[bluhd]: Basic Bodily Fluid Clean-Up Procedures

by Steve Lemon

The opinions and perspectives expressed here and in all my articles are my own and may, or may not, align with those of the Event Safety Alliance.

 A worker recently suffered a reportable injury on one of my jobsites. While our event EMT attended to the worker, I formed a checklist of (obvious) next steps:

·      Block off the area.

·      Call for a golf cart to take him to a car, which would take him to a nearby urgent care facility.

·      Locate the urgent care facility and make sure the driver knows where to go.

·      Photograph the area, the metal piece, the guy’s leg, everything that was somehow involved.

·      Get a list of witnesses and arrange for them to fill out reports.

·      Get a report from the medic, and file my own report as well.

 

With some help from the internet, I realized I had omitted an important item:

 ·      Contain the blood to as small an area as possible and prepare to implement “standard clean-up procedures”.

I had no idea what “standard clean-up procedures” were so I began to research further. I easily found three reliable resources: one from the Center for Disease Control (CDC), one from OSHA, and one ‘best practices’ white paper. Basically, they all prescribed the same process with varying degrees of complexity.

By the time I realized my plan was missing the containment aspect, some contaminated items had already been removed from the scene: the roadbox with blood on the top, the bloody piece of metal that had cut the worker, some hand tools on top of the roadbox. Thanks to a photograph taken of the area shortly after the incident, we were able to collect the missing items for cleaning.  

It is not lost on me that I should have immediately taken control of these items until they were ready to be placed back into circulation. My key take-away: I needed to better inform myself on reacting to these matters, and that was the inspiration for this article.


Introduction

Many injuries, including non-reportable ones, can involve a little blood. Think of all the paper cuts, scrapes, stapler punctures, case-latch cuts and so on that occur daily where only a trace of blood is apparent. From a safety perspective, whether you are dealing with a drop, a smear, or a 6-inch puddle, blood needs to be properly cleaned up. Rarely does a cleanup require a complete shutdown of operations. In many cases, clean up is a simple procedure of wiping the surface with a disposable towelette with bleach and disposing of the towelette, taking less than a minute and it can often be done by the injured worker.

In the event business, we deal with “bodily fluids” every day, in restrooms (and occasionally outside of restrooms), first aid stations, drinking fountains, and shower trailers to name a few examples. Once familiar with them, you will start to spot a variety of situations in your own environments where there is an increased likelihood of exposure to bodily fluids.

Q: If it is common that an event site has opportunities for the public to be exposed to bodily fluids, is it reasonable to expect that event staff should know how to properly identify and clean up bodily fluids?

A: Yes, it is.

Though reasonable, as of today, most event staff are not trained to identify bodily fluids, or how to perform a simple cleanup, or even to have the phone number of a cleanup service that specializes in such matters.

To check me on the above generalization, consider asking a variety of workers on your site to list the items they consider to be bodily fluids, then ask them how they would effectively clean up a bodily fluid spill. Comparing their answers with the information below should give you an idea of your team’s ability to react to a spill, log that information and then build from there. Make sure they know this is a learning moment and not a ‘gotcha’ moment.

You will notice the processes for most bodily fluid cleanups are similar. I chose blood for my examples because if you prepare for that, the others should be easy, with the exception of fecal matter which you will probably want to have a service clean up anyway.

My goal for you is after you read this, you will feel equipped to confidently perform a basic cleanup. Remember, with large spills or really gross situations, you can always call a service that specializes in such matters. You will see that procedures for the majority of cleanups are not very complicated or time consuming.

 

Impact on Event Operations

Once the injured are in the care of qualified medical staff, immediate attention needs to be focused on containment of the contaminant, the incident investigation, and the cleanup so you don’t suffer delays in event operations. Unless of course, the scope and severity of the incident require suspending event operations, and provided the staff are emotionally prepared to remobilize.

Prior to pushing for a rapid return to normal operations, management should consider the severity of the incident, and its emotional impact on the workforce. The ability and desire of workers to carry on after an incident should not be presumed. With incidents where someone is severely injured or killed, remobilizing may take some time. Consider meeting with department heads, respectfully address the state of the injured, the incident, and the emotional state of the staff. The department heads will know how their crews are reacting, as well as how and when to remobilize their crews and under what conditions.

