The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [112]
Sharps bins in use should be positioned at a height that enables safe disposal by all members of staff and secured to avoid spillage.
Wear gloves in any situation where contact with blood is anticipated.
Avoid wearing open footwear in any situation where blood may be spilt or where sharps are used.
Always cover any cuts or abrasions, particularly on the hands, with a waterproof dressing while at work. Wear gloves if hands are particularly affected.
Wear facial protection consisting of a mask and goggles or a face shield in any situation that may lead to a splash of blood or other high-risk fluid to the face. Do not rely on prescription glasses – they may not provide sufficient protection.
Clear up any blood spillage promptly and disinfect the area. Use any materials or spillage management packs specifically provided for this purpose in accordance with the manufacturer’s instructions.
(UK Health Departments 1998)
Complications
In the event of an inoculation injury occurring, prompt and appropriate action will reduce the risk of subsequent infection. These actions are described in Box 3.3 and should be taken regardless of what is thought to be known about the status of the patient whose blood has been inoculated. HIV, for example, has a 3-month ‘window’ following infection during which the patient has sufficient virus in their blood to be infectious but before their immune system is producing sufficient antibodies to be detected by the normal tests for HIV status.
Box 3.3 Actions to take in the event of inoculation injury
Encourage any wound to bleed to wash out any foreign material that has been introduced. Do not squeeze the wound, as this may force any virus present into the tissues.
Wash any wound with soap and water. Wash out splashes to mucous membranes (eyes or mouth) with large amounts of clean water.
Cover any wound with a waterproof dressing to prevent entry of any other foreign material.
Ensure the patient is safe then report the injury as quickly as possible to your immediate line manager and occupational health department. This is because postexposure prophylaxis (PEP), which is medication given after any incident thought to carry a high risk of HIV transmission, is more effective the sooner after the incident it is commenced (DH 2008).
Follow any instructions given by the occupational health department.
Co-operate with any action to test yourself or the patient for infection with a bloodborne virus but do not obtain blood or consent for testing from the patient yourself; this should be done by someone not involved in the incident.
Complete a report of the incident according to local protocols.
(UK Health Departments 1998)
Management of waste in the healthcare environment
Definition
Waste is defined as ‘any substance or object the holder discards, intends to discard or is required to discard’ (European Parliament 2008).
Evidence-based approaches
Rationale
Waste material produced in the healthcare environment may carry a risk of infection to people who are not directly involved in providing healthcare but who are involved in the transport or disposal of that waste. All waste disposal is subject to regulation and hazardous waste is subject to further controls, depending on the nature of the hazard (DH 2006a). To ensure that everyone involved in waste management is aware of, and protected from, any hazard presented by the waste with which they are dealing, and that the waste is disposed of appropriately, a colour coding system is used. The colours in general use are shown in Table 3.6.
Table 3.6 Waste colours code
Waste receptacles are plastic bags or rigid plastic containers of the appropriate colour (see Table 3.7).
Table 3.7 Waste containers
Legal and professional issues
The producer of hazardous waste is legally responsible for that waste, and remains responsible for it until its final disposal by incineration, alternative treatment or landfill (DH 2006a). In order to track waste to its point of origin, for example if it is necessary to identify where