APPENDIX A*

PREVENTING TRANSMISSION OF INFECTIOUS AGENTS: GENERAL RECOMMENDATIONS FOR THE HANDLING OF BLOOD AND BODY FLUIDS

The following guidelines are meant to provide simple and effective precautions against transmission of disease for all persons, including pregnant women, potentially exposed to any blood or body fluids.

Does Contact with Body Fluids Present a Risk?

The body fluids of all persons should be considered to contain potentially infectious agents (germs).

The term "body fluids" includes: blood, semen, drainage from scrapes and cuts, feces, urine, vomitus, respiratory secretions (e.g., nasal discharge) and saliva. Contact with body fluids presents a risk of infection with a variety of germs.

In general, however, the risk is very low and dependent on a variety of factors including the type of fluid with which contact is made and the type of contact made with it.

Table 1 provides examples of particular germs that may occur in body fluids and the respective transmission concerns. It must be emphasized that with the exception of blood, urine and semen, which are normally sterile, the body fluids with which one may come in contact usually contain many organisms, some of which may cause disease. HIV infection can only be transmitted by blood, semen or vaginal secretions. These are the only vehicles of transmission. There is no well-documented scientific evidence for HIV transmission by any other body fluid . Transmission of HIV occurs when direct blood-to-blood, semen-to-blood or vaginal secretions-to- blood contact. Such contact is more likely if the HIV infected blood, semen or vaginal secretions contact broken skin or mucous membranes. Furthermore, many germs may be carried by persons who have no symptoms of illness.

These individuals may be at various stages of infections: incubating disease, mildly infected without symptoms , or chronic carriers of certain infectious agents including the AIDS and hepatitis viruses.

In fact, transmission of communicable diseases if more likely to occur from contact with the infected body fluids of unrecognized carriers than from contact with fluids from recognized individuals because these simple precautions are not carried out.

What Should Be Done To Avoid Contact With Body Fluids?

When possible, direct skin contact with body fluids should be avoided. Disposable gloves should be available where body fluids can be expected to be routinely encountered . Gloves are recommended when direct hand contact with body fluids is anticipated. Gloves used for this purpose should be put in a plastic bag or lined trash can, secured and disposed of daily.

What Should Be Done if Direct Skin Contact Occurs?

In many instances, unanticipated skin contact with body fluids may occur in situations where gloves may not be immediately available (e.g., when wiping a runny nose, applying pressure to bleeding injury, helping a person in the bathroom).

In these instances, hands and other affected skin areas of all exposed persons should be routinely washed with soap and water after direct contact has ceased.

Clothing and other non-disposable items (e.g., towels used to wipe up body fluid) that are soaked through with body fluids should be rinsed and placed in plastic bags for transport to the laundry. If presoaking is required to remove stains (e.g., blood, feces), use gloves to rinse or soak the item in cold water. Contained disposable items (e.g., tissues, paper towels, diapers) should be handled with disposable gloves.

How Should Spilled Body Fluids Be Removed from the Environment?

Many agencies have standard procedures already in place for removing body fluids (e.g., vomitus). These procedures should be reviewed to determine whether appropriate cleaning and disinfection steps have been included.

Many stock sanitary absorbent agents are specifically intended for cleaning body fluid spills (e.g., ZGOOP, Parsen Manufacturing Company, Philadelphia, PA).

Disposable gloves should be worn when using these agents.

The dry material is applied to the area, left for a few minutes to absorb the fluid, and then vacuumed or swept up.

The vacuum bag or sweepings should be disposed of in a plastic bag.

Broom and dustpan should be rinsed in a disinfectant. No special handling is required for vacuuming equipment.

Hand Washing Procedures

Proper hand washing requires the use of soap and water and vigorous washing under a stream of running water for approximately 10 seconds. Soap suspends easily removable soil and microorganisms allowing them to be washed off. Running water is necessary to carry away dirt and debris.

Rinse under running water. Use paper towels to thoroughly dry hands.

