COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION Infection Control POLICY NUMBER: 860 Effective Date: August 31, 2006 SUBJECT: (INFECTIOUS) WASTE This cancels Nursing Procedure 860 dated 6/1/05 1. PURPOSE: To provide guidelines for the prevention of cross contamination and infection of employees and individuals served by the proper collection, handling, storage, and transportation of biohazardous wastes. 2. POLICY: 1. All biohazardous (infectious) wastes shall be collected, handled, stored, transported, and disposed of separately from all other solid waste and only as described in the procedure outlined below. 2. The entire system for dealing with biohazardous (infectious) wastes shall be approved periodically in writing by the Fresno County Department of Environmental Health Service and shall not be revised in any way without their approval and the approval of the Coalinga State Hospital Infection Control Committee. 3. Non-Biohazardous (non-infectious) waste should not be placed in the "Biohazardous (Infectious)" Waste receptacles. 4. Unit nursing personnel are responsible for the collection and, in most areas, the disposal of infectious waste. 5. The fluid blood and moist body substance of all individuals served, staff, and visitors shall be treated as though they were contagious. 6. Individuals served are never to handle any contaminated materials. -1-
3. DEFINITION OF WASTE: -Significant laboratory wastes including microbiologic specimens (including cultures) from Individual, and disposable fomites; discarded live or attenuated vaccine or containers. -Human tissues and disposable materials from medical/dental clinics and unit examinations and treatment rooms suspected of being contaminated with infectious agents contagious to humans. -Waste which contains recognizable fluid blood or blood products (free, on equipment, or in containers) -Waste containing discarded materials contaminated with excretion, exudate, or secretions of individuals served placed in isolation room to protect others from highly communicable diseases. -Coalinga State Hospital also treats as Biohazardus Waste the following categories that are listed by CAL-OSHA as Regulated Waste. Regulated waste is defined as: contaminated items that would release blood or other potentially infectious materials ( OPIM ) if compressed, or that are caked with dried blood or OPIM, or that contains liquid OPIM. OPIM is defined to include: semen (except for discarded condoms), vaginal secretions (except for discarded peri pads or tampons), saliva from dental procedures, and fluid from internal body cavities. DOES NOT INCLUDE: -Paper towels, paper products, urine, feces, saliva (except from dental procedures) sputum, nasal secretions, sweat, tears, or vomits unless any of the preceding contain fluid blood. 3. PRECAUTIONS: 1. In all reasonably anticipated exposures to blood or other potentially infectious material personal protective equipment and engineering controls shall be used. Engineering controls isolate or remove the blood borne pathogen hazard from the work place (i.e. sharps containers). Personal protective equipment is special clothing or equipment worn by an employee for protection against a hazard. General work clothes (e.g., uniforms, pants, shirts, or blouses) not intended to function as protection against a hazard are not considered to be personal protective equipment. 2. It is the responsibility of all nursing personnel who handle "Biohazardous Waste" to ensure that it is not mixed with "non-infectious waste." -2-
3. If "Biohazardous Waste" is accidentally placed in a non-infectious container, the entire contents of the container must then be considered contaminated. It must be immediately bagged and disposed of as "Biohazardous Waste." The container from which it was taken shall be cleansed with detergent-germicide solution. If noninfectious waste is accidentally placed in the "Biohazardous Waste Container" it is considered contaminated and may not be removed. 4. IMPLEMENTATION AND INTERVENTION: PLACING INFECTIOUS WASTE IN RECEPTACLE: NURSING ACTION A. Biohazardous waste must be placed in the special receptacles marked Biohazardous Waste Only or Biohazardous with symbol on the cover and on visible lateral sides. B. These receptacles should be considered contaminated on all surfaces and care taken not to touch them except as necessary and with proper hand hygiene after each exposure. C. Never place biohazardous waste in a biohazardous receptacle which does not have the appropriate lettering and symbols D. All biohazardous waste receptacles will have a foot pedal to open the lid. When the lid mechanism is not working properly, the receptacle should be replaced. E. The lids of the biohazardous waste receptacles must be closed except when briefly opened for placement of biohazardous material inside. No container without a lid should be used for infectious waste. KEY POINTS A. Infectious waste must not be mixed with non-infectious waste. B. All waste should be considered hazardous but known biohazardous waste requires special precautions. C. All receptacles should have a transport container inside. An intact can liner prevents contamination of the receptacle. Placing contaminated waste directly in receptacle grossly contaminates it and it will require special cleaning with detergent germicidal solution immediately. D. Proper procedures require functioning equipment. E. The closed lid prevents airborne contamination and helps control odors. -3-
F. Bio-hazardous waste should always be gently and carefully placed in the receptacle. F. Avoid all forceful agitation of infectious waste. Biohazardous waste can be life threatening. G. Care should be taken to place the waste within the plastic bag can liner without contamination of the lid or outer surface(s) of the receptacle. H. Do not overfill the biohazardous waste receptacles! I. Broken glass fragments and other sharp infectious waste items should be contained in a sharps disposal container. H. Full means 2/3 full. Failure to follow this procedure will result in serious contamination of the environment. I. The sharps container must be delivered to the biohazardous waste barrel be the next day if blood or tissue is placed in it. EMPTYING WASTE RECEPTACLES: NURSING ACTION A. Get one (1) red plastic bag labeled Biohazardous Waste with a biohazard symbol. B. Care must be taken not to spill any of the biohazardous waste at any time. C. Open the biohazardous waste receptacle, place hands under the cuff, and gently close the bag and tie. Lift transport container (with tied red bag inside) from the waste can and put transport container lid in place. D. Place a new transport container into the biohazardous waste receptacle. -4- KEY POINTS A. Double bagging is no longer required. Transport containers are used. B. If a spill should occur, clean up immediately. Wearing gloves, apply a solution of Powder Keg or other approved disinfectant to contaminated surface(s). Clean-up Kit should be used before wiping up liquid blood spills. C. Do not compress bag prior to tying. D. The rigid container with tight fitting cover prevents accidental injury and spills, which may result in contamination of the environment.
E. Place the clean red bag marked with the biohazard symbol and labeled Biohazardous Waste in the transport container. Carefully fold a cuff down around the top outside of the transport container. F. If the large drum is full, return to unit with biohazardous waste in transport container and notify Housekeeping or Public Health office. E. Handle only the inside surfaces of the new can liner. F. If after hours, leave word on the voicemail system. TYPES OF CONTAINERS, WHERE OBTAINED AND WHERE DISPOSED OF: MATERIAL TO BE BAGGED Infectious Linen Contaminated Laundry (Double Bagged) WASTE (Does Not Include Infectious Sharps UNLESS IN SHARPS CONTAINER) Non-disposable Infectious Items (i.e. instruments, etc.) TYPE OF BAG OR CONTAINER Clear, Water Soluble Bag Yellow Plastic (outer) Bag A SINGLE, RED PLASTIC BAG MARKED WASTE Clean with soap and water on the unit and place in a puncture-resistant, plastic contained labeled WHERE OBTAINED Laundry Main Warehouse Central Supply WHERE DISPOSED OF Soiled Linen Room Place in a WASTE Barrel Return to Central Supply -5-