Confirm there are no complications with EHS and your supervisor when to access the scene, clean up the area, and remobilize the affected areas. Once a cleanup is complete and the site is again fully operational, remember to include all information in the incident log in the event operations binder.

 

Policies

Some companies have incident response plans and cleanup policies in place. If you are not sure, check with your company now, in advance of an incident, to familiarize yourself with the company’s policies. In addition, verify that staff training has been provided and the materials are in place for when a cleanup is required.

If your company does not have a policy, beginning one is easy and it will then become part of the company’s overall safety policy. As with any policy, it will not start out perfect, and it should be updated to reflect the needs of your company’s unique work situations.


Bodily Fluids

Today’s bodily fluids of greatest concern are defined as:

·      Human blood, human blood components, and products made from human blood.

·      Any fluid from the body that is visibly contaminated with blood.

·      All body fluids in situations where it is difficult or impossible to differentiate between body fluids.

·      Other potentially infectious materials (OPIMs) including semen, vaginal secretions, fluids from around the heart, lungs, brain or spinal cord, joints, abdominal cavity, amniotic fluid, and saliva in dental procedures.

(University of Wisconsin, Superior, 2013)


Other Potentially Infectious Materials (OPIM)

(Occupational Exposure to Blood borne Pathogens, 29 CFR 1910.1030)

OPIMs are defined as:

·      Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any bodily fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; 

·      Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and, 

·      HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. 

The OSHA website has a lot of information for people who specialize in cleanup operations. Just search for “blood clean up”.

 

Blood Borne Pathogens

What exactly are blood borne pathogens?

Blood borne pathogens are infectious microorganisms present in blood that can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), the virus that causes AIDS. Workers exposed to blood borne pathogens are at risk for serious or life-threatening illnesses.

(USDL, Occupational Safety and Health Administration, 2011)

 

Training

Staff training is an important part of protecting your workers, your company’s business, and the business entity should you end up in court. In addition to clean-up procedures, staff need to be trained to report incidents to help make the site safer in the future. This point should be reinforced during morning safety meetings and toolbox talks, it’s as simple as “Remember to report incidents and near misses to your supervisor.” It’s that simple. 

A trained workforce has greater confidence in the team around them, they exhibit safer behaviors overall, and they react more quickly and decisively during an incident. In the event industry where work is time-sensitive, losing a linear hour of time from a day can be hard to make up. The faster a site can be remobilized, the sooner normal operations resume, provided a third-party investigation is not required after the incident.

 

Personal Protective Equipment (PPE)

The list of PPE an employer is expected to have on hand includes but is not limited to:

  •   Gowns

  •   Aprons

  •   Lab coats

  •   Suits

  •   Face shields or masks

  •   Eye protection

  •   Shoe covers or boots

  •   Surgical caps or hoods.

 

Other items may include:

  •  Mouthpieces

  •   Resuscitation bags

  •   Pocket masks

  •   Other ventilation devices may also be considered PPE

 

Clean-Up Kit

Here is a checklist of some items you will want to have on hand and readily available:

  • Disposable latex gloves

  • Protective cap

  • Eye protection

  • Protective gown

  • Particle mask

  • Absorbent material (kitty litter, sand etc.)

  • Disinfecting towelettes (the kind with bleach)

  • Towels and/or rags

  • Bleach or another tuberculocidal disinfectant (1:9 mix of bleach to water)

  • Bucket

  • Biohazard “red bag” with zip ties

  • Plastic sheeting / visqueen

  • Red 2-inch gaffers tape

  • A scoop (a child’s beach shovel works)

  • (Culture of Safety, 2018)

 

Basic Clean-Up Processes

From stubbed toes, nosebleeds, cut fingers, scrapes, torn fingernails, to more serious cuts, blood is blood and it will need to be contained and cleaned up. Below are some basic processes for bodily fluid cleanups. The presence of blood may not be visible to the human eye. As a precaution, it is recommended you treat every bodily fluid cleanup as though blood is present. Here is the basic cleanup process:

1.     Call for help and care for the injured until help arrives.

2.     Put on your cleanup PPE.

3.     Contain the spill with a barrier or absorbent material so it doesn’t expand.

4.     Block off the area so people don’t wander into it and become contaminated. Even if this is as far as you can get on this list, you have achieved the minimum necessary until experienced janitorial or professional cleanup service can arrive.

