Guidelines

Cleaning Blood and/or Other Body Fluid Spills

Policy Bulletin 231

OBJECTIVES

1. To provide a safe and consistent approach to cleaning surfaces and objects that have been contaminated with biological fluids (i.e. blood and/or other body fluids).

2. To ensure that specifically trained staff or trained inmates or outside contractors involved in the cleaning up of blood and/or other body fluids wear appropriate personal protective equipment thus reducing the risk of exposure capable of causing blood-borne pathogen transmission.

3. To provide a brief set of directions for specifically trained staff or trained inmates or outside contractors (inmates must be under the supervision of specifically trained staff) to follow for the cleaning up of blood and/or other body fluids.

AUTHORITIES

4. CD 254 - Occupational Safety and Health and Return to Work Programs

Treasury Board Occupational Safety and Health Directive, Personal and Protective Equipment and Clothing

Canada Labour Code, Part II

Canada Occupational Health and Safety Regulations

CROSS-REFERENCES

5. GL 254-1 - Occupational Safety and Health Program

CD 568-4 - Preservation of Crime Scenes and Evidence

CD 821 - Management of Infectious Diseases

Protocol 821-1 - Managing Exposure to Blood and/or Body Fluids

GL 821-2 - Bleach Distribution

DEFINITIONS

6. Blood-borne pathogens: viruses found in blood such as hepatitis B and C virus, or human immunodeficiency virus (HIV) which produce infection.

7. Contamination: a disinfected or sterile item or surface that becomes soiled with micro-organisms.

8. Cross-contamination: the transfer of an infectious agent from a contaminated source to a non-contaminated source.

9. Disinfection: a process that kills or destroys most disease producing micro-organisms.

10. Personal protective equipment: equipment designed to provide a barrier between a person and a known or potential hazardous material in order to minimize, reduce, or eliminate the risk of exposure to the hazardous material.

11. Single-use: devices that are designed to be used once and discarded as these items cannot be adequately cleaned and disinfected or sterilized.

RESPONSIBILITIES

12. The Institutional Head or his/her delegate is responsible for :

1. determining who will be involved in the cleaning up of blood and/or other body fluids:
   1. specifically trained staff, or
   2. specifically trained inmates (they must be under the supervision of specifically trained staff), or
   3. specifically trained staff and specifically trained inmates, or
   4. outside contractors;
2. maintaining a list of specifically trained staff and inmates;
3. providing the required training; and
4. maintaining a supply of personal protective equipment and appropriate cleaning products.

PERSONAL PROTECTIVE EQUIPMENT

13. Pursuant to CD 821, the following clothing and material must be fluid resistant and readily available in identified locations:

1. face shields;
2. masks;
3. non-latex gloves (e.g. nitrile or other barrier material);
4. disposable gowns or waterproof aprons;
5. protective footwear;
6. eye protection (i.e. close fitting glasses or goggles); and
7. spill clean-up kit - commercial or one that contains gloves, pick-up scoop with scraper, intermediate level disinfectant, paper towels and garbage bags.

RECOMMENDATIONS FOR CLEANING UP BLOOD AND/OR OTHER BODY FLUID SPILLS

14. Pursuant to CD 568-4, Security staff will protect the scene prior to cleaning. Therefore, the affected area must be cleared by Security in order to preserve evidence. The affected area may need to be cordoned off to ensure no one is able to walk through the affected area.

15. Pursuant to CD 821, appropriate personal protective equipment must be worn for cleaning up blood and/or other body fluid spills. This equipment should be changed if torn or soiled, followed by hand washing.

16. Single-use impermeable gloves need to be worn during the cleaning and disinfection procedures. If the possibility of splashing exists, the specifically trained staff or trained inmates or outside contractors need to wear a face shield or goggles and a gown.

17. The blood and/or other body fluid spill area needs to be cleaned of organic matter for the disinfection to be effective. Surfaces (walls, floor, counter tops, inanimate objects) that have been contaminated with blood or other body fluids need to be wiped up with disposable towels or other absorbent material. Disposable towels used for wiping up blood or other body fluids need to be discarded in a plastic bag and can be placed in the regular garbage. Only items that are blood soaked (if squeezed they would drip blood) need to be discarded in a PLASTIC BIOHAZARD BAG.

18. Surfaces contaminated with blood and/or other body fluids, and immediately adjacent to contaminated areas, need to be disinfected with an intermediate level disinfectant (e.g., Accel TB), ensuring sufficient contact time.

