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Cleaning of contaminated work surfaces after completion of procedures is required to ensure that employees are not unwittingly exposed to blood or other potentially infectious material remaining on a surface from a previous procedure. Appropriate disinfectants include a diluted bleach solution, Environmental Protection Agency or EPA-registered tuberculocides, EPA-registered sterilants, or products registered as effective against HIV or HBV. The lists of these EPA Registered Products are available from the EPA at telephone number 1-800-424-9346, or you can also find it at the EPA website epa.gov. The list of products registered against HIV and HBV includes quaternary ammonia products that EPA has approved as effective against HIV and HBV. These products can be used to comply with California section 5193, provided the surfaces on which they are used have not become contaminated with agents or volumes or concentrations of agents for which higher levels of disinfection are recommended. Disinfectant products must be used according to all label instructions, including the concentration, the volume to be applied on a given surface area and the contact time. Now we’re going to talk about how to disinfect contaminated work surfaces. There's several things that we're gonna start with. First of all there's certain materials you've gotta have present to be able to do this properly. Personal protective equipment is the utmost important. So if you think there's a chance that you're gonna get a splash in the eyes, get it on your clothing, you need to have personal protective equipment equivalent to what you're going to need to do. So let's say this was machinery that you've gotta spray down and there's a chance that it could splash back, you might have a disposable apron with gloves and a face shield, eye shield combination. In this case this is a flat work surface, we have some droplets of blood from an injury that took place a while ago. The blood is already starting to coagulate and so it's not going to splash anywhere unless I do it. So we just need to have care when we do that. I'm going to make sure that I've got at least a few pair of gloves, because we want to remember that we're actually gonna be changing our gloves every time we might touch contamination, and then go to a clean object. So when I first do the first wipe down, I'm gonna throw all that away, put new gloves on properly and then grab my bleach solution, spray down the surface, wipe it down, throw that away, take off the gloves appropriately and then yet a third pair of gloves to grab the bottle and spray down for our wet to dry disinfecting time. And you'll see that as we go here in how I'm gonna display this. We also want to make sure that we've got the right kind of cleaning material, wiping material. You don't to use toilet paper that's gonna shred or maybe like household napkins, they tend to break down in fluids and that's not what we're looking for. We're looking for maybe a more commercial grade paper towel or something that's appropriate to wipe up these spills. So let's go ahead and get started. If there were any sharp objects, remember that we would remove those sharp objects, broken glass, sharps, needles, things like that with tongs. Put them into a contaminated sharps protecting basin of sorts so that we can disinfect that at a later time or dispose of it properly in a sharps container. We do not have any sharps so I'm gonna go ahead and put on my first pair of gloves. After my first pair of gloves are on, I'm gonna take my towels and I'm gonna wipe down, being careful not to cross contaminate. I want to keep all the fluids on the surface and just kinda wipe up the majority of the copious amounts of the spill. We're not trying to get it perfect. Then we're going to properly remove the gloves. Then the finger on the inside. Into the trash it goes. Now we don our second pair of clean gloves. You might notice these are blue gloves, these are the nitrile gloves. But these are medical grade. You want to make sure that your gloves are medical grade so that the pores of whatever the protecting barrier is is small enough to protect from any of the infectious diseases. Hepatitis B, Hepatitis C, HIV. Industrial grade gloves may not have that quality. The pores may be too big, they may have permeable pin hole size things in there. They're not graded the same as medical grade gloves. So that's a distinguishing piece you want to be careful about. Now this is a really big one. You can look this up on the CDC's guidelines, but I'm gonna simplify it for you here. The Centers for Disease Control will say one part household bleach to nine parts water to make the appropriate solution that is strong enough to kill all bloodborne pathogens. That's important to remember, and it can be in any size increment that's appropriate. But now I'm gonna take my bleach solution, which is extremely cost effective. If you use another chemical to disinfect, you just need to remember that the chemical must be legally approved to kill the appropriate micro-organisms to disinfect and to protect against viruses, bacteria and other pathogens. So you'll want to make sure that you're using an industry grade appropriate chemical if you're not gonna use the bleach solution. Grab a couple more of the paper towels, now we're wiping down the surface that's been sprayed with the bleach solution in this case. Making sure not to cross contaminate and spill it off the edges. If it does, then we're gonna have some floor to clean up. Once again, glove on glove, skin on skin, for removing the gloves. Now I throw those in the trash, and now one more time. I know this seems redundant, but this is so that we're not cross contaminating between potentially infectious materials and clean items, and that would be the same as if you were grabbing fresh paper towels or opening doors or whatever the case may be. Taking off your gown. If you were to take off your gown that might have splash on it, you would take it off with dirty gloves, then take the dirty gloves off, throw them in the trash, grab another pair of clean gloves, and then take off your face shield with your eye shield and throw that in the trash, and then put on new clean gloves. So we're always making sure to put a barrier, which we talked about earlier, to break the route of infection. That's why personal protective equipment is so effective. Lastly with clean gloves on, we're gonna lightly mist the surface that was contaminated. This would include a floor or materials and now we allow this surface to evaporate. The evaporation time from wet to dry is the appropriate amount of time for bleach solution and in many cases even industrial strength disinfectants to actually have what we call a kill time, and that's important to remember when you're doing the final step of this disinfection of a contaminated surface.