5.     Gather the cleaning equipment and materials required to cleanup.

6.     Diligently clean up the spill and sanitize the affected areas, see below examples on how to clean up.

7.     Double check the area for anything you may have missed.

8.     Properly dispose of contaminated items including your PPE if necessary.

9.     Verify with EHS and your supervisor, then reopen the area.

10.  File a report in the log.

…and that is the basic process for most cleanups you will perform.

Here are some specific examples of how to clean up spills on common surfaces after the injured are cared for.

 

Hard Surfaces.

Spills on hard surfaces are the most common and significantly easier to clean than absorbent surfaces. However, with hard surfaces, spills spread faster so you will need to contain the spill quickly to limit contamination and the surface area to be cleaned.

1.     Install barrier around the area to block and restrict access to the area until cleanup and disinfection is complete. For example, caution tape is quick and easy to install.

2.     Gather the PPE and cleaning materials required.

3.     Put on disposable latex gloves.

4.     Contain the spill to as small an area as possible with an absorbent like kitty litter or sand, this can be done sooner if the containment process does not expose you to directly to the contaminant.

5.     Wipe up the spill as much as possible with paper towel or other absorbent material, disposing of that material into a plastic trash bag as you go.

6.     Gently pour bleach solution, 1-part bleach to 9-parts water, onto all contaminated areas. Let bleach solution remain on contaminated area for 20 minutes and then wipe up remaining bleach solution.

7.     Clean contaminated tools and equipment, use the same solution to wet a paper towel and thoroughly wipe down the items, disposing of the paper towel after each wipe, then getting a new one and repeating until clean.

8.     All non-disposable cleaning materials such as mops, brushes and rags need to be disinfected by saturating with a bleach solution and then allowed to air dry. In extreme cases, you will need to discard the item after being sanitized. Do not toss a bloody item into a trash can or dumpster, as it poses a risk to others, see #10 below.

9.     Remove your latex gloves and place in the garbage bag with all other soiled cleaning materials.

10.  Double bag and securely tie up garbage bags and discard. Important note: If any of the items are saturated and wet with blood, use a biohazard “red bag”, and call a qualified disposal company to dispose of the bag. DO NOT throw this red bag into a normal dumpster going to a local landfill.

11.  Thoroughly wash hands with soap and water, then remove the barrier from the spill area and you’re done!

 

Spills on Carpeted Floors.

Carpets are usually absorbent and harder to clean. There is no way to completely disinfect carpet, so the best option is to clean and sanitize as best you can. Most clean-up procedures for carpet will be the same as other areas. As always, you can also elect to simply call a service who specializes in these types of clean ups.

Be prepared for a spill on your carpet! Sooner or later a spill will occur and having the right materials on hand can save you time and money. Here is the protocol for cleaning a spill on a carpeted surface:

1.     Install barrier around the area to block and restrict access to the area until cleanup and disinfection is complete. For example, caution tape is quick and easy to install.

2.     Gather the cleaning materials required.

3.     Put on disposable latex gloves.

4.     Contain the spill to as small an area as possible with an absorbent like kitty litter or sand, this can be done sooner if the process does not expose you to the contaminant.

5.     Once the area is contained, spray the affected area with an appropriate carpet detergent to help kill pathogens. After spraying the area, allow it to sit for 10 minutes so the disinfectant has time to work. Follow your carpet manufacturer’s recommendations since certain products can damage carpet fibers and dyes.

6.     Blot up excess fluids using disposable towels or rags to blot as much excess fluid as you can and then carefully dispose of the soiled rags in a sealable bag.

