Infection Prevention and Control Guidelines: Spillage Management CLINICAL GUIDELINES ACE 639 (formerly section 6 of 16 from ACE153) VERSION No 2 DATE OF FIRST ISSUE May 2017 REVIEW INTERVAL 2 Yearly AUTHORISED BY Quality, Safety and Assurance Group AUTHOR Lead for Infection Prevention and Control COPY Electronic LOCATION OF COPIES ACE Extranet Document review history Review date Reviewed by Signature May 2017 (v1) Jennifer Day November 2017 (v2) Alli Munson & Katy Scott * this was previously one of 16x sections forming policy ACE153. During November 2017, each section was broken up into individual policies. * January 2020
Title CONTENTS Page Number Infection Prevention and Control Guidelines 3 PURPOSE 3 SCOPE 3 EQUALITY IMPACT ASSESSMENT 3 DUTIES WITHIN THE ORGANISATION 4 GUIDELINE DEVELOPMENT 4 DISSEMINATION AND IMPLEMENTATION PROCESS INCLUDING TRAINING 5 LIBRARY AND ARCHIVING ARRANGEMENTS 5 MONITORING AND EVALUATION 5 ASSOCIATED DOCUMENTS AND POLICIES 6 USEFUL CONTACT NUMBERS 7 Spillage Management 8 INTRODUCTION 8 BLOOD AND BODY FLUID SPILLAGE 8 DEALING WITH SPILLAGES 9 TRAINING 11 APPENDIX 1: HOW TO DEAL WITH DIFFERENT BODY FLUID SPILLAGES 12 Date of Issue : January 2018, Review Date: January 2020 Page 2 of 12
INFECTION PREVENTION AND CONTROL GUIDELINES INTRODUCTION These guidelines must be read in conjunction with the over-arching ACE Infection Prevention and Control Policy and Assurance Framework ACE 265 (which refers to all National legislation and guidance including the duties of the Health and Social Care Act 2008: Code of Practice for on the prevention and control of infections and related guidance DH 2015). Infection control is an important part of an effective risk management programme to improve the quality of patient care and the occupational health of staff. The organisation has a legal obligation to take appropriate steps to protect service user, staff and visitors from harm. PURPOSE The purpose of this manual is to assist the Anglian Community Enterprise (ACE) in meeting their legal obligations in regard to the prevention and control of infections and to ensure that every member of staff is aware of their individual responsibility in relation to the prevention and control of infection. SCOPE The document includes guidance on care provided in Community Hospitals, clients own homes, clinics, day care facilities, GP Practices covering all areas of healthcare provision as provided by ACE. It is acknowledged that some users of these guidelines work in premises over which they have little or no control (e.g. client s own homes). Therefore in some instances users will have to use their own judgement in the interpretation of the guidelines. Further advice is available from the ACE Infection Prevention and Control Team (IPCT). Please be aware that the ACE IPCT is NOT responsible for care homes or services provided by agencies outside the Organisation. NB For advice or to report an outbreak of infection in a care home, calls should be directed to the Public Health England (Essex) (0300 303 8537). EQUALITY IMPACT ASSESSMENT This document has been assessed for equality impact. The policy is applicable to every member of staff within ACE irrespective of their race, ethnic origin, nationality, gender, culture, religion or belief, sexual orientation, age or disability. Date of Issue : January 2018, Review Date: January 2020 Page 3 of 12
DUTIES WITHIN THE ORGANISATION All staff are expected to understand the importance of infection prevention and control precautions and procedures, particularly the value of hand hygiene. All staff have an implicit responsibility to ensure they abide by these guidelines and the associated Infection Prevention and Control Policy and Assurance Framework ACE 265. The philosophy of this set of guidelines is to encourage individual responsibility by every member of staff. All staff should participate in the prevention and control of infection ensuring that there are effective arrangements in place and to take the necessary actions to prevent the spread of infections. Where reference is made to follow the manufacturers guidance, It is the responsibility of the user to ensure that they have sourced the guidance from the manufacturer themselves. GUIDELINE DEVELOPMENT CONSULTATION AND COMMUNICATION WITH STAKEHOLDERS DURING DEVELOPMENT The guidelines have been approved by the Virtual Clinical Group (VCG) and ratified by the Quality and Safety Assurance Group. At its inception the 224 page policy titled ACE 153 Infection Prevention and Control Guidelines (Standard Infection Control Precautions) contained 16 subsections. During the Autumn of 2017, it was decided to break the large into 16 smaller, more manageable documents with their own policy numbers: TITLE Allocated No. 1. Infection Prevention and Control Principles ACE 153 2. Standard Infection Control Precautions ACE 636 3. Hand Hygiene ACE 273 4. Personal Protective Equipment ACE 637 5. Safe Use and Disposal of Sharps ACE638 6. Spillage Management ACE 639 7. Collection of Microbiological Specimens ACE 621 8. Food Safety and Hygiene ACE 640 9. Linen and Laundry Management ACE 641 10. Mattress Management ACE 642 11. Single-Use and Single-Patient Use Medical Devices ACE 646 12. Decontamination of Medical Devices and Equipment ACE 367 13. Skin Cleansing ACE 260 14. Aseptic Non Touch Technique ACE 368 15. Management of Invasive Medical Devices ACE 643 16. Environmental Cleaning ACE 644 Date of Issue : May 2017, Review Date: May 2019 Page 4 of 12
