When disposing of waste in a clients room the nurse would place which item s in a biohazard red bag?

Cleaning is important for infection control – particularly in work areas – because deposits of dust, soil and microbes on surfaces can transmit infection. Contaminated areas such as operating rooms or isolation rooms must be cleaned after each session, and spot cleaned after each case or thoroughly cleaned as necessary.

The following basic principles should be followed:

• written cleaning protocols should be prepared, including methods and frequency of cleaning; protocols should include policies for the supply of all cleaning and disinfectant products
• standard precautions (including wearing of personal protective equipment [PPE], as applicable) should be implemented when cleaning surfaces and facilities (see ‘Standard and additional precautions’)
• cleaning methods should avoid generation of aerosols
• all cleaning items should be changed after each use and cleaned and dried before being used again. They should also be changed immediately following the cleaning of blood or body fluid/substance spills. Single-use cleaning items are preferred, where possible, such as lint-free cleaning cloths
• sprays should not be used, because they can become contaminated and are difficult to clean. Sprays are not effective, as they do not touch all parts of the surface to be cleaned
• detergents should not be mixed with other chemicals
• all cleaning solutions should be prepared fresh before use.

Cleaning – specific procedures

Surface cleaning

Floors in hospitals and day-care facilities should be cleaned daily or, as necessary, with a vacuum cleaner fitted with a particulate-retaining filter. The filter should be changed in accordance with the manufacturer’s instructions.

The exhaust air should be directed away from the floor to avoid dust dispersal.

A ducted vacuum cleaning system can also be used, as long as safe venting of the exhaust air is ensured.

Damp dusting using a lint-free cloth is essential. Brooms disperse dust and bacteria into the air, and should not be used in patient or clinical areas. Dust-retaining mops, which are specially treated or manufactured to attract and retain dust particles, do not increase airborne counts as much as ordinary brooms and remove more dust from surfaces. However, brooms and dust-retaining mops should not be used in clinical areas where there is a high risk of infection associated with dust (for example, burns units).

The procedure for routine surface cleaning is as follows:

• All cleaning solutions should be prepared immediately before use.
• Work surfaces should be cleaned (wiped over) with a neutral detergent and warm water solution, rinsed and dried before and after each session, or when visibly soiled. Spills should be cleaned up as soon as practical.
• When a disinfectant is required for surface cleaning, the manufacturer’s recommendations for use, and workplace health and safety instructions should be followed.
• Buckets should be emptied after use, washed with detergent and warm water, rinsed in hot water and stored dry (turned upside down).
• Mops should be laundered or cleaned in detergent and warm water, rinsed in hot water, then stored dry. Mop heads should be detachable or stored with the mop head up.

Specialised areas

Isolation rooms and ensuite bathrooms should be cleaned at least twice daily, depending on the type of microorganism.

Operating rooms and day procedure rooms, including endoscopy rooms, should be cleaned after each operating session and when visibly soiled. Thorough cleaning of the operating suite should be performed daily in addition to the cleaning performed after each operating session.

Obstetric areas, particularly delivery suites, should be cleaned after each delivery, when visibly soiled and at least daily.

Oncology areas should be cleaned twice daily.

Sterilising processing departments should be cleaned at least twice daily and when visibly soiled.

Wet areas

The following should be cleaned at least daily and more frequently as required:

• toilets, sinks, washbasins, baths and shower cubicles
• all fittings attached to showers, baths and handbasins
• surrounding floor and wall areas.

Walls and fittings

Walls and screens should be cleaned quarterly or if visibly soiled.

Blinds and curtains should be cleaned quarterly or if visibly soiled.

Carpets should be vacuumed daily and other floor surfaces washed daily and when soiled.

Bed and examination screens should be changed weekly and when visibly soiled.

Cleaning Creutzfeldt-Jakob disease infectious agents

Spills of central nervous system tissue or cerebrospinal fluid should be absorbed with paper towels and disposed of by incineration. The surface should then be soaked with one molar sodium hydroxide or 2.0–2.5 per cent sodium hypochlorite, left for 1 hour and cleaned again with paper towels that are disposed of by incineration.

Cleaning other infectious disease agents

Spills of blood or other body fluids and tissues should be cleaned using standard spills management procedures. PPE used when cleaning contaminated surfaces should be incinerated after use. Reusable eye protection should be cleaned as above.

Maintenance of cleaning equipment

Cleaning items (including solutions, water, buckets, cleaning cloths and mop heads) should be changed after each use. They should also be changed immediately following the cleaning of blood or body substance spills.

These items should be washed in detergent and warm water, rinsed and stored dry between uses. Mops with detachable heads should be laundered between uses.

Spills of laboratory cultures of human pathogens

Spills of laboratory cultures should be absorbed with paper towels and disposed of as clinical waste. The contaminated surfaces should be treated with 2.0–2.5 per cent sodium hypochlorite, left for 1 hour and cleaned again with paper towels that are disposed of as clinical waste.