7.     Extract the absorbed fluids, the carpet will absorb some of the fluid so removing those fluids will be the next step. Use a wet-vacuum to thoroughly wet and remove any fluids. Repeat the process of wetting and suctioning several times. While wetting the affected area try to prevent moisture from spreading beyond the initial spill’s boundary.

8.     Re-disinfect after vacuuming, thoroughly re-saturate the area with an appropriate disinfectant. Each time allow the disinfectant to set and work for up to 20 minutes to make sure it has the full effect. Repeat this step of disinfecting and then allowing to sit for 10-20 minutes- two more times.

9.     Once the final round of disinfecting is complete, rinse the area one last time to remove any remaining detergent or disinfecting solution. After rinsing, wet-vacuum the area.

10.  Dry the area thoroughly with rags to draw out any remaining moisture and then place fans near the area to completely dry it.

11.  After the area is clean, properly dispose of all rags and PPE contaminated by the spill. In addition, thoroughly clean all other equipment used during the spill cleanup, such as the wet-vacuum, work shoes and so on.

12.  All non-disposable cleaning materials such as mops, brushes and rags need to be disinfected by saturating with a bleach solution and then allowed to air dry. In extreme cases, you will need to discard the item after being sanitized. Do not toss any bloody item into a trash can or dumpster, as it poses a risk to others.

13.  Remove your latex gloves and place in the garbage bag with all other soiled cleaning materials.

14.  Double bag and securely tie up garbage bags and discard. Important note: If any of the items are saturated and wet with blood, use a biohazard red bag, and use a qualified disposal company to dispose of the bag. DO NOT throw this red bag into a normal dumpster going to a local landfill.

15.  Thoroughly wash hands with soap and water.

16.  Once the carpeted area is completely dry, remove the barrier from the spill area and you’re done!

Other considerations include:

·      Work fast, blood will harden and set up quickly. Once the injured individual is safe, get on your PPE and begin as soon as possible.

·      Use appropriate products. Bleach and other decontamination products can damage or destroy carpet. Look into manufacturer approved carpet shampoos and cleaners, and be sure to use one with some anti-microbial properties to help sanitize the area as thoroughly as possible. It is recommended to repeat the process once or twice more since the absorbent nature of carpet can still conceal some pathogens.

·      Steam cleaning of carpet, in addition to the above, is advisable. Though more expensive than simply washing the carpet area, steam cleaners will clean, remove debris, and sanitize carpeting more completely than conventional washing.

·      Alternatively, you can replace the carpet section entirely or change carpet tiles if that’s an option. Remove the affected carpet or tiles, clean the area underneath, replace the original carpet with new carpet or tiles after cleaning. If disposing of the original carpet or tiles, they are contaminated and must be disposed of properly.

 

Spills on Furniture.

Depending on the furniture, cleanup will be similar to either the hard surface or carpet sections above. Fabrics require more treatment than leather, wood, metal or plastic. As with carpet, you should consult your furniture manufacturer for appropriate cleaning materials and acquire them before you have a need for them. As with the others, contain the spill as quickly as possible, this may entail containment of the spill or the removal of the fabric. If the fabric is not removable, it is best to treat the spot as you would a blood spill on carpet. If the spill is severe, call a professional cleaning service to perform the cleanup.

Depending on the type of fabric and the severity of the spill, the best method is to remove the fabric from the furniture if possible and launder it by itself on a warm wash cycle using the manufacturers recommended cleaning agent. Spills on leather, wood, metal, and plastic furniture are still a threat and should be cleaned, they will not be as laborious as spills on fabrics.

 

Spills in Pools

The Center for Disease Control (CDC) website states that chlorine kills germs found in blood, and they are not aware of any instances in which a person has become infected with these germs after being exposed to a blood spill in a pool. The CDC also notes that a properly maintained pool contains enough chlorine to kill any blood borne pathogen and there is no action required other than attending to the injured individual and making sure the blood does not contaminate anywhere else.

