CODE: 5141.2R
SECTION: PUPILS
PROCEDURES ON HANDLING BODY FLUIDS IN SCHOOL FOR THE PREVENTION AND CONTROL OF COMMUNICABLE DISEASE
The following guidelines are meant to provide simple and effective precautions against transmission of disease for all persons, including pregnant women, potentially exposed to the blood or body fluids of any student. No distinction is made between body fluids from students with a known disease or those from students without symptoms or with an undiagnosed disease.
The body fluids of all persons should be considered to contain potentially infectious agents. The term "body fluids" includes blood, semen, drainage from scrapes and cuts, feces, urine, vomitus, respiratory secretions (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 (see page 4) provides examples of particular germs that may occur in body fluids of children and the respective transmission concerns. It must be emphasized that, with the exception of blood, which is normally sterile, the body fluids with which one may come in contact usually contain many organisms, some of which may cause disease. Furthermore, many germs may be carried by individuals who have no symptoms of illness. These individuals may be at various stages of infection: 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 is more likely to occur from contact with infected body fluids of unrecognized carriers than from contact with fluids from recognized individuals because simple precautions are not always carried out.
A. 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 in at least the office of the custodian, nurse, or principal. Gloves are recommended when direct hand contact with body fluids is anticipated (treating bloody noses, handling clothes soiled by incontinence, cleaning small spills by hand). If extensive contact is made with body fluids, hands should be washed afterwards. Gloves used for this purpose should be put in a plastic bag or lined trash can, secured, and disposed of daily.
B. 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 be immediately unavailable (when wiping a bloody nose, applying pressure to a bleeding injury outside the classroom, helping a child in the bathroom). In these instances, hands and other affected skin areas of all exposed should be routinely washed with soap and water after direct contact has ceased. Clothing and other undisposable items (towels used to wide up body fluids) that are soaked through with body fluids should be rinsed and placed in plastic bags. If pre-soaking is required to remove stains (blood, feces), use gloves to rinse or soak the item in cold water prior to bagging. Clothing should be sent home for washing with appropriate directions to parents/teachers. Contaminated disposable items (tissues, paper towels, diapers) should be handled as with disposable gloves.
C. How should spilled body fluids be removed from the environment?
Use standard procedures already in place for removing body fluids (vomitus) by using sanitary absorbent agents specifically intended for cleaning body fluids spills. 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, 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.
D. Hand washing Procedures
Proper Hand washing requires the use of soap and water and vigorous washing under a stream of running water for approximately l0 seconds.
Soap suspends easily removable soil and microorganisms allowing them to carry away dirt and debris. Rinse under running water. Use paper towels to thoroughly dry hands and turn off faucet.
E. Disinfectants
An intermediate level disinfectant should be used to clean surfaces contaminated with body fluids. Such disinfectants will kill vegetative 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. Hypochloride 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 (Ex.Lysol).
3. Sodium hypochlorite with at least 100 ppm 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 a 2% aqueous solution (Ex. Tri-quat, Mytar, or Sage).
5. Iodphor germicidal detergent with 500 ppm available iodine (Ex. Wescodyne).
(Brand names are used only for examples of each type of germicidal solution and should not be considered the only product available.)
F. Disinfection of Hard Surfaces and Care of Equipment
After removing the soil, a disinfectant is applied. Mops should be soaked in the disinfectant after use and rinsed thoroughly or washed in a hot water cycle before rinse. Disposable cleaning equipment and water should be placed in a toilet or plastic bag as appropriate. Non-disposable cleaning equipment (dust pans, buckets)
should be thoroughly rinsed in the disinfectant. The disinfectant solution should be promptly disposed down a drain pipe. Remove gloves and discard in appropriate receptacles.
G. Disinfection of Rugs
Apply sanitary absorbent agent, let dry, and vacuum. If necessary, mechanically remove with a dust pan and broom, then apply rug shampoo (a germicidal detergent) with a brush and re-vacuum. Rinse dust pan and broom in disinfectant. If necessary, wash brush with soap and water. Dispose of non-reusable cleaning equipment as noted previously.
H. Laundry Instructions for Clothing Soiled with Body Fluids
The most important factor in laundering clothing contaminated in the school setting is elimination of potentially infectious agents by 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. Pre-soaking may be required for heavily soiled clothing. Otherwise, wash and dry as usual. If the material is bleachable, add ½ cup household bleach to the wash cycle. If material is not colorfast, add ½ cup non-clorox bleach (Clorox II, Borateem) to the wash cycle.
TABLE 1
TRANSMISSION CONCERNS IN THE SCHOOL SETTING
BODY FLUID SOURCE OF INFECTIOUS AGENTS
BODY FLUID-SOURCE ORGANISM OF CONCERN TRANSMISSION CONCERN
Blood
Cuts/abrasions
Hepatitis
B virus
Blood
stream inoculation
Nosebleeds
AIDS
Virus
through
cuts and abrasions
Menses
Cytomegalovirus
on
hands
Contaminated needle
*Feces
Incontinence
Salmonella
bacteria
Oral
inoculation from
Shigella
bacteria
contaminated
hands
Rotavirus
Hepatitis
A virus
*Urine
Incontinence
Cytomegalovirus
Bloodstream
and oral
inoculation
from
contaminated
hands
Respiratory Secretions
Saliva
Mononucleosis
virus
Oral
inoculation from
Nasal discharge
Common
cold virus
contaminated
hands
Influenza
virus
AIDS
virus
Bloodstream
inoculation
Hepatitis
B virus
through
cuts and abrasions
on
hands; bites
*Vomitus
Gastrointestinal
Oral
inoculation from
viruses,
e.g.,
contaminated
hands
(Norwalk
agent Rotavirus)
TABLE 1
TRANSMISSION CONCERNS IN THE SCHOOL SETTING
BODY FLUID SOURCE OF INFECTIOUS AGENTS
BODY FLUID-SOURCE ORGANISM OF CONCERN TRANSMISSION CONCERN
Semen
Hepatitis
B
Sexual
contact
AIDS
virus
(intercourse)
Gonorrhea
*Possible transmission of AIDS and Hepatitis B is of little concern from these sources. There is no evidence at this time to suggest that the AIDS virus is present in these fluids.
First Reading: December 12, 2000
Adopted: December 19, 2000