FILE: GAMFB


GUIDELINES FOR HANDLING BODY FLUIDS IN SCHOOL

The body fluids of all persons should be considered to contain potentially infectious agents (germs). The term "body fluids" includes: blood, semen, 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. 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.

The following table provides examples of particular germs that may occur in body fluids of children and the respective transmission concerns. 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 precautions are not always carried out.

TRANSMISSION CONCERNS IN THE SCHOOL SETTING

BODY FLUID SOURCE OF INFECTIOUS AGENTS

BODY FLUID SOURCE ORGANISM OF CONCERN TRANSMISSION CONCERN

Blood Hepatitis B virus Bloodstream inoculation

-cuts/abrasions AIDS virus through cuts and

-nosebleeds Cytomegalo virus abrasions on hands

* Feces Salmonella bacteria Oral inoculation from

-incontinence Shigella bacteria contaminated hands

Rotavirus

Hepatitis A virus

* Urine Cytomegalovirus Bloodstream and oral

-incontinence inoculation from

contaminated hands

Respiratory Mononucleosis Oral inoculation from

Secretions Common cold virus contaminated hands

-saliva Influenza virus

-nasal discharge

Hepatitis B virus Bloodstream

inoculation through cuts and abrasions on hands; bites

* Vomitus Gastrointestinal Oral inoculation from viruses, e.g., contaminated hands

(Norwalk agent Rotavirus)

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.

A. CONTACT WITH BODY FLUIDS

When possible, direct skin contact with body fluids should be avoided. Disposable gloves should at least be available in the office of the custodians, nurses, or principal. It is recommended that gloves be available in every classroom, and convenient to teachers on playground duty. Gloves are recommended when direct hand contact with body fluids is anticipated (e.g., treating bloody noses, handling clothes soiled by incontinence, cleaning small spills by hand). Gloves used for this purpose should be put in a plastic bag, and sprayed with a solution of 1 part bleach to 10 parts water, mixed fresh, and disposed in a lined trash can, secured, and disposed of daily.

B. DIRECT SKIN CONTACT

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 disinfectant soap and water for a full three (3) minutes 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), 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 (e.g., tissues, paper towels, diapers), should be handled as with disposable gloves.

C. REMOVING SPILLED BODY FLUIDS FROM THE ENVIRONMENT

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 disinfection steps have been included. Many schools stock sanitary, absorbent agents specifically intended for cleaning body fluid 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, 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 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 one minute.

Soap suspends easily removable soil and microorganisms allowing them to be washed off. Running water is necessary to carry away dirt and debris. Rinse under running water. Use paper towels to thoroughly dry hands.

Should an ungloved person have any contact with bodily fluids, the person having contact should wash his/her hands for a full three (3) minutes using disinfectant soap and water.

E. DISINFECTANTS

An intermediate level disinfectant should be used to clean surfaces contaminated with body fluids. Such disinfectants will kill vegetative bacteria, fungi, tuberculosis 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. Hypochlorite 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 per cent aqueous solution (e.g., Lysol*)

3. Sodium Hypochlorite with at least 100 ppm available chlorine ( cup household bleach in 1 gallon water, needs to be freshly prepared each time it is used)

4. Quaternary ammonium germicidal detergent in 2 per cent aqueous solution (e.g., Tri-quat*, Mytar* or Sage*)

5. Iodophor germicidal detergent with 500 ppm available iodine (e.g., Wescodyne*)

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

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 dust pan and broom in disinfectant. If necessary, wash brush with soap and water. Dispose of nonreusable cleaning equipment as noted above.

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. 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 the material is not colorfast, add cup of non-hypochlorite solution to the wash cycle.

Ref: Information and Guidelines: Prevention of Disease Transmission in Schools, Acquired Immune Deficiency Syndrome (AIDS). State of Connecticut, Department of Education and Department of Health Services, March 1985; Bulletin 741, Louisiana Handbook for School Administrators.