 

Vomit and ‘Formed Fecal Matter’ in Pools

Vomit on surfaces can generally be treated as a bodily fluid spill as discussed above. However, when a vomit spill or formed fecal matter dropping occurs in a pool, the circumstances change. Depending on regulations in your area, closure of the pool may be necessary, and possibly even a complete draining. I recommend you check for state and local guidelines in your area to be clear on the regulations. If the vomit or formed fecal matter is found in a hot tub or smaller pool, the CDC recommends a complete drain and clean.

The vomit germs most likely to be spread are ‘noroviruses’, also known as ‘Norwalk-like’ viruses. Fecal matter can transmit Giardia, which is not always killed by the active chlorine in the pool. Local guidelines should define whether a complete draining and scrubbing of the pool facility is required and under what conditions. 

For more information on responding to vomiting or formed fecal matter in a pool, check with your local health department and the CDC’s web page on these special clean up cases.

 

Notable Points from the CDC:

·      Chlorine kills germs found in blood, however it does not kill all germs found in vomit or formed fecal matter.

·      In public pool situations, swimmers generally want something to be done after a blood spill. While unnecessary, in order to satisfy patrons expectations, some public pool operators elect to take actions such as closing the pool for a short period, possibly performing a check on the chemical balances in the water etc. then re-opening. This generally satisfies the public’s expectations with regard to the situation.

 

Spills Outdoors

Cleaning blood spills outdoors can present unique challenges. Bodily fluids on dirt or grass can leave you scratching your head wondering how to apply basic clean-up procedures. As there is still a potential for exposure, there are a few measures you can take to reduce that exposure.

·      Relocate the activity to another area.

·      Gather the cleaning materials required.

·      Put on disposable latex gloves.

·      Contain the spill if necessary.

·      Block off the contaminated area.

·      Disinfect the area with bleach, consider using a garden sprayer with bleach to evenly distribute the bleach.

·      Rinse thoroughly with water.

·      Remove your latex gloves and place in the garbage bag with all other soiled cleaning materials.

·      Double bag and securely tie up garbage bags and discard. Important note: If any of the items are saturated and wet with blood, use a biohazard red bag, and use a qualified disposal company to dispose of the bag. DO NOT throw this red bag into a normal dumpster going to a local landfill.

·      Thoroughly wash hands with soap and water.

·      Once dry, reopen the area.

(Culture of Safety, 2018)

 

Record keeping

In addition to ‘exposure control plan’ record, confidential medical records should be kept for the duration of employment plus 30 years, with the exception of employees who work less than one year. Staff training records need to be kept for three years. A sharps injury log must be kept for five years after the calendar year’s end. This is easy, all you need is a three-ring binder and some index tabs, or you can do it digitally. Regardless, the health of your business may one day hinge on the records you have kept, they tell your story and a jury will judge you based on the information in those records.

 

Disposal of Items

Whether you can simply dispose of your waste in the regular trash, without special labeling or red bags, will depend on whether the waste is regulated. OSHA defines regulated as liquid or semi-liquid blood or OPIMs; contaminated items that would release blood or OPIMs in a liquid or semi-liquid state if compressed (like when wringing the liquid out of a towel for example); also, when items are caked with dried blood they are capable of releasing these materials during handling; as well as sharps, and pathological and microbiological wastes containing blood or OPIMs. If regulated, the waste may require special packaging readily available over the counter at medical supply shops, and special handling by a firm specializing in disposal of these items, these firms are usually easy to find as well.

Small finger bandages, facial tissues used to stop a nosebleed, and feminine hygiene products in most cases would not be considered regulated waste and may be placed in an ordinary plastic bag or wax-lined waste container, unless your state and local environmental laws state otherwise. The key takeaway is to know your state’s regulations and follow them.

  

Additional Information

·      All larger companies should have at least one worker trained to perform clean-up procedures. There was no definition of “larger” but it’s common sense to have someone trained in first aid and CPR on any jobsite. See OSHA 1910.1030 for more information.

·      One tidbit that surfaced on the OSHA site is:

“OSHA requires the use of a tuberculocidal disinfectant to clean up blood or bodily fluids. A disinfectant known to kill blood borne pathogens is required for adequate cleaning. Because contaminated work surfaces present the same hazard regardless of where they are located in a facility, tuberculocidal disinfectants are required wherever there is contamination from blood or OPIM, regardless of the setting.” The good news is, household bleach apparently qualifies as a tuberculocidal disinfectant!

