INFECTION PREVENTION AND CONTROL

INFECTION PREVENTION AND CONTROL MANAGEMENT OF SPILLAGES POLICY REFERENCE NUMBER: Clin 021 NUMBER VERSION 2 RATIFYING COMMITTEE DATE Infection Prevention and Control Committee 03/12/2009 Provider Integrated Governance 13/01/2010 Integrated Governance 15/01/2010 IMPLEMENTATION DATE 15/02/2010 NEXT REVIEW DATE Feb 2012 (or sooner if required) ACCOUNTABLE DIRECTOR Jonathan Hildebrand, Joint Director of Public Health Celia McGruer, Director of Professional and Clinical Development LEAD POLICY AUTHOR Clare Cooper Community Infection Control Nurse Version date: V2. Page 1 of 11 Ref: Clin 021

Record of Amendments Date of Amendment Version No Page No(s) Paragraph No(s) Membership of Policy Development Group Clare Cooper Community Infection Control Nurse Consultation This policy was distributed to the following people during the consultation phase. Kingston PCT Infection Prevention and Control Committee members: Dr. Jonathan Hildebrand Joint Director of Public Health/ Director of Infection Prevention and Control Celia McGruer Director of Professional and Clinical Development Dr. Jill Leach - Consultant Microbiologist Susie Puffett Managing Partner - Churchill Medical Practice Fiona Hegarty Board Lead for Short Term Care & Universal Services Yvonne Young - Consultant in Communicable Disease Control Simon Jefferies LDC Secretary/Dentist Rani Stewart Team Manager Grant Henderson - Therapy Lead and Outpatients Manager Jill Pearse Head of Information and Performance Julie Sherlock Business Services Manager Louise Harvey Health Protection Nurse Ann Warren Clinical Lead Nurse - Tolworth Hospital Teresa Candfield Project Support Officer Peer Review Peer reviewed for specialist content by: Peer reviewed for policy components by: Linda Fairhead Consultant Infection Control Nurse St Peters Hospital Moira Ford - Provider Board Lead for Business Development and Performance Version date: V2. Page 2 of 11 Ref: Clin 021

Table of Contents 1. Introduction...4 2. Rationale...4 3. Aim...4 4. Policy statement...4 5. Scope...4 6. Responsibilities of managers and staff...5 7. Training...5 8. Implementation...5 9. Audit and review...5 10. Procedures or guidance...5 Equipment required...6 Procedure for dealing with large spillages...6 Procedure for splashes and drips...7 Procedure for dealing with urine /vomit spillages...7 Procedure for dealing with spillages on carpet within PCT premises...7 Procedure for dealing with urine/vomit spillages on carpet...7 Procedure for dealing with spillages in the home...8 11. Accidents and Incidents...8 12. References...9 Appendix 1....10 Appendix 2 - Audit Tool for...11 Version date: V2. Page 3 of 11 Ref: Clin 021

1. Introduction Spillages of blood and body fluids must be dealt with immediately as they may present an infection risk to others as they may contain a variety of harmful microorganisms. Whilst caring for patients either in the inpatient areas or the clinic setting spillages can occur and it is essential that these are dealt with in a safe and timely manner in order to protect staff, patients and the general public. 2. Rationale Blood and blood stained body fluid spillages may contain hazardous infectious agents and because of this it is essential that safe and effective procedures are carried out by all staff. The procedures outlined will ensure that all staff that may be required to deal with such are protected and use the correct procedures to ensure containment and removal. 3. Aim This policy is for use within NHS Kingston (NHSK) and it s Provider Services (Your Healthcare), and aims to ensure that all spillages are dealt with correctly and safely using the appropriate products and that any waste generated is correctly disposed of. In addition the procedures used must be implemented taking into account Infection Control Principles with regard to personal protective equipment (PPE) and Hand Hygiene. 4. Policy statement This policy contains the required procedures to enable all spillages are dealt with correctly and safely. This will include: The correct PPE to be worn The correct procedures depending on the area affected, and equipment required carrying out the task. Procedures to follow when dealing with splashes, drips, urine and vomit. The different procedure to be followed if spillages occur in carpeted areas. The procedure to follow if a spillage occurs in a patient s own home. An equality impact assessment was undertaken as part of this policies development process. 5. Scope This policy and procedure is for use by all NHSK and Provider Services employed staff working in clinical areas and providing patient / client care. It also applies to bank and agency staff working in these areas. It must be adopted by independent practitioners contracted by the organisation. It is recommended that the policy and procedure is adopted by Independent contractors and their staff. Version date: V2. Page 4 of 11 Ref: Clin 021