In this lesson, you'll learn how to clean and disinfect contaminated surfaces, whether floors, tables, or equipment, along with some safety issues pertaining to cleanup. But first, let's begin by a better understanding of what an appropriate disinfectant is.
Appropriate Disinfectants
Cleaning up after every procedure is required to ensure that employees are not exposed to blood or other potentially infectious materials that remain on surfaces and equipment from previous procedures.
Appropriate disinfectants include:
- Bleach solution
- EPA registered tuberculocidal
- EPA registered sterilants
- Products registered as effective against HIV and HBV
A thorough list of these products can be found at www.epa.gov.
These products can be used to comply with California section 5193 provided that the surfaces on which they are used have not become contaminated with agents or volumes or concentrations for which higher levels of disinfectant are required.
Disinfectants should always be used according to the manufacturer's label instructions including:
- The concentration
- The volume
- The contact time
Personal Protective Equipment
Before disinfecting any contaminated areas or surfaces, first ask yourself if you have the proper PPE – personal protective equipment – to complete the job safely.
PPE you may need includes:
- Gloves, always
- Face shield and/or eye protection
- An apron or gown
In most cases, these three items will be enough, and in many instances, gloves alone will suffice.
When should you use a disposable apron or gown?
Whenever there's a reasonable chance you could get bloodborne pathogens or other potentially infectious materials on your clothing. The biggest problem involved with getting pathogens on clothing is cross-contamination, and we'll get into this more in a minute.
When should you use a face or eye shield?
Whenever there's a reasonable chance of spraying or splashing. If you're cleaning dried blood off a counter, you probably don't need to go that extra mile. But what if you were disinfecting a piece of machinery with many parts at or around eye level? Mostly it just comes down to common sense.
Having the proper cleanup equipment and personal protective equipment is the first step in any cleanup project. Make sure you have everything you need for the task at hand. And always err on the side of caution.
Pro Tip #1: Not all gloves are created equally. Always use medical-grade gloves when cleaning bloodborne pathogens and OPIM. While the term industrial-grade sounds strong and safe, this isn't always the case, as industrial grade gloves tend to have larger pores than medical-grade gloves, which may not keep all the bad stuff out.
Also, one pair of gloves isn't going to cut it. In order to keep from re-contaminating the scene, or even contaminating another scene, you'll change your gloves a few times in the course of one cleanup job. Which brings up a good point …
Warning: Pay attention to what you're touching with your contaminated gloves. It should go without saying to avoid touching any part of yourself, but also be sure not to touch clean surfaces or equipment that hasn't been contaminated. But if you do, it's not the end of the world; just remember to disinfect those as well.
Cleaning Supplies Matter
There are only two essential supplies you need: paper towels and bleach. Don't use toilet paper or napkins or even low-quality paper towels. The paper towels you use should be commercial grade and able to withstand the task at hand without falling apart.
Bleach is super cheap and super effective, so there's no point in substituting. However, if you are going to substitute, make sure the cleaner or disinfectant you're using is up for the job. As in specifically manufactured to kill microorganisms and protect against all viruses, bacteria, and other pathogens and infectious materials.
Body Fluid Cleanup Procedure
The first thing you want to do is make sure the scene is safe. If there are any sharp objects, like broken glass or needles, remove those using tongs (or another safe method) and put all sharps into a contaminated sharps disposal container so you can disinfect them or dispose of them properly later.
For the purpose of instruction, let's assume you're cleaning off a table with a modest amount of dried blood. There is no chance of spraying or splashing, and unless you're really reckless, you shouldn't have to worry about contaminating your clothing.
- Put on your 1st pair of medical grade gloves and remove any sharp objects.
- Wipe up as much of the dried blood as you can using a paper towel. Be sure to keep the blood isolated to the table or the paper towels. If you get some on the floor, be sure to disinfect it as well.
- Remove your 1st pair of gloves as shown in the video – using glove on glove for the first, and bare finger against your wrist for the second. Throw away both gloves.
- Put on your 2nd pair of medical grade gloves.
- Mix your bleach solution in a spray bottle and liberally spray the solution on the table where the dried blood was located.
- Wipe down with paper towels and make sure all the blood is visibly gone.
- Remove your 2nd pair of gloves using the same protective method as before.
- Put on your 3rd pair of gloves. (Yes, this is a bit of a pain. But if you don't do it this way, there's no point in cleaning up, as the risk of infection will likely still remain thanks to dirty gloves.)
- Lightly mist the surface of the table with your bleach solution and allow it to evaporate. The time it takes for the liquid solution to evaporate equals the time it takes to completely kill any pathogens remaining.
Pro Tip #2: The CDC (Centers for Disease Control and Prevention) recommends a bleach solution of one part bleach to nine parts water. This solution should be strong enough to kill any bloodborne pathogens and infectious materials you may encounter.
Pro Tip #3: In general, when handling or cleaning up infectious materials and bloodborne pathogens, your goal is to create barriers. These barriers will halt the spread of infection, whether the barrier is a piece of protective clothing or a safe container to dispose of infectious materials.