APPROVAL AND RATIFICATION PROCESS The guidelines are approved and ratified by the Clinical Effectiveness Group and Integrated Governance and Risk Committee. OWNER AND VERSION CONTROL/REVIEW PROCESSES These guidelines are reviewed constantly to reflect any changes in legislation, national and expert guidance, Department of Health guidance or local developments. However, if no updates or developments are received, then these guidelines are reviewed every two years. DISSEMINATION AND IMPLEMENTATION PROCESS INCLUDING TRAINING These guidelines are available on the ACE Intranet and are disseminated via team meetings through the monthly Inside ACE bulletin. They must be read in conjunction with Infection Prevention and Control Policy and Assurance Framework ACE 265 and other associated documents and policies. Training and education on Infection Prevention and Control is mandatory for all clinical staff, and is undertaken in face to face sessions on induction to the organisation and thereafter every two years as e-learning or workbook. Additional sessions are arranged for particular needs and mini sessions are undertaken where requested. LIBRARY AND ARCHIVING ARRANGEMENTS Once an out of date policy has been removed from the extranet, the policy will be stored in an electronic archive file, maintained by Clinical and Corporate Governance Teams. MONITORING AND EVALUATION Monitoring of compliance with these guidelines will be undertaken through the following methods: Regular hand hygiene audits within community hospitals and other applicable areas; Annual infection control audits of community clinics, community hospital wards and departments by the Infection Prevention and Control Team (IPCT); ANTT - Aseptic Non Touch Technique Rolling Audit Programme; Regular visits by the infection prevention and control team to re-iterate correct practices; Observational audits undertaken by the infection prevention and control team monthly for key clinical interventions, these will include: o Preventing the spread of infection - hand hygiene, personal protective equipment, sharps and aseptic non-touch technique; o Catheter insertion and ongoing care; o Enteral feeding care; o Central venous access devices; o Peripheral intravenous cannula insertion and ongoing care. Date of Issue : May 2017, Review Date: May 2019 Page 5 of 12
These are registered with the Infection Prevention and Control Clinical Audit Programme and reported to the ACE Infection Prevention and Control Group. The results inform training needs and support development of practice. In addition information from clinical incident reporting will inform action planning. ASSOCIATED DOCUMENTS AND POLICIES ACE 265 Infection Prevention and Control Policy and Assurance Framework ACE 629 Infection Prevention and Control Guidelines (Outbreak and Isolation Management) ACE 615 Antimicrobial Stewardship Policy ACE 277 Methicillin Resistant Staphylococcus aureus (MRSA) Policy and Procedure ACE 275 Policy for Peripheral Vascular Devices and Intravenous Therapy (Adult) ACE 368 Aseptic Non-Touch Technique. Principles of best practice for clinical procedures ACE 45 Needlestick and Contamination Injuries Procedure ACE 5 Dress Code for Staff/Uniform Policy, Operational policy for clinical staff uniform/non-uniform and guidance for other staff ACE 84 Policy and procedure for the prevention and management of clostridium difficile associated disease (CDAD) in the community hospitals ACE 295 Clinical Waste Policy. ACE 153 Infection Prevention and Control Principles ACE 636 Standard Infection Control Precautions ACE 273 Hand Hygiene ACE 637 Personal Protective Equipment ACE638 Safe Use and Disposal of Sharps ACE 639 Spillage Management ACE 621 Collection of Microbiological Specimens ACE 640 Food Safety and Hygiene ACE 641 Linen and Laundry Management ACE 642 Mattress Management ACE 646 Single-Use and Single-Patient Use Medical Devices ACE 367 Decontamination of Medical Devices and Equipment ACE 260 Skin Cleansing ACE 368 Aseptic Non Touch Technique ACE 643 Management of Invasive Medical Devices ACE 644 Environmental Cleaning Date of Issue : May 2017, Review Date: May 2019 Page 6 of 12
USEFUL CONTACT NUMBERS PHE East of England Health Protection Team 0300 303 8537 Out of Hours 01245 444417 (Essex) ACE On-call Integrated Care Manager 07919 527771 Infection Prevention and Control Team 01255 201692 Infection Prevention and Control Lead 07786 334419 CHUFT Microbiology 01206 747374 Facilities Management (NHS Property Services) 01902 575050 Date of Issue : May 2017, Review Date: May 2019 Page 7 of 12