19. Surfaces that have not been directly contaminated with blood or other body fluids, and/or that are in close proximity to contaminated areas may be cleaned with detergents.

20. Clothing contaminated with blood and/or other body fluids can be cleaned through regular laundering. Once removed, clothes should be placed in a plastic bag and care should be taken when placing these items in the washing machine not to cross-contaminate or handle without gloves.

21. Once removed, single-use personal protective equipment should be placed in a plastic garbage bag stored with the regular garbage. Hands should be washed following glove removal. Care needs to be taken not to contaminate the outside of the garbage bag. Double bag if contamination is suspected.

22. Once removed, non-disposable personal protective equipment should be disinfected with an intermediate level disinfectant, ensuring sufficient contact time.

HANDLING SECURITY EQUIPMENT THAT HAS BEEN IN CONTACT WITH BIOLOGICAL FLUIDS

23. Place the equipment in transparent non-permeable (no holes) plastic bag of the appropriate size.

24. Handle the bag from the outside as the inside is considered to be contaminated.

25. Place a yellow or red biohazard label on the bag to indicate that it contains equipment contaminated with biological fluids.

26. Send the bag to the Security Maintenance Officer for decontamination of the equipment. For those institutions that do not have a Security Maintenance Officer, send the bag to the designated person.

27. Gloves need to be worn when handling this equipment prior to decontamination. Care needs to be taken not to cross-contaminate.

PROPER TECHNIQUES

Hand Washing

28. The purpose of hand washing is to remove soil, organic material and transient micro-organisms from the skin. A good hand washing technique reduces contamination by contact and helps to eliminate the transmission of pathogens to non-contaminated areas. Hand washing is considered one of the most important single interventions for preventing infections.

29. To wash hands well:

1. remove all jewellery before hand washing (contaminated jewellery to be treated the same as hands);
2. rinse hands under warm running water to allow for suspension and washing away of the loosened micro-organisms;
3. lather with soap and, using friction, cover all surfaces of the hands and fingers (the minimum duration of this step is 10 seconds, but more time may be required if hands are visibly soiled);
4. carefully clean frequently missed areas such as thumbs, under nails, backs of fingers and hands;
5. rinse hands from fingertips to wrist under warm running water to wash off micro- organisms and residual hand washing agent;
6. dry hands thoroughly with single-use towel or forced air dryer (reusable towels are avoided because of the potential for microbial contamination); and
7. turn off faucet using a paper towel to prevent recontamination of hands.

30. Faucet taps need to be decontaminated.

31. The efficacy of hand washing depends on the time taken and the technique.

32. To avoid potential cross-contamination, it is important not to splash clothing, other skin surfaces or inanimate items during hand washing.

Gowns

33. Long sleeved garments are preferred to minimize contamination of skin or clothes.

34. To put on the gown:

1. unfold the gown and hold the gown so that the opening faces you;
2. one arm at a time, put on the gown;
3. pull the gown over the shoulders; and
4. tie strings in the back so that the gown overlaps.

35. To take off the gown:

1. untie the strings in the back of the gown;
2. remove the gown without touching the outside of the gown;
3. place the gown in the garbage; and
4. wash hands.

Masks

36. To put on the mask:

1. position the mask over the nose and mouth;
2. bend the nose bar if applicable, over the bridge of the nose; and
3. depending on the type of mask, either tie the strings over the back of the head and behind the neck or place loops behind the ears.

37. To take off the mask:

1. untie the mask strings or release the elastics;
2. remove the mask from face without touching the outside surface with bare hands; and
3. drop mask into the garbage.

Gloves

38. Gloves need to be worn at any time contact with blood, body fluids, mucous membranes or non intact skin is expected or can be reasonably anticipated. Gloves used are not sterile.

39. To put on the gloves:

1. remove gloves from the box by grasping them near the wrist and pull glove over the hand; and
2. change and discard gloves at the first sign of cracking, peeling and if torn or punctured.

40. To take off the gloves:

1. pinch first glove below the wrist;
2. pull the glove so that it turns inside as you remove it;
3. slide an ungloved finger inside the cuff of the remaining glove;
4. pull downward toward the finger tips, off of the hand and over top of the first glove;
5. drop the gloves into the garbage without touching the soiled outer surface of the used gloves with your bare hands; and
6. wash hands.

41. Please note that gloves need to be the last item to be removed.

Assistant Commissioner, Health Services

Original signed by:

Leslie MacLean,
Cheryl Fraser

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