Keeping a Lid on Fluid Spills on the OR
By Kathy Dix
Not much has been new in the area of fluid management and infectious materials spills until the recent Association of periOperative Registered Nurses (AORN) Recommended Practices for Environmental Cleaning in the Surgical Practice Setting and new Centers for Disease Control and Prevention (CDC) guidelines on environmental infection control in healthcare facilities.
Theres a new guideline that just came out from the CDC for environmental infection control in healthcare facilities, says Joan Blanchard, a perioperative nurse specialist at the Association for periOperative Registered Nurses (AORN).
In their recommendations for cleaning up fluid spills, they do talk about the concern with HIV, hepatitis B, and that it needs to be (cleaned up with) an EPA-approved disinfectant, she adds. Something as inexpensive as sodium hypochlorite isnt used because of the fumes that it may release, Blanchard points out. It can be used, in a 1-to-10 dilution. The problem with sodium hypochlorite is because of the fumes that it may release, Blanchard points out. If youre using it on metal, it can corrode it, so thats one of the drawbacks. If you go to the EPA list C and EPA list E, that gives you information on the different types of germicides that you can use that are effective with infectious or biohazardous waste.
With large spills of body fluids, a blood and body fluid spill kit is best, says Blanchard. They do make the custom kits. Whats included in a custom kit especially for blood you have isolyzer, which helps make a gel of blood, you have a fluid shield mask, a gown, latex gloves or non-latex gloves, biohazard bag, and a plastic scoop, so that you have everything you need to handle the spill.
Of note, if sodium hypochlorite (bleach) is your cleaner of choice, even in a 1-to-10 dilution, it may be necessary to use an N-95 mask due to the fumes that the agent releases. Many times, sodium hypochlorite isnt used because of the fumes that it may release, Blanchard points out. I think in the military, they use it quite a bit, but in hospitals or healthcare facilities, they dont use it as much.
Until the CDC guidelines were released in June 2003, there had been no clinical guideline update in some time. However, AORN also updated its environmental cleaning recommended practices for 2003 as well.
The guidelines state, During surgical procedures, contamination should be confined and contained within the immediate vicinity of the surgical field to the degree possible. Spills of contaminated debris (e.g., blood, tissue, body fluids) in areas outside the surgical field should be removed as promptly as possible. Prompt cleanup and decontamination of potentially infectious materials helps maintain a safe, clean surgical environment. When cleaning spills of blood or other potentially infectious material, use gloves and other personal protective equipment (PPE) as appropriate to the task. It is unknown which patients may harbor harmful pathogens. Use of PPE protects healthcare workers from direct exposure to potentially infectious microorganisms.
Pat Moleski, associate director of perioperative services at North Shore University Hospital in Manhasset, N.Y., says that there is little new technology for spill kits.
When it comes to preventing spills of hazardous chemicals, Moleski says, We try to self-contain everything. Any of our hazardous materials we keep in a self-contained hazardous cabinet that is outside the operating room (OR), (a modification) that was based on regulations instituted as long as five years ago. First of all, you have to minimize as much of your hazardous materials as possible, really limit the volume that you need. Anything we have that would be hazardous, we have in a patient flow area. Its still within the OR, but its not within a restricted area. (Its stored) in a hazardous container the size of small refrigerator, and it has a lock and key.
If her facility does have a spill, Moleski says, We have eyewash stations throughout the OR, so if anyone had caustic materials in their eyes, there are sinks available. If anyone were exposed to it and they became symptomatic, we would immediately pull them out, restrict traffic, confine, and then bring them to the Emergency Department. But again, we have minimal volume (of hazardous materials) in our hospital. I strongly recommend thats what should be done in any hospital. It pays to have more frequent trips to pathology or to the lab to pick up hazardous material rather than having large quantities of it (by the OR).
Moleski points out that regardless of what products your facility is utilizing, You really do need the appropriate ventilation, too. Her facilitys ventilation systems are monitored on at least a semiannual basis.
If there is a spill, Moleskis hospital requires a call to the safety officer, and if additional help is needed for a cleanup, they can call upon the laboratory. Based on the type of spill, if it were formalin or something, they would just want to make sure we followed the policy and procedure, and confined it in one area, she adds. And we always follow up any of our spills with an incident report and send that to Quality Management.
If an employee has been exposed to an infectious bodily fluid, it is imperative that they see the employee health services nurse as soon as possible, says Blanchard. Now with hepatitis B, there is prophylactic therapy; with hepatitis C there isnt, and with HIV, there are varying types of treatment protocols. That would be dependent on the infectious disease doctors, making recommendations as to what they should take, she says.