Laboratories should also refer to AS/NZS 2243.3:2002: Safety in laboratories – microbiological aspects and containment facilities.

Waste disposal

All healthcare facilities should have policies and procedures in place for the correct management of all waste generated. The Environmental Protection Authority (EPA) has clear guidelines on how waste should be managed. The National Health and Medical Research Council (NHMRC) also has guidelines on the management of waste generated in healthcare facilities.

Waste is classified into three main groups of waste:

• general
• clinical
• pharmaceutical.

All waste should be stored in secure areas until collected. Waste disposal companies licensed with the EPA will collect all clinical and pharmaceutical waste for disposal in specialised waste disposal facilities, which are also licensed by the EPA.

Waste should be removed from clinical areas at least three times each day and more frequently as needed, such as from specialised areas. Waste bags should be tied before removing from the area.

General waste disposal

Place in general waste bin for removal.

Clinical waste disposal

Place in biohazard bags as soon as possible. Biohazard bags have a biohazard symbol and are currently coloured yellow.

Single-use sharps should be placed (by the user) into a sharps container that meets the Australian and New Zealand Standards AS 4031:1992 and AS/NZS 4261:1994.

Pharmaceutical waste disposal

When uncertain about how to dispose of leftover pharmaceuticals, they should be returned to pharmacy for correct disposal.

Most disinfectants can be disposed of through the sewer system by running cold water into the sink before pouring the disinfectant into the sink. Leaving the cold water running for a few moments after the disinfectant has been disposed of dilutes the disinfectant.

In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of handling hazardous and infectious materials in order to:

• Identify biohazardous, flammable and infectious materials
• Follow procedures for handling biohazardous materials
• Demonstrate the safe handling techniques to staff and client
• Ensure safe implementation of internal radiation therapy

Hazardous materials are defined as those things that are not biological but still remain hazardous to human beings including patients and staff. Examples of hazardous materials are chemicals and radiation.

The US Occupational Safety and Health Administration mandates that information about all hazardous materials is readily accessible to workers including those who work in the health care environment. Information about hazardous materials is found on Material Safety Data Sheets which are published and distributed to the users of their products to fulfill the mandates of OSHA and to protect workers.

Material Safety Data Sheets (MSDS) include the name of the product, information about the product's risks, measures, such as washing the skin, that must be taken when a person has been exposed to some risk relating to the product and information about the procedures for using, handling, disposing of and storing the particular product.

Biohazardous waste is defined as biological waste that can be hazardous to humans. Items such as sharps and bed linens that are contaminated with blood or other bodily fluids, such as feces, are considered biohazardous medical waste.

The careful handling and disposal of all hazardous materials protects staff, clients, and visitors from harm.

Biohazardous materials are heavily regulated at the national, state and local levels. All health care facilities, therefore, are legally mandated to have complete and appropriate policies and procedures relating to the labelling, storage, use and disposal of biohazardous, or biomedical, materials.

Biohazardous materials place clients, staff and visitors at risk for exposures to bloodborne pathogens and pathogens transmitted with bodily fluids.

Flammable and Combustible Materials

Examples of some of the flammable and combustible materials that are commonly used within health care settings and facilities are medical gases, such as oxygen and nitrous oxide, flammable and combustible liquids such as those contained in some cleaning fluids and aerosol cans.

Following Procedures for Handling Biohazardous Materials

Biohazardous materials threats can be decreased and eliminated with a combination of administrative controls, work related controls and engineering controls.

Established policies and procedures are examples of administrative controls to decrease the dangers associated with biohazardous materials risk; the utilization of proper and safe practices such as handwashing is an example of a work related control that decreases the threats associated with biohazardous materials; and engineering controls aim to decrease the dangers associated with biohazardous materials and these controls include such things like the selection of and placement of impervious red containers in all client rooms to collect disposable, contaminated sharps.

Some of the other preventive measures relating to biohazardous exposures include:

• The use of single patient disposal supplies and equipment such as a disposable, single use blood pressure cuffs
• Needleless systems
• Proper handwashing
• Standard and special transmission precautions
• Red biohazardous waste containers and bags
• The use of personal protective equipment
• The use of a neutral zone in surgical areas and other areas where invasive procedures are done
• The safe disposal of sharps not only in health care facilities but also in the client's home and their community

The U.S. Environmental Protection Agency mandates the safe disposal of needles, syringes and other sharps in all areas of the community, in addition to their proper and safe disposal by health care facilities.

The proper and safe disposal of biohazardous material in the community includes:

• Community Drop Boxes and Supervised Collection Sites: The client can dispose of used needles in many doctors' offices, hospitals, pharmacies, health departments, and fire stations.

