Cleaning Up Blood and Body Fluids
November 11, 2006
Concern over infectious diseases related to pathogens found in blood and body fluids continues to grow on a global basis. Today it is critical to be more cautious when working around blood because of the uncertainties and the exposures, which lead to greater risks.
This feature relates primarily to topical blood spots and spills that generally are confined to a surface area not to exceed 12 to 18 inches in diameter. It does not cover major trauma incidents or catastrophes. Quantities of blood or body fluids exceeding 12 to 18 inches in diameter, or that soak into carpet, pad and sub-flooring require removal as a hazardous medical waste, or more elaborate procedures performed by specially trained professionals.
Uninfected blood is not a health threat, but we rarely know the health status of the person from whom the blood originated. Therefore, it is only prudent to use OSHA's "universal precautions" and treat all blood, wet or dry, as if it were highly infectious.
There is no evidence that hepatitis B virus (HBV), hepatitis C (HCV) or immunodeficiency virus (HIV) have ever been transmitted to humans from a hard floor surface or a soft floor covering such as carpet. Nonetheless, prompt removal and disinfection of an area contaminated by either blood or body fluids is prudent infection-control practice.
The following guidance is based on recommendations from The Centers for Disease Control and Prevention (CDC), OSHA and the public health community for reducing the risk of exposure to blood-borne pathogens during cleaning.
Most direct exposures to blood/body fluids spills do not result in infection. In general, the risk of human infection from such spills is very low. However, risk of infection from direct contact to blood/body fluids is based on many factors, including but not limited to:
- The pathogen involved.
- Type of and duration of exposure.
- The amount of blood/body fluids involved in the exposure.
- The amount of pathogen in the blood/body fluids at the time of exposure.
In commercial or institutional buildings, employers or administrators must have, as part of their safety or "hazard-communication" plan, a procedure for anticipating and reporting blood/body fluid spills and exposure, for evaluating the risk of infection. Accompanying this plan must be a procedure for blood/body fluid cleanup and cleaning-waste disposal.
Whether blood/body fluid cleanup in carpet is undertaken by a professional carpet cleaner or other party, the following steps greatly reduce the risk of infection. All steps must be followed completely and in the order presented for this process to be fully effective.
The CDC and the public health community recommends using "universal precautions" when cleaning up blood/body fluid spills. The concept of "universal precautions" assumes that all individuals are infected with blood-borne pathogens. It is especially important to avoid transfer of these pathogens by splashing contaminated materials into the mucous membranes of the eyes, nose or mouth, or into any cuts, abrasions or open sores. Universal precautions require the use of appropriate personal protective equipment, particularly disposable gloves, face shield, splash goggles or pocket mask, to prevent contact with blood-borne pathogens.
Pathogens are most viable immediately after a blood/body fluid spill. Response to spills must be made as rapidly as possible, and include the following steps:
1. Contain blood/body fluid spills by creating a barrier around the perimeter of the spill with an absorbent compound, such as kitty litter, diatomaceous earth, sand or even salt.
2. Initially, in an effort to kill or deactivate a portion of the viable pathogen population, carefully pre-treat (spray) the affected area with an appropriate detergent such as a mild detergent solution, _-teaspoon dishwashing liquid to one quart of cool water. Allow approximately 10 minutes of dwell time for the disinfectant to work.
3. Blot up treated blood/body fluid spills with paper towels immediately after placing contaminated towels in a plastic bag and sealing it carefully.
4. Extract blood/body fluids from carpet using the following procedure:
a. Initially, extract excess blood/body fluids using well-controlled water flow and wet vacuuming.5. After the initial containment, vacuuming, disinfectant treatment and pre-rinse extraction, affected carpet areas should be completely and thoroughly saturated with an appropriate disinfectant solution. Standard EPA-registered chemical germicides, used according to label directions, can rapidly inactivate most pathogens of concern. Note that some standard germicides can damage carpet dyes or fibers, especially those containing chlorine bleach.
b. b. Next, rinse the carpet by thoroughly wetting the contaminated area with cool water and suctioning it up with a wet-dry vacuum, or a professional or home hot-water extraction carpet-cleaning machine.
c. c. Do not permit fluids to migrate beyond their initial boundaries during the extraction process.
6. To prevent damage to carpet components, one of the following agents is recommended as an effective disinfectant solution:
a. 70 percent alcohol (isopropyl)
b. 3 percent hydrogen peroxide
c. two tablespoons of household ammonia to 2 cups water
7. A dwell time of 10 to 20 minutes is required for the disinfectant to have its full effect on the pre-rinsed carpet.
8. Following disinfectant treatment, the affected carpet area must be saturated a second time with an appropriate detergent (neutral carpet cleaner/shampoo or _-teaspoon dishwashing liquid to 1 quart cool water). Do not use dishwashing liquids containing soil-attracting lanolin or hand lotions.
9. Allow approximately 5 to 10 minutes of dwell time for detergents to work.
10. Thoroughly flush affected carpet areas multiple times with water and extract it with a wet-dry vacuum or hot-water extraction cleaning machine until excess moisture, detergent and residue is removed, and the carpet is no longer saturated.
11. Force-dry damp areas. Use fans that pass air directly over the damp carpet. Dry the carpet within 8 to 12 hours maximum.
12. Thoroughly clean and sanitize all equipment used in cleaning up blood/body fluids before storing them for future use.
Failing to follow the recommended steps in sequence merely dilutes the contaminations, while adding excess moisture that encourages microorganism development and amplification. This may result in future odor and sanitation problems.
Treat all absorbent compounds, towels and extracted wastewater as hazardous medical wasters, following workplace safety guidelines. Place all contaminated solid material in plastic bags, sealing and properly labeling them with a biohazard label, or use red bags. Dispose of the bags as infectious waste in accordance with all applicable OSHA, state and/or provincial safety and health regulations. Dispose of extracted wastewater in a sanitary (treated) sewage system only.
Finally, after removing personal protective equipment and cleaning or disposing of it properly, wash your hands and then wash all exposed skin surfaces thoroughly with soap and water.