For instance, if they have had the hepatitis B series, they would do a blood titer to see if they have hepatitis B protection from their hepatitis B series. The physician would make the determination on whether to prescribe for the HBIG vaccine, if thats necessary, or any of the medications that are available for HIV if that were a concern.
Choosing the Right Product
Many of the products are similar, says Moleski. We have switched products a couple of times over the last five or 10 years and they are all compatible.
However, Blanchard points out, The custom pack gives everything you need right away. Some hospitals have a smaller setup and may not use an isolyzer; what they may use is an absorbent material like cotton wool, where they would collect it and then disinfect the area.
To view the CDCs Guidelines for Environmental Infection Control in Health-Care Facilities, visit www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm.
The Dornoch Transposal System consists of the Safety Station and High Fluid Cart. The Safety Station empties, cleans, and disinfects reusable 1800 or 2800cc suction canisters. The High Fluid Cart conveniently collects up to 48 liters of fluid in one or two reusable reservoirs. High Fluid Carts can be used to simplify fluid collection during high fluid volume arthroscopy and cysto surgical cases. As a completely closed system, Transposal protects employees while meeting engineering control requirements specified under OSHAs 1991 Bloodborne Pathogens Standard. Moreover, Transposals reusable technology eliminates both the weight and volume of all suction canister waste in a facility.
The OMNI/ajax BioSet Body Fluid Encapsulant/Solidifier is a patented cementatious mixture designed for reducing the risk of contamination and exposure. BioSet spill kits are especially designed for encapsulating and removing vomitus, blood and other body fluid spills to address the issue of Universal Precautions. Simply sprinkle the BioSet encapsulator on spilled blood, urine, vomit or other potentially hazardous waste and the fluid is absorbed in seconds while the cementatious reaction continues to solidify the mass. Scoop up the treated waste and dispose as medical wast in accordance with facility policies.
The Vac-U-Station Liquid Infectious Waste Management System is designed to be a safe, fast, and economical way to disposal of suction canister contents. It dramatically reduces exposure to splattering, spilling and aerosolization of infectious waste fluids. Patented, bottom drainage ports on Vac-U-Port disposable canisters open with a simple pull of a handle, allowing contents to empty directly into the sanitary sewer system. A window allows the operator to make certain the contents are completely drained and an attached spray hose can be used to rinse the canister. No costly solidifiers are needed. Hooks up easily to existing plumbing and requires no electricity.
(800) 366-7651, ext. 5467
Richard Wolf Medical Instruments Corp.
The Richard Wolf Fluid Manager is designed to prevent fluid overload by the accurate management of fluid inflow and deficit for hysteroscopy. The Fluid Manager is an easy-to-use complete system for hysteroscopic fluid monitoring in a compact, standalone unit. Features include At-a-Glance monitoring unit for quick recognition of inflow and deficit. Fluid bags are at a convenient height for clinical staff. There is no stopping of the operation to exchange fluid bags and containers. Proprietary Best Flow automatic instrument detection increases accuracy by adjusting for back pressure created by smaller scopes.
Colby Manufacturing Corp.
SurgiSafe Absorbent Floor Pads are designed to quickly soak up and retain irrigants, blood, and body fluids through a wicking action. Since pads conform to uneven floor surfaces and remain flat without bunching, and because they have no tubing to connect to other devices, there is little to trip over. The pads help prevent slipping on wet floors and protect the floors from chemical stains. Offered in varying widths and lengths, SurgiSafe Pads can be positioned in as small or as large a surface area as needed and improve OR turn-around times. Once used, mats are folded, red-bagged and disposed of in accordance with normal hazardous-waste procedures.
Safetec of America, Inc.
Safetecs Universal Precautions Compliance Kit is a combination protection/clean-up kit designed to help protect hospital personnel from potentially infectious blood or body fluid spills. The kit features Safetecs RED-Z solidifier for easy cleanup and removal of body fluids, as well as other items mandated by OSHA, CDC, and state health departments for optimal protection. Safetec also specializes in custom kits and private labeling, along with their full line of infection control and first aid products.
Caltechs ready-to-use BioHazard Spill Kits are designed to contain, remove and dispose of spilled bodily fluids and to quickly clean/disinfect the spill site. Each sealed kit contains an 8 oz. tuberculocidal disinfectant bottle of either DISPATCH ® Hospital Cleaner Disinfectant with Bleach #SK960 or PRECISE® QTB Hospital Cleaner Disinfectant (non-bleach product) #SK008, gloves (non-latex), absorbent powder, paperboard spatula, towel, biohazard bag with twist tie, antimicrobial hand wipe and easy-to-follow step-by-step instructions.
(800) 234-7700 or www.caltechind.com
Send product information to Tina Brooks at: [email protected]