Disinfectants

An intermediate level disinfectant should be used to clean surfaces contaminated with body fluids. Such disinfectant will kill vegetable bacteria, fungi, tubercle bacillus and viruses. The disinfectant should be registered by the U.S. Environmental Protection Agency (EPA) for use as a disinfectant in medical facilities and hospitals.

Various classes of disinfectants are listed below. Hypochlorite solution (bleach) is preferred for objects that may be put in the mouth.

1. Ethyl or isopropyl alcohol (70%)

2. Phenolic germicidal detergent in a 1% aqueous solution (e.g., Lysol*)

3. Sodium Hypochlorite, with at least l00ppm available chlorine (1/2 cup household bleach in 1 gallon of water, needs to be freshly prepared each time it is used)

4. Quaternary ammonium germicidal detergent in 2% aqueous solution (e.g., Tri-quat*, Mytar*, or Sage*)

5. Iodophor germicidal detergent with 500ppm available iodine (e.g., Wescodyne*)

Disinfection of Hard Surfaces and Care of Equipment

After removing spilled body fluids, apply a disinfectant. Mops should be soaked in the disinfectant after use and rinsed thoroughly or washed in a hot water cycle before rinse. Non-disposable cleaning equipment (dust pans, buckets) should be thoroughly rinsed in the disinfectant. The disinfectant solution and rinse water should be promptly disposed down a drain pipe. Disposable cleaning equipment should be placed in a plastic bag. Apply the sanitary absorbent agent, let dry and vacuum. If necessary, mechanically remove the matter with a dust pan and broom, then apply rug shampoo (a germicidal detergent) with a brush and re-vacuum.

Rinse the dust pan and broom in disinfectant. If necessary, wash the brush with soap and water. Dispose of non-reusable cleaning equipment as noted above.

Disinfection of Rugs

If a wet vacuum is used, run½ gallon of a 1:10 dilution of chlorine bleach in water through the machine after use. It is not necessary to dismantle the machine.

Laundry Instructions for Clothing Soiled with Body Fluids

The most important consideration of laundering contaminated clothing is to eliminate potentially infectious agents with soap and water.

Addition of bleach will further reduce the number of potentially infectious agents.

Clothing soaked with body fluids should be washed separately from other items. Presoaking may be required for heavily soiled clothing. Otherwise, wash and dry as usual.

If the material is bleachable, add½ cup household bleach to the wash cycle.

If material is not colorfast, add½ cup non­ chlorine bleach (e.g., Clorox II*, Borateem*) to the wash cycle.

* Brand names are used only as examples of each type of germicidal solution and should not be considered an endorsement of a specific product.

TABLE I

TRANSMISSION CONCERNS OF INFECTIOUS AGENTS BY BODY FLUIDS - SOURCE

BODY FLUID - SOURCE

Blood cuts/abrasions nosebleeds menses contaminated needle

*Feces- incontinence

Respiratory Secretions saliva, nasal discharge

Semen

*Urine

ORGANISM OF CONCERN

Hepatitis B Virus HIV (AIDS) Virus

Cytomegalovirus

Salmonella Bacteria Shigella Bacteria Rotavirus

Hepatitis A Virus Giardia

Mononucleosis Virus Common Cold Virus Influenza Virus

Hepatitis B Virus HIV (AIDS) Virus

Gonorrhea Cytomegalovirus

TRANSMISSION CONCERN

Bloodstream inoculation through cuts and abrasions on hands

Direct bloodstream inoculation

Oral inoculation from contaminated hands

Oral inoculation from contaminated hands

Sexual Contact (intercourse)

Bloodstream and oral inoculation from contaminated hands

*Vomitus Gastrointestinal Viruses, e.g., Norwalk Agent Rotavirus

Oral inoculation from contaminated hands

*Transmission of HIV (AIDS) virus and Hepatitis B virus is not a concern from these sources unless they are visibly contaminated with blood.

Adopted: February 28, 1994