SPILLAGE MANAGEMENT The purpose of this policy is to ensure that every member of staff understands the importance of dealing with blood and body fluid spillages quickly and efficiently to reduce the potential risk of transmission of pathogens from a contaminated environment. INTRODUCTION Blood and body fluid spillages must be dealt with immediately and in the correct manner in order to ensure any risks to health from transmission of pathogens from a contaminated environment are reduced. All staff should know who is responsible for spillage management in their work area. In clinical areas this would normally be the clinical staff; however domestic staff will also take responsibility in areas such as public toilets, etc. Domestic cleaning may also be required after the body fluid spillage has been dealt with. When dealing with blood and body fluid spillages it is essential that environmental cleaning is carried out in accordance with the recommended standards that promote infection prevention and control processes and reduces the likelihood of transmission of pathogens that cause disease. BLOOD AND BODY FLUID SPILLAGE All blood and body fluid spillages are a risk to other service users, visitors, staff and the environment regardless of whether the source / service user is known to be infected or not. Standard infection control precautions (SICPs) must always be used when dealing with these spillages. HIGH RISK BODY FLUIDS Blood and some types of body fluid, including any body fluid contaminated with blood considered high risk. blood; cerebrospinal fluid; pleural fluid; amniotic fluid; semen; vaginal secretions; unfixed tissues and organs; any other body fluid containing visible blood; any body fluid from a service user in a high risk category (e.g. HIV, Hepatitis); LOW RISK BODY FLUIDS These include: Date of Issue : January 2018, Review Date: January 2020 Page 8 of 12
vomit; faeces; urine; sputum. See Appendix 1 for flow chart on How to Deal with Different Body Fluid Spillages. DEALING WITH SPILLAGES Adequate and appropriate cleaning equipment, disinfectant preparations, protective clothing and clinical waste bags must be readily available. Floor signs indicating danger of slippage must also be used where appropriate. Spillages of blood and other high risk body fluids should be dealt with using a chlorine releasing agent e.g. sodium hypochlorite or one containing NaDCC (Sodium Dichloroisocyanurate). These are available as solutions and tablets (which require diluting to reach the correct concentration) or as powders and granules which contain an appropriate concentration. Powders and granules are available as spillage kits which often contain all the equipment required for the spill including yellow bags and card / scoop for removal of spill. The manufacturer s instructions for use should always be followed when using these kits. Powders and granules are the preferred method of disinfection as they require no pre-mixing and have a longer shelf-life. They are also easier to use. Urine and vomit spills should not be treated with chlorine-releasing products as these body substances are usually acidic (with a low ph) and can react with chlorine to release noxious gases which may be inhaled and / or cause severe irritation to the eyes (particularly in confined spaces such as toilets). Some manufacturers provide spill kits of granules specifically for use on vomit and urine and if using these, the manufacturer s instructions for use should always be followed. Liquid preparations should be available in the correct concentration. A hypochlorite concentration of 10,000 parts per million (ppm) of available chlorine is necessary for use on blood and body fluid spillages. A weaker concentration of 1,000 ppm is used for environmental cleaning. Preparations must be diluted immediately before use and any unused liquid must be discarded. Do NOT store reconstituted solution as it rapidly loses its efficacy. Pre-packed / portable spillage kits are recommended for use in all areas. Manufacturer s instructions for use should always be followed. PROCEDURE FOR DEALING WITH BLOOD AND BODY FLUID SPILLAGES: HIGH RISK BODY FLUID SPILLAGE WHERE MATERIAL HAS NOT DRIED For this type of spillage it is recommended that sodium hypochlorite disinfectant granules are used. When using chemicals always follow safety procedures see Control of Substances Hazardous to Health (COSHH) data sheet. NB When using sodium hypochlorite preparations ensure the manufacturer s instructions are used to get the right concentration - 10,000 parts per million of Date of Issue : May 2017, Review Date: May 2019 Page 9 of 12
