Infection Control Today - 02/2004: OR Topics

Keeping a Lid on Fluid Spills on the OR

By Kathy Dix

Not much has been new in the area of fluid management andinfectious materials spills until the recent Association of periOperativeRegistered Nurses (AORN) Recommended Practices for Environmental Cleaning in theSurgical 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 CDCfor environmental infection control in healthcare facilities, says JoanBlanchard, a perioperative nurse specialist at the Association for periOperativeRegistered Nurses (AORN).

In their recommendations for cleaning up fluid spills, theydo talk about the concern with HIV, hepatitis B, and that it needs to be(cleaned up with) an EPA-approved disinfectant, she adds. Something asinexpensive as sodium hypochlorite isnt used because of the fumes that it mayrelease, Blanchard points out. It can be used, in a 1-to-10 dilution. The problem with sodium hypochlorite is because of the fumesthat 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 Cand EPA list E, that gives you information on the different types of germicidesthat you can use that are effective with infectious or biohazardous waste.

With large spills of body fluids, a blood and body fluid spillkit is best, says Blanchard. They do make the custom kits. Whats includedin a custom kit especially for blood you have isolyzer, which helps makea gel of blood, you have a fluid shield mask, a gown, latex gloves or non-latexgloves, biohazard bag, and a plastic scoop, so that you have everything you needto handle the spill.

Of note, if sodium hypochlorite (bleach) is your cleaner ofchoice, even in a 1-to-10 dilution, it may be necessary to use an N-95 mask dueto the fumes that the agent releases. Many times, sodium hypochlorite isntused because of the fumes that it may release, Blanchard points out. Ithink in the military, they use it quite a bit, but in hospitals or healthcarefacilities, they dont use it as much.

Until the CDC guidelines were released in June 2003, there hadbeen no clinical guideline update in some time. However, AORN also updated itsenvironmental cleaning recommended practices for 2003 as well.

The guidelines state, During surgical procedures,contamination should be confined and contained within the immediate vicinity ofthe surgical field to the degree possible. Spills of contaminated debris (e.g.,blood, tissue, body fluids) in areas outside the surgical field should beremoved as promptly as possible. Prompt cleanup and decontamination ofpotentially infectious materials helps maintain a safe, clean surgicalenvironment. When cleaning spills of blood or other potentially infectiousmaterial, use gloves and other personal protective equipment (PPE) asappropriate to the task. It is unknown which patients may harbor harmfulpathogens. Use of PPE protects healthcare workers from direct exposure topotentially infectious microorganisms.

Pat Moleski, associate director of perioperative services atNorth Shore University Hospital in Manhasset, N.Y., says that there is littlenew 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 isoutside the operating room (OR), (a modification) that was based on regulationsinstituted as long as five years ago. First of all, you have to minimize as muchof 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. Itsstill within the OR, but its not within a restricted area. (Its stored) ina hazardous container the size of small refrigerator, and it has a lock and key.

If her facility does have a spill, Moleski says, We haveeyewash stations throughout the OR, so if anyone had caustic materials in theireyes, there are sinks available. If anyone were exposed to it and they becamesymptomatic, we would immediately pull them out, restrict traffic, confine, andthen bring them to the Emergency Department. But again, we have minimal volume (of hazardous materials) inour hospital. I strongly recommend thats what should be done in anyhospital. It pays to have more frequent trips to pathology or to the labto pick up hazardous material rather than having large quantities of it (by theOR).

Moleski points out that regardless of what products yourfacility is utilizing, You really do need the appropriate ventilation, too.Her facilitys ventilation systems are monitored on at least a semiannualbasis.

If there is a spill, Moleskis hospital requires a call tothe safety officer, and if additional help is needed for a cleanup, they cancall upon the laboratory. Based on the type of spill, if it were formalin orsomething, they would just want to make sure we followed the policy andprocedure, and confined it in one area, she adds. And we always follow upany of our spills with an incident report and send that to Quality Management.

Post-exposure Treatment

If an employee has been exposed to an infectious bodily fluid,it is imperative that they see the employee health services nurse as soon aspossible, says Blanchard. Now with hepatitis B, there is prophylactictherapy; with hepatitis C there isnt, and with HIV, there are varying typesof treatment protocols. That would be dependent on the infectious diseasedoctors, making recommendations as to what they should take, she says.

For instance, if they have had the hepatitis B series, theywould do a blood titer to see if they have hepatitis B protection from theirhepatitis B series. The physician would make the determination on whether toprescribe for the HBIG vaccine, if thats necessary, or any of the medicationsthat are available for HIV if that were a concern.

Choosing the Right Product

Many of the products are similar, says Moleski. We haveswitched products a couple of times over the last five or 10 years and they areall compatible.

However, Blanchard points out, The custom pack giveseverything you need right away. Some hospitals have a smaller setup and may notuse an isolyzer; what they may use is an absorbent material like cotton wool,where they would collect it and then disinfect the area.

Toview the CDCs Guidelines for EnvironmentalInfection Control in Health-Care Facilities, visitwww.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm.

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Dornoch

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Richard Wolf Medical Instruments Corp.

The Richard Wolf Fluid Manager is designed to prevent fluidoverload by the accurate management of fluid inflow and deficit forhysteroscopy. The Fluid Manager is an easy-to-use complete system forhysteroscopic fluid monitoring in a compact, standalone unit. Features includeAt-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 bagsand containers. Proprietary Best Flow automatic instrument detection increases accuracy by adjustingfor back pressure created by smaller scopes.

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Colby Manufacturing Corp.

SurgiSafe Absorbent Floor Pads are designed to quickly soak upand retain irrigants, blood, and body fluids through a wicking action. Sincepads conform to uneven floor surfaces and remain flat without bunching, andbecause they have no tubing to connect to other devices, there is little to tripover. The pads help prevent slipping on wet floors and protect thefloors from chemical stains. Offered in varying widths and lengths, SurgiSafe Pads can bepositioned in as small or as large a surface area as needed and improve ORturn-around times. Once used, mats are folded, red-bagged and disposed of inaccordance with normal hazardous-waste procedures.

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Safetec of America, Inc.

Safetecs Universal Precautions Compliance Kit is acombination protection/clean-up kit designed to help protect hospital personnelfrom potentially infectious blood or body fluid spills. The kit features Safetecs RED-Z solidifier for easycleanup 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.

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Caltech Industries

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Send product information to Tina Brooks at: tbrooks@vpico.com