaces play a minor role in the transmission of infections, a regular cleaning and maintenance schedule is necessary to maintain a safe environment in health centres.

Surfaces should be cleaned on a regular basis using only cleaning procedures that minimise dispersal of micro-organisms into the air.

In in-patient areas and health centres generally, floors should be cleaned daily or as necessary with a vacuum cleaner fitted with a bacteria-retaining filter, which should be changed in accordance with manufacturer's instructions. The exhaust air should be directed away from the floor to avoid dust dispersal. Alternatively, damp dusting or cleaning with a dust-retaining mop is acceptable. Brooms disperse dust and bacteria into the air and should not be used in patient areas. Routine surface cleaning should proceed as follows-

1. clean and dry work surfaces before and after each session, or when visibly soiled. Spills should be dealt with immediately;
2. use detergent and warm water for routine cleaning;
3. where surface disinfection is required, use in accordance with manufacturer's instructions;
4. clean and dry surfaces before and after applying disinfectants;
5. empty buckets after use, wash with detergent and warm water and store dry; and
6. mops should be cleaned in detergent and warm water then stored dry.

Chemical disinfectants are not recommended for routine cleaning, although chlorine releasing agents (CRAB) are still recommended and are widely used in circumstances during which significant risk of infection transfer may be identified, for example, treatment of spillage of contaminated exudates from infected patients

Chlorine concentrations may decrease with time of storage, elevated temperature, and exposure to light. It has also been established that pH has a great influence on the antimicrobial activity of chlorine, with low activity at alkaline pH, and high activity at neutral pH. Where chlorine solutions are required, these should be made up daily or as required. Chlorine solutions are also corrosive to some metals, especially aluminium, and may not be appropriate in some situations.

Disposable coverings, for example, plastic-backed single-use paper bench liners, may be used to reduce surface contamination. They are often a viable and economical alternative to surface disinfection but should be changed frequently and when visibly soiled or damaged. When liners are changed, the underlying bench surface should be cleaned as above, and disinfected if contaminated. Trays (which can be disinfected or sterilized according to need) to hold and carry instruments should also be used where possible to assist in reducing surface contamination.

2. Spills management in health services areas in high and low security facilities

Health care establishments should have management systems in place for dealing with blood and body substance spills. Standard precautions apply where there is a risk of contact with blood or body substances. The management of spills should be sufficiently flexible to cope with the circumstances in which the spill occurs, and may depend on a number of factors, including-

1. the nature of the spill (e.g. sputum, vomit, faeces, urine, blood or laboratory culture);
2. the likely pathogens that may be involved in these different types of spills (e.g. Mycobacterium tuberculosis in sputum);
3. the size of the spill (e.g. spot, small or large spill);
4. the type of surface (e.g. carpet or impervious flooring); and
5. the area involved (i.e. whether the spill occurs in a contained area) and whether or not there is a likelihood of bare skin contact with the soiled surface.

In areas such as patient treatment areas, in-patient areas or health centres, blood and body substance spills should be dealt with immediately.

3. Small blood spills

Small blood spills can be easily managed by wiping the area immediately with paper towelling and then cleaning the area with water and detergent. If there is a possibility of bare skin contact with the surface, for example on an examination couch, the area should be disinfected with a suitable disinfectant such as sodium hvpochlorite containing 1000-ppm available chlorine. Small spots or drops of blood or body fluids can be removed immediately by wiping the area with a damp cloth, tissue or paper towelling. A disposable alcohol wipe can also be used.

4. Large blood spills in a 'wet' area e.g. a bathroom or toilet area

The spill should be carefully hosed off into the sewerage system and the area flushed with water and detergent. After the area is cleaned and if there is a possibility of bare skin contact with the surface, the area should be disinfected as above with sodium hypochlorite (1000 ppm available chlorine) or other suitable (equivalent acting) disinfectant.

5. Large blood spills in 'dry' areas

The area should be decontaminated and the area of the spill contained. In these circumstances, and for the protection of health staff involved in removal of a large spill, concentrations of 10000 ppm available chlorine are usually recommended. Granular formulations that produce high available chlorine concentrations and also contain the spilled material are preferred. A scraper and pan should be used to remove the absorbed material. The area of the spill should then be cleaned with a mop and bucket of water and detergent. The bucket and mop should be thoroughly cleaned after use and stored dry. If contact with bare skin is likely, the area should be again disinfected with sodium hypochlorite (1000 ppm available chlorine) or other suitable disinfectant, as above.

6. Standard cleaning equipment

This should include a mop and cleaning bucket plus cleaning agents should be readily available for spills management and should be stored in an area known to all staff. This is particularly important in patient areas such as treatment areas. To facilitate management of spills in areas where cleaning materials may not be readily available, a disposable 'spills kit' could be used, assembled as follows-

1. A large (10 litre) reusable plastic container or bucket with fitted lid, containing-
   
   
   1. 5 litre impervious container (treated cardboard or plastic) with fitted lid for waste material;
   2. 2 large (10 litre) zip seal plastic bags for waste material;
   3. a disposable, sturdy cardboard scraper and pan (similar to a 'pooper scooper');
   4. 5 granular disinfectant sachets containing 10 000 ppm available chlorine or equivalent (each sachet should contain sufficient granules to cover a 10 cm diameter spill);
   5. disposable rubber gloves suitable for cleaning;
   6. eye protection (disposable or re-usable);
   7. a plastic apron; and
   8. a mask (for protection against inhalation of powder from the disinfectant granules, or aerosols from high risk spills which may be generated during the cleaning process).
   
   

With all spills management protocols, it is essential that the area is left clean and dry.

F P Rockett
Director-General

---