6. Responsibilities of managers and staff Heads of Wards, Services, Departments / Team Leaders / Service Managers are responsible for ensuring that all staff are familiar with the policy procedures and that the management of spillages of body fluid is carried out in their areas in accordance with legislation, policy and best practice. Managers are responsible for ensuring their staff are aware of this policy and procedure and that this information is provided to all new staff on induction Staff are obliged to adhere strictly to this policy and procedure Staff will attend mandatory annual infection control training. 7. Training No formal training is required for this policy however all staff involved directly or indirectly in patient care must attend an annual Infection Control update which includes Standard Principles of Infection Control, Hand Hygiene and PPE which incorporates the management of spillages of body fluids. Infection control Training is mandatory and thus linked to Knowledge and skills frameworks. Attendance will be monitored by managers through personal development plans and through training needs analysis by the Education and Training Department. Training on all aspects of PPE will be provided at NHSK and Provider induction for all new staff and yearly within infection control update sessions for all clinical staff. 8. Implementation This policy and procedure will be accessible to all staff via the intranet and will be implemented via training sessions undertaken by the Infection Control Nurse to staff members within the organisation. 9. Audit and review Infection Control environmental and compliance audits will be undertaken quarterly throughout NHS Kingston and the Provider clinical areas by Infection Control Link Practitioners in conjunction with the Community Infection Control Nurse. Outcomes of audits will be reported to the Infection Control Committee and the Integrated Governance Committee. The compliance with any action plan resulting from audits will be monitored by the Infection Control Link Nurses and reported to the Infection Control Nurse Specialist. The outcomes of all audits will be reported in the Annual Infection Control Report. 10. Procedures or guidance On discovering a spillage, the member of staff must immediately alert others to prevent a slip, trip or accident. This can be achieved by placing the yellow hazard sign by its side and informing all staff. Version date: V2. Page 5 of 11 Ref: Clin 021

Equipment required Biohazard Kit. All patient areas must ensure that they have a biohazard kit available or the components required to carry out this task in the clinical area. Order details can be found at the end of this policy. If a kit is not available gather the equipment you will need: Protective clothing - disposable gloves, apron and face visor or goggles if there is a risk of splashing NADCC granules to sprinkle on the spill or Haz Tabs reconstituted to 10,000ppm. Use the specific dilutor container available see Appendix 1 for dilution chart N.B. Charts are also available in each sluice room in inpatients areas Absorbent paper towels to mop up the spill Orange clinical waste bag to dispose of the used materials Mop and bucket to clean the area after the spillage has been cleaned up Procedure for dealing with large spillages Wear gloves and an apron. A mask and goggles may also be required if there is a risk of splashing. Sprinkle the spill with NADCC (Sodium dichloroisocyanurate) granules until the fluid is absorbed or cover the spillage with paper towels to absorb all liquid and carefully pour a freshly prepared hypochlorite solution of 4 Haz-Tab tablets, (4.5g each) dissolved in one litre of water, this is 10,000pppm available chlorine. Leave the spill for a contact period of approximately 3 minutes to allow for disinfection. Ensure the area is safe. Depending on the method used, either scoop up the absorbed granules or lift the soiled paper towels and discard into an orange clinical waste bag. Wipe the surface area with fresh hypochlorite solution and rinse with clean water, as hypochlorite may be corrosive. Dry the surface with paper towels. Remove gloves and plastic apron and discard into a clinical waste bag. Immediately wash and dry hands thoroughly. Version date: V2. Page 6 of 11 Ref: Clin 021

Procedure for splashes and drips Wear gloves and an apron. Wipe the area immediately with paper towel soaked in hypochlorite solution of HazTab tablets, (4.5g each) dissolved in one litre of water, this produces 10,00ppm available chlorine. Rinse treated area with clean water as hypochlorite solution may be corrosive. Clean the area with water and detergent using disposable paper towels/wipes Dry the area using disposable paper towels. Remove gloves and plastic apron and discard into a clinical waste bag. Immediately wash and dry hands thoroughly. Procedure for dealing with urine/vomit spillages Wearing gloves and an apron, cover the area with paper trowels to absorb all liquids. DO NOT USE HAZ TAB solution/granules on urine /vomit spillages as this may result in fumes being released. Discard all waste in a orange clinical waste bin The area should then be wiped over with a freshly prepared solution of hypochlorite (10,00ppm). Remove gloves and plastic apron and discard into a clinical waste bag. Immediately wash and dry hands thoroughly. Procedure for dealing with spillages on carpet within PCT premises Wearing gloves and aprons soak up spillage with disposable paper towels until area is dry. Discard soiled paper towels into an orange clinical waste bag. Wash area with warm soapy water using disposable cloths. Clean the area with water and detergent. Dry the surface with disposable paper towels. Remove gloves and plastic apron and discard into a clinical waste bag. Immediately wash and dry hands thoroughly. Procedure for dealing with urine/vomit spillages on carpet Wearing gloves and aprons, soak up spillage with disposable paper towels until dry Discard soiled paper towels into a orange clinical waste bag Wash the area with warm soapy water using disposable cloths Rinse and blot dry with paper towels Remove gloves and plastic apron and discard into a clinical waste bag Immediately wash and dry hands thoroughly Discard paper towels into a orange clinical waste bag Arrange for carpet cleaning by Domestic staff, using an extraction procedure Chlorine will bleach the colour from carpets and soft furnishings and its use should be the last resort. Version date: V2. Page 7 of 11 Ref: Clin 021