·      For employers, there is a OSHA document available on their site that describes blood borne pathogens and an employer’s obligations. While it is not a great resource for someone trying to clean up a blood spill, the OSHA site has many good points employers should be familiar with, with regard to their responsibilities for their employees and other workers.

·      There is a standard on Occupational Exposure to Blood borne Pathogens, 29 CFR 1910.1030 which further defines “Other Potentially Infectious Materials” widely referred to as “OPIM”.

·      Some job classifications include occupational exposure to bodily fluids and they require compliance with OSHA standard 1910.1030. Those classifications include employees who render first aid who are either assigned by the employer to do so as part of their job duties, or employees who commonly render first aid with the knowledge of the employer. So, if you render first aid as part of your gig, you need to comply. However, if an employee simply helps another employee who is bleeding, that exposure would fall under the “good Samaritan” act and that would not be considered as “occupational exposure”.

·      It’s wise for employers to place blood cleanup kits in areas where workers experience cuts.

·      One reference noted that if the injured person is able to dress their own wound and clean up the blood themselves, it’s typically a minor cut and a minor clean up easily completed using a towelette with bleach or the blood cleanup kit. When the wound is serious and the blood spill is larger, it must be cleaned up by another worker using either the basic cleanup kit or the other methods mentioned in this article. There was no definition of the difference between minor cuts and serious cuts, however I would lean toward using the non-reportable injury versus reportable injury definitions.

 

Summary

·      When responding to an incident, always tend to the injured before making efforts to clean up.

·      Training is important. Trained staff know how to deal with the injured, the environment, the investigation, the clean-up of an incident, and the remobilization of a site. The result is better care for the injured, a better response by staff to manage the affected areas and equipment, and less work time lost due to the incident.

·      Review reporting procedures during morning tool box talks.

·      If a worker notices blood in their work area, they should first look for the victim and offer assistance, then contain it, report it upline, clean it up, and file a report.

·      The quicker you react, the easier to contain and clean up a contaminant spill.

·      Have the necessary PPE, tools and materials at the ready in the road box so you don’t have to search for them or go purchase them after an incident has occurred.

·      Do a little homework and know what regulations apply to your place of business and add a section on bodily fluid cleanups to your company’s safety policy.

·      Know the manufacturer’s recommended methods for cleanups on their surfaces in advance, and acquire the materials now so you don’t have to scramble later.

·      Keep some household bleach around, it’s a versatile cleaner to have in the roadbox.

·      You cannot just “throw away” some types of items contaminated with blood and bodily fluids, know how and where to dispose of such items.

·      Report all incidents and near misses.

Below is an informative table, prepared by the University of Wisconsin, with some best practices on handling items after a cleanup.

Bluhd-final.jpg

(University of Wisconsin, Superior, 2013)

Works Cited

Culture of Safety. (2018, 1 1). Proper Blood Clean Up. Retrieved May 16, 2018, from Culture of Safety, The Silver Lining: https://cultureofsafety.thesilverlining.com/safety-tips/proper-blood-clean up/

University of Wisconsin, Superior. (2013, 1 1). Bodily Fluid Cleanup, UW Superior Bloodborne Pathogens Program 2013. Retrieved May 19, 2018, from University of Wisconsin, Superior: https://www.uwsuper.edu/ehs/hsprogram/upload/Bodily-Fluid-Cleanup-and-Waste-Disposal-2013.pdf

USDL, Occupational Safety and Health Administration. (2007, May 22). Standard Interpretations/Application of OSHA's Bloodborne Pathogens standard to contractors who clean up blood following accidents. Retrieved May 22, 2018, from United States Department of Labor, Occupational Safety and Health Administration: https://www.osha.gov/laws-regs/standardinterpretations/2007-05-22

USDL, Occupational Safety and Health Administration. (2011, 1 1). OSHA.gov. Retrieved from OSHA Fact Sheet, OSHA's Bloodborne Pathogen's Standard: https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf

Jacob Worek