UINTAH SCHOOL DISTRICT POLICY ACTION REVIEW

 

1st Reading           

1/11/00

New

X

2nd Reading

1/25/00

Revised

 

Approved

1/25/00

Substitute

 

 

007.0715         GUIDELINES FOR HANDLING BODY FLUIDS IN SCHOOL

 

NEW POLICY

 

1.0              CONCERNS

1.1              The following guidelines are meant to provide effective precautions against transmission of disease for all persons 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.

 

2.0              DOES CONTACT WITH BODY FLUIDS PRESENT A RISK

2.1              The body fluids of all persons should be considered potentially infectious.  The term “body fluids” includes: blood, semen, tears, drainage from scrapes and cuts, feces, urine, vomitus, respiratory secretions (e.g., nasal discharge) and saliva.  Contact with body fluids presents a risk of infection with a variety of germs; however, the risk is very low and dependent on a variety of factors including the type of contact made with the body fluid.

2.2              Table 1 below provides examples of particular organisms 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, organisms 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 HIV 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 taken.

 

3.0              TABLE

 

TRANSMISSION CONCERNS IN THE SCHOOL SETTING

BODY FLUID SOURCE OF INFECTIOUS AGENTS

 

BODY FLUID-SOURCE

ORGANISM OF

CONCERN

TRANSMISSION CONCERN

Blood

-          cuts/abrasions

-          nosebleeds

-          menses

-          contaminated needles

Hepatitis B Virus

HIV

Cytomegalovirus

HCV

Blood stream inoculation through cuts and abrasions on hands.

 

Direct blood stream inoculation.

Feces*

-          incontinence

Salmonella bacteria

Shingella bacteria

Rotavirus

Hepatitis A virus

Oral inoculation from hands

Urine*

-          incontinence

Cytomegalovirus

Bloodstream and oral inoculation from contaminated hands

Respiratory secretions

-          saliva

-          nasal discharge

Mononucleosis virus

Common cold virus

Influenza virus

Oral inoculation from contaminated hands

Vomitus*

Gastrointestinal viruses (e.g. Norwalk agent

Rotavirus)

Oral inoculation from contaminated hands

Semen

Hepatitis B

HIV

Gonorrhea

Sexual contact (intercourse)

 

*Possible transmission of HIV and Hepatitis B and C is of little concern from these sources.

 

 

4.0              WHAT SHOULD BE DONE TO AVOID CONTACT WITH BODY FLUIDS?

4.1              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 (i.e., treating bloody noses, handling clothes soiled with incontinence, cleaning small spills by hand).  If contact is made with body fluids, hands should be washed afterwards with soap and water.  Gloves used for this purpose should be put in a plastic bag or lined trashcan, secured, and disposed of daily.

 

5.0              WHAT SHOULD BE DONE IF DIRECT SKIN CONTACT OCCURS?

5.1              In many instances, unanticipated skin contact with body fluids may occur in situations where gloves may be immediately unavailable (e.g., when wiping a runny 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 persons should be routinely washed with soap and water after direct contact has ceased.  Clothing and other non-disposable items (e.g., towels used to wipe up body fluid) that are soaked through with body fluids should be rinsed and placed in plastic bags.  If presoaking is required to remove stains (e.g., blood, feces), used items (e.g., tissues, paper towels, diapers) should be handled with disposable gloves.  Preferably, these items should be bagged immediately rather than an attempt made to clean them and if items belong to student they should be sent home with him/her.

 

6.0              HOW SHOULD SPILLED BODY FLUIDS BE REMOVED FROM THE ENVIRONMENT?

6.1              Most schools have standard procedures already in place for removing body fluids (e.g., vomitus).  These procedures should be reviewed to determine whether appropriate cleaning and disinfectant steps have been included.  Disposable utility 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, and 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 only EPA approved solution or a ratio of 1 to 10 fresh bleach solution disinfectant.  No special handling is required for vacuuming equipment.

 

7.0              HAND WASHING PROCEDURES

7.1              Proper hand washing requires the use of soap and water and vigorous washing under a steam of running water for approximately 10 seconds.  Use paper towels to thoroughly dry hands.

 

8.0              DISINFECTANTS

8.1              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.

8.2              Various classes of disinfectants are listed below: Hypochlorite solution (bleach) is preferred for objects that may be put in the mouth.

·         Ethyl or isopropyl alcohol (70%);

·         Phenolic germicidal detergent in a 1% aqueous solution (e.g., Lysol*);

·         Sodium Hypochlorite with at least 100 ppm available chlorine (1/2 cup household bleach in 1 gallon water, needs to be freshly prepared daily);

·         Quaternary ammonium germicidal detergent in 2% aqueous solution (e.g., Triquat*, Mytar* or Sage*);

·         Brand names used only for examples of each type of germicidal solution and should not be considered an endorsement of a special product.

 

9.0              DISINFECTIONS OF HARD SURFACES AND CARE OF EQUIPMENT

9.1              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 (dustpans, buckets) should be thoroughly rinsed in the disinfectant.  The disinfectant solution should be promptly disposed of down a drainpipe.  Remove gloves and discard in appropriate receptacles.

 

10.0          DISINFECTIONS OF RUGS

10.1          Apply sanitary absorbent agent, let dry and vacuum.  If necessary, mechanically remove with dustpan and broom, then apply rug shampoo (a germicidal detergent) with a brush and re-vacuum.  Rinse dustpan and broom in disinfectant.  If necessary, wash brush with soap and water.  Dispose of non-reusable cleaning equipment as noted above.

 

11.0          LAUNDRY INSTRUCTIONS FOR CLOTHING SOILED WITH BODY FLUIDS

11.1          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.  Presoaking may be required for heavily soiled clothing.  Otherwise, wash and dry as usual.  If the material is bleachable, add ˝ cup household bleach to the wash cycle.  If material is not colorfast, add ˝ cup non-chlorine bleach (e.g., Clorox II, Borateem) to the wash cycle.

 

Special Note:  Guidelines for handling body fluids in schools was prepared by Elaine Brainer, M.S., R.N., State Department of Education in consultation with Hames Hadler, M.D., MPH Chief, Epidemiology Section, Patricia Checko, MPH Epidemiology Program, and William Sabella, AIDS Coordinator, Connecticut State Department of Health Services.