available chlorine (av. Cl.) = (1% hypochlorite solution). For example: one part household bleach to ten parts of water or ten x 1.7g Actichlor tablets in one litre of water. Always ensure adequate ventilation of the area i.e. open windows where possible. If in doubt seek advice from your infection prevention and control team. METHODOLOGY FOR HIGH RISK SPILLAGES prevent access to the area containing the spillage until it has been safely dealt with; wear disposable gloves and apron, including facial protection if required; soak up excess fluid using disposable paper towels; cover spillage with sodium hypochlorite granules or cover area with towels soaked in sodium hypochlorite solution (10,000 parts per million of available chlorine); leave for at least two minutes then remove with a scoop and disposable paper towels; dispose of waste carefully into the clinical waste stream; clean area with neutral detergent and warm water, then dry; discard personal protective equipment as clinical waste; wash hands with soap and water and dry thoroughly. NB Chlorine fumes will be released when chlorine-releasing substances are used; so ensure the area is well ventilated. LOW RISK BODY FLUID SPILLAGE For this type of spillage it is recommended that absorbent granules /powders (nonchlorine based) maybe used and the area be cleaned with detergent and water. METHODOLOGY FOR LOW RISK SPILLAGES prevent access to the area containing the spillage until it has been safely dealt with; wear disposable gloves and apron; absorb spillage with granules / powder or with disposable paper towels; dispose of waste carefully into the clinical waste stream; clean surface thoroughly using a solution of detergent and warm water and paper towels or disposable cloths; rinse the surface and dry thoroughly; once cleaned the area can be cleaned with a sodium hypochlorite solution (1,000 parts per million of available chlorine); dispose of all cleaning materials as clinical waste; clean the bucket / bowl in fresh warm, soapy water and dry; discard personal protective equipment as clinical waste; wash hands with soap and water and dry thoroughly. DANGER - Do not put chlorine-releasing substances including granules on urine spills. If blood is visible in the urine, mop up the urine spill first and clean with Date of Issue : May 2017, Review Date: May 2019 Page 10 of 12
detergent, then wipe over the area with a 10,000 parts per million of available chlorine solution. Contact domestic staff to spot clean the area with detergent after spillage has been dealt with. TREATING BODY FLUID SPILLAGE ON CARPETS / SOFT FURNISHINGS Disinfectants used to decontaminate spillages of blood and other body fluids may cause damage to carpets and soft furnishings. It is advisable that in areas where such spillages are likely that only floor covering and furniture which can withstand cleaning with a hypochlorite solution is selected. However, this may not be possible in service users own homes. All body fluid spillages on carpets and soft furnishings should therefore be treated using warm water and detergent. METHODOLOGY FOR SPILLAGE ON CARPETS / SOFT FURNISHINGS wear disposable gloves and apron; absorb spillage with granules / powder or with disposable paper towels; dispose of waste carefully into the clinical waste stream; clean area with cold water; clean surface thoroughly using a solution of detergent and warm water and disposable cloths; allow to dry; dispose of all cleaning materials as clinical waste; clean the bucket / bowl in fresh warm, soapy water and dry; discard personal protective equipment as clinical waste; wash hands with soap and water and dry thoroughly; where possible, once dry, go over area with a mechanical cleaner or steam clean. TRAINING All staff should be aware of their responsibilities when dealing with blood and body fluid spillages; which should be included in staff induction and infection prevention and control training. Date of Issue : May 2017, Review Date: May 2019 Page 11 of 12
SECTION 6 APPENDIX 1 HOW TO DEAL WITH DIFFERENT BODY FLUID SPILLAGES Which body fluid has been spilt? High Risk Blood Any other blood stained body fluid except urine Low Risk Urine Faeces Vomit 1. Cordon off affected area; 2. Wear disposable gloves and aprons and if risk of splashing face protection; 3. Ensure adequate ventilation; 4. Apply chlorine releasing granules (e.g. Haz Tab) directly to the spill and leave for two minutes; 5. Remove spillage with a scoop if available, or envelope spillage in paper towels and discard into clinical waste bag; 6. Clean the area using general purpose detergent and warm water; 7. Rinse and dry; 8. Discard mop head and cleaning cloths into clinical waste; 9. Dispose of PPE and wash hands. 10. Alternatively If granules not available or spillage is dry place paper towels over the spillage to absorb and contain it and apply chlorine releasing solution e.g. Actichlor 10,000ppm onto the towels and allow to soak for two minutes and proceed from number 5. 1. Cordon off affected area; 2. Wear disposable gloves and aprons and if risk of splashing face protection; 3. Absorb spillage with paper towels and discard into clinical waste bag; 4. Clean area with general-purpose detergent and warm water; 5. If blood stained decontaminate area with hypochlorite solution 1,000ppm; 6. Rinse and dry; 7. Discard mop head and cleaning cloths into clinical waste; 8. Dispose of PPE and wash hands. Spillage on soft furnishings 1. Discard if heavily contaminated; 2. If it is safe to use detergent and chlorine releasing agents follow the procedure as above appropriate to the type of spill; 3. Soft furnishings should be able to withstand appropriate cleaning without compromising the method due to inappropriate materials. Date of Issue : January 2018, Review Date: January 2020 Page 12 of 12