• At-Home Needle Destruction Devices: At home needle destruction devices destroy used needles and, as such, make them safe for household disposal. Clients in the home should be instructed to contact their solid waste disposal company for specific local information and resources relating to sharps disposal.

• Syringe Exchange Programs: Sharps users can also safely exchange used needles for new needles by contacting the North American Syringe Exchange Network at (253) 272-4857 for no cost. The site is www.nasen.org

• Mail-Back Programs: Sharps can also be disposed of by mailing them in a special container to a collection center for a fee.

Following Procedures for Handling Flammable and Combustible Materials

Flammable and combustible medical gases can be stored in individual canisters or provided to the client care area with a centralized medical gas delivery system. Emergency shut off valves are mandated for centralized medical gas delivery system in the case of an emergency.

Medical gas containers must be designed, constructed, and labeled according to OSHA regulations. The following color labels are used for the following gas canisters.

• White: The international color for oxygen
• Yellow: Air
• Green: Oxygen
• Light Blue: Nitrous oxide
• Red: Ethylene
• Orange: Cyclopropane
• Brown: Helium
• Brown and Green: Helium and oxygen
• Gray: Carbon dioxide
• Gray and Green: Carbon dioxide and oxygen

Oxygen Safety

Oxygen safety in the health care setting and within the home environment includes the use of a "No Smoking" signs, avoiding all synthetic fibers and fabrics near the oxygen because fabrics and fibers other than cotton can create static electricity, and not using any flammable liquids like acetone near the oxygen source.

In the health care facility and also within the home oxygen canisters must be safely secured and transported.

Educating and Demonstrating Safe Handling Techniques to Staff and Clients

The registered nurse, as an educator, must assess the learning needs of clients and staff members in terms of their ability and competency related to the safe handling and management of biohazardous materials and materials that are flammable or combustible.

For example, clients and staff should have a thorough understanding of and knowledge about types of things that are considered biohazardous and they should also demonstrate the proper, safe and correct techniques related to the correct handling and disposal of sharps and other biohazardous waste.

Ensuring the Safe Implementation of Internal and External Radiation Therapy

Radiation therapy can be broadly categorized as external and internal radiation therapy.

Radiation safety is based on the three safety principles of time, distance and shielding. In other words, the risk of exposure to internal and external radiation can be decreased when the nurse, and other health care personnel such as an X ray technician, minimize and decrease the amount of time that they are exposed to and in close proximity with radiation; they must also maximize the distance between themselves and the source of the radiation, and, they must also shield themselves from the radiation using things like a lead apron and gloves when they are near the source of radiation.

The risk for exposures to radiation decreases when the duration of the time exposed to the radiation is decreased and when the distance from the radiation and the shielding is maximized.

External ionizing radiation is used for diagnostic testing and also for therapeutic care. For example, a chest x ray uses radiation for diagnosis and therapeutic external radiation, sometimes referred to as teletherapy, is done by using a linear accelerator that delivers electron and gamma ionizing radiation for a minute or so to treat and reduce the size of a tumor.

Therapeutic internal radiation, which is also referred to as brachytherapy, internal radiation, interstitial radiation and intracavity radiation, is a therapeutic procedure that entails the internal placement of some radioactive material into or near the client's tumor. Therapeutic internal radiation entails the delivery of high doses of radiation using a needle, wire or radioactive seed.

Brachytherapy is most often delivered to clients who are affected with tumor and cancer of the prostate, lungs, esophagus, cervix, endometrium, rectum, breast, head and neck.

Special radiation precautions are initiated when a client is receiving brachytherapy in order to protect visitors and health care staff from the harmful effects of the radiation. Some of these special internal radiation precautions include:

• The minimization of the duration of time that health care providers are in the client's room to deliver care and services to the client

• The placement of the client receiving internal radiation in a private room

• The prohibition of the client's activities outside of their room

• The initiation of complete bed rest for the client until the treatment is discontinued

• The provision of education to the family members and other visitors that includes information about their need to limit the time of their visits to at least less than 1 hour, to stay at least 6 feet away from the client and to not enter the room if a visitor or family member is pregnant.

• The need for health care staff to minimize the amount of time spent in the room, to decline to enter the room if they are pregnant, to retain all supplies and equipment including things like bed linens in the client's room until they are deemed safe for disposal by a person who is competent to make this decision, and how and when to report concerns about the client's treatment such as when implanted seeds inadvertently leave the client's body.

RELATED CONTENT:

SEE - Safety & Infection Control Practice Test Questions

Alene Burke RN, MSN is a nationally recognized nursing educator. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. She got her bachelor’s of science in nursing with Excelsior College, a part of the New York State University and immediately upon graduation she began graduate school at Adelphi University on Long Island, New York. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Association’s task force on competency and education for the nursing team members.

Latest posts by Alene Burke, RN, MSN (see all)