Procedure for dealing with spillages in the home Wear gloves and apron Soak up as much of the spillage as possible using disposable kitchen towel/old newspapers or paper towels Use a solution of detergent and warm water to clean the area using a disposable cloth or a cloth that can be disposed of Do not use hypochlorite on a carpet as this will bleach it Discard cloth, gloves, apron and paper towels into a orange clinical waste bag Where this is not possible wrap all items to be discarded in double wrapping and place in a domestic waste bin When blood spillage is a frequent occurrence, it is advisable to make arrangements for a collection service Soiled clothing can be safely washed in a washing machine on a standard cycle. For items soiled with blood a cold wash re-wash cycle will help to dispel any blood prior to a hot wash Wash hands thoroughly on completion 11. Accidents and Incidents Should an accident occur due to a spillage incident, first aid should be administered and the injured person should attend the local Accident and Emergency Department. Staff should refer to and follow the Incident Reporting Policy and ensure the incident form is completed and forwarded to the Customer Care Manager. If urgent advice relating to the spillage is required please contact the Infection Control Nurse on: 0208 547 6865 or mobile 07799895059 during office hours 8.30am 3pm Version date: V2. Page 8 of 11 Ref: Clin 021

12. References Ayliffe GA, et al, Control of hospital infection - a practical handbook, 5th edition. Published by Arnold, London 2009. Ayliffe, GA, Coates D, Hoffman PN, Chemical Disinfection in Hospital. PHLS Publication, 2nd Ed.1993 Control of Substances Hazardous to Health Regulations 2002 (as amended) 2002 SI 2677/2002. The Stationery Office 2002 ISBN 0 11 042919 2 Control of substances hazardous to health (Fifth edition). The Control of Substances Hazardous to Health Regulations 2002 (as amended). Approved Code of Practice and guidance L5 (Fifth edition) HSE Books 2005 ISBN 0 7176 2981 3 Guidance on Decontamination from the Microbiology Advisory Committee to the Dept of Health Medical Devices Agency, 1996 Guidance for Clinical Health Care Workers: Protection against infection with blood borne viruses. Department of Health, 1998 Health & Social Care Act, (2008), Department of Health Wilson, J Infection Control in Clinical Practice Bailliere Tindall London 2006 ICNA Audit Tools for Monitoring Infection Control Guidelines within the Community. www.ips.uk.net (2005) Version date: V2. Page 9 of 11 Ref: Clin 021

Appendix 1. PREPARATION AND USE OF CHLORINE RELEASING SOLUTION Chlorine releasing agents can damage skin therefore gloves and aprons must be worn when preparing and /or using these solutions. If there is a risk of splashing, goggles should be worn. Wash any skin splashes with cold, running water immediately. Chorine agents must not be mixed with hot water, urine, vomit or any other cleaning agents as toxic fumes are released. Urine is a low infection risk, unless blood stained, therefore the use of GPD (general purpose detergent and hot water is recommended. Any unused solution must be discarded immediately after the task has been completed and not kept. N.B. CONTAINERS AND LIDS must not be discarded. Spares can be obtained from the ICN CHLORINE CONCENTRATIONS Strength Uses 10,000 parts per million (ppm) Decontamination of spillages of blood or blood stained body fluids 1,000 parts per million (ppm) For disinfection of surfaces contamination with body fluids e.g. commodes CHLORINE-RELEASING PREPARTIONS Presentation To make a dilution of 1.000 ppm To make a dilution of : 10,000ppm 4.5g tablets 1 tablet in 1 litre of tepid water ( use the designated container) 4 tablets in 1 litre of tepid water (use the small 1 litre designated container)r Product Information: Guest Medical Haz Tabs 4.5 g tablets -Order code:h8801 Haz Tabs Granules - Order Code H8800 Guest Medical Biohazard Spill Kit Order Code: H8616 Guest Medical Biohazard Spill Kit Midi (for areas where spills happen less frequently e.g. wards, out patient environments) Order Code: H8615 Version date: V2. Page 10 of 11 Ref: Clin 021

Appendix 2 - Audit Tool for Use the following are five questions to assess your understanding and implementation of this policy (Score yourself - Yes or No) 1. Do you understand the responsibilities under this policy? Yes/No 2. Do you know what PPE you need to wear when dealing with body? Fluid spillages? Yes/No 3. Do you understand the procedure for dealing with spillages of blood? Yes/No 4. Do you understand the procedure for dealing with spillages of urine /vomit Yes/No 5. Do you understand the procedure for dealing with spillages on carpet or in a patient s home Yes/No If you score no for any of these questions, please re-read the relevant sections of the policy. If you are still unclear please contact Infection Control. A copy of this should be kept in your personal file and may be used as part of a continuous profession development folder. Signed Role... Date Version date: V2. Page 11 of 11 Ref: Clin 021