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Infection Control: Sharps, Waste Management, and Cleaning Protocols

Needlestick and Sharps Injuries

Any needlestick or sharps injury must be reported immediately. This is crucial due to the potential exposure to bloodborne pathogens such as Human Immunodeficiency Virus (HIV) or Hepatitis. Upon reporting, individuals will typically be sent home or to a lab for immediate blood work to assess for potential infection. Sharps must always be disposed of in designated containers that are tightly packed and puncture-proof.

Waste Management Protocols

Proper waste management is essential, especially when dealing with individuals on precautions. Staff handling waste from such individuals must wear personal protective equipment (PPE) like gowns and gloves to prevent carrying or transmitting infections.

General Waste

This category includes everyday garbage and recyclable materials. It is disposed of through normal channels.

Radioactive Waste

Radioactive waste originates from sources that can cause direct radiation exposure. Examples include materials from chemotherapy treatments or diagnostic procedures like X-rays. During X-rays, precautions are taken to shield patients (e.g., around the stomach for pregnant individuals) and staff (e.g., standing behind a protective wall) from radiation. Any waste from these areas or treatments involving radioactive rays or substances is considered radioactive. Proper disposal involves closing the garbage bag securely before removing it from the patient's room.

Cytotoxic (Chemotherapy) Waste

Waste from individuals receiving chemotherapy or cytotoxic medications requires special handling. This often involves a stringent policy for disposal, which may include:

  • Double gloving: Staff should wear nitrile gloves.
  • Double bagging: After tying off the first garbage bag, staff should remove their gloves, put on a new pair, and then place the first bag into a second garbage bag. This ensures the outer layer remains clean, protecting subsequent handlers. These bags typically feature a clear biohazardous symbol.

Biohazardous Waste

Biohazardous waste includes blood and any bodily fluids, secretions, or excretions that come from inside the body. These materials should always be marked with a biohazardous symbol. Double bagging is not always necessary unless the exterior of the first bag is visibly contaminated. Transport procedures for persons on transmission-based precautions often vary by employer but are designed to protect staff from infection by keeping this waste separate from general garbage.

Principles of Cleaning and Disinfection

Effective infection control involves a hierarchy of methods: cleaning, disinfection, and sterilization.

Cleaning

Cleaning is the basic process of washing or wiping surfaces and equipment. This might involve using a disinfectant solution, wipe, sanitizer, or spray. While cleaning can kill some microbes, it may not eliminate all stains or spores. For example, a blood pressure cuff and stethoscope should be cleaned with a wipe after each use.

Disinfection

Disinfection aims to destroy all pathogens, but it does not eliminate spores or eggs. Common disinfectants include germicides, CaviWipes, and stronger solutions specifically designed to kill pathogens like COVID-19 and HIV germs. These solutions can be in liquid or wipe form. It's important to note that disinfectants like CaviWipes are generally not used on skin; alcohol swabs or other antiseptics are preferred for skin. Germs are ubiquitous, found on surfaces, tables, human beings, paper, laptops, iPads, and other objects. Disinfectants can be applied through spraying or wiping. Spores and eggs can persist after disinfection and proliferate if they encounter a favorable environment (e.g., warmth and moisture).

Sterilization

Sterilization is the most rigorous process, designed to kill all microorganisms, including non-pathogens, pathogens, spores, and eggs. This is typically achieved using very high temperatures (e.g., in autoclaves) or highly potent chemical solutions within healthcare facilities. For instance, instruments like forceps used in procedures such as Pap smears are first washed with soap and water, then sterilized in an autoclave or by soaking in a strong solution for a specified duration (e.g., 2 to 4 hours), depending on the solution's strength and the equipment used.

Practical Application and Best Practices

It is crucial to clean equipment between uses for different residents. For example, a floor lift must be cleaned with a disinfectant wipe (e.g., CaviWipe) after each patient. Despite what some colleagues may suggest, it is imperative to clean high-touch areas where hands or gloved hands may come into contact during patient care (e.g., pressing buttons, lifting clients). Neglecting to clean these areas poses a significant risk of cross-contamination.