Definition
Disinfection of blood and body fluid spills is a critical infection control procedure that protects patients, staff, and the environment from exposure to pathogens like hepatitis B/C, HIV, and other microorganisms.
Purposes
- To keep the ward or unit clean and free from microorganisms.
- To prevent spread of infection.
Types of Spillages
- Spot spill.
- Small spill (up to 10cm diameter).
- Large spill (> 10 cm diameter).
Articles
A spill kit contains:
- Goggles-1.
- Apron-1.
- Latex gloves-2 pairs.
- Mask-2.
- Red rubber gloves.
- Tissue paper/cotton roll.
- Yellow plastic cover-2.
- Bottle with 100 ml, 10% hypochlorite solution.
- Piece of old newspaper-2/used X-ray films.
- Empty plastic bottle.
- 10 mL syringe.
Procedure
| NURSING ACTIONS | RATIONALE | |
| Step 1: Cleaning of spills | ||
| 1. | Don a pair of rubber/latex gloves and wear disposable plastic apron. | Avoids contamination. |
| 2. | Pickup any glass pieces, needles, or sharp objects that may puncture the skin, using brush and dustpan, tongs, or forceps. | Avoids cuts/injury. |
| 3. | Cover the spilled area with paper towel and then pour 10% bleach solution (sodium hypochlorite). Allow the solution to soak into the contaminated area or material. | Pouring solution on paper towel contains the solution to the contaminated area. |
| 4. | After 20 minutes, wipe the bleached material with paper towels or absorbent pads. Place the paper towels in yellow clinical waste bag. Remove any impacted material or spills on hard surfaces with an abrasive (stiff bristled) brush. | Friction helps to dislodge impacted materials. |
| 5. | If mercury spill, use a regular syringe for sucking the mercury droplets. Left out small beads are to be gathered with old X-ray film or newspaper and then scooped. | Do not touch the mercury. Never vacuum; it will release mercury vapors into the air. |
| 6. | Mop the floor/surface with antiseptic, such as Savlon, Dettol, or bleach. | Disinfects the contaminated area. |
| 7. | Remove the articles used for cleaning which are to be reused, to its proper place. | Serves for later use or safe disposal as appropriate. |
| 8. | Dispose of other materials in proper receptacles lined with color coded bags. | Follows proper method of waste disposal. |
| 9. | Remove and dispose of the glove and wash hands. | Avoids chances of contamination. |
| 10. | Report the incidence to the senior nurse on duty and the infection control nurse. | Acts as a communication between staff members. |
| Step 2: Cleaning contaminated articles | ||
| 1. | Don clean gloves. | |
| 2. | Rinse the article with soap and water. | Removes visible contamination, such as blood, pus, and secretions. |
| 3. | Take out articles, which are soaked in disinfectant and rinse with normal saline/sterile water. | Removes disinfectant solution completely. |
| 4. | Dry the instruments/articles and store it in proper place for appropriate treatment and use. | Serves to next use. |
| Disinfection and cleaning of stains on mattresses/furniture | ||
| 5. | Don clean gloves. | |
| 6. | Clean the stained area with cold, soapy water until stains disappear. | Emulsifying action of soap reduces the surface tension and facilitates the removal of dirt. Use of cold water is preferred as hot water coagulates protein material. |
| 7. | If blood stains are old or infected, soak it in a mixture of hydrogen peroxide and ammonia for several hours, and then clean with cold water, followed by soap and warm water. | |
| 8. | If blood stain is fresh, soak it in sodium hypochlorite solution for 20-30 minutes and then follow step 3. | |
| 9. | Dry the article under sunlight. | Aids in destruction of microorganisms if present. |
| Step 3: Fumigation (Terminal disinfection) | ||
| 1. | fumigation with sulfur: Place the required quantity of sulfur (220 g for a 100 square feet room) in an earthenware pot allow it to stand in a large vessel containing water and boil it until fumes fill the room. Pour methylated spirit over sulfur and light fire to the sulfur and close the door with proper sealing. Open the room after 24 hours | Sulfur fumes act better on a damp surface. The room should be filled with sulfur fumes by boiling a kettle of water in the room. Ensures burning of sulfur completely. |
| 2. | Fumigation with formalin: Fora 100-ft2room, take 140 g of potassium permanganate crystals and 250 ml of formalin in a metal bowl and mix it well The room should be sealed for 12-24 hours. | The heat produced by the chemical action evaporates the formaldehyde. |
| 3. | Spray method: Fumigant substances can be used as sprays to disinfect the entire room. |
POINTS TO BE REMEMBERED WHEN SELECTING THE DISINFECTANT
- The disinfectant chosen should be efficient to destroy pathogens.
- They should be used in correct strength.
- The article should be fully immersed in it.
- The article should be soaked for about 20-30 minutes in it.
- The disinfectant should not be injurious to the skin and articles.
- The article should be thoroughly cleansed prior to immersing in germicide to remove the organic material, which will protect the bacteria against the action of disinfectants.
- The disinfectant should be inexpensive.
- Instrument soaked in germicides must be adequately rinsed with sterile water or normal saline before being used.
| SELECTION OF DISINFACTANTS COMMONLY USED ANTISEPTICS & DISINFECTANTS, AND THEIR EFFECTIVENESS | |||||
| Agents | Bacteria | Fungi | Viruses | Spores | Use on |
| Isopropyl and ethyl alcohol | * | * | * | – | Hands, thermometers and vial stoppers |
| Chlorine (bleach) | * | * | * | * | Blood spills |
| Carbolic acid (diluted) | * | * | * | * | Surfaces |
| Iodophors | * | * | * | * | Equipment, intact skin and tissue (in diluted form) |
| Phenol | * | * | * | – | Surfaces |
| Chlorhexidine gluconate | * | – | * | – | Hands |
| Trichlosan | * | – | – | – | Hands, intact skin |
(*)-EFFECTIVE
(-)-NOT EFFECTIVE
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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