- Care providers should have a policy on how to clean all areas of the environment, fixtures and fittings that includes what to do and what products to use if there is a spillage of blood or body fluids.
- Spillages of blood must be decontaminated with an appropriate disinfectant.
- All spillages should be treated as potentially infectious and appropriate precautions should be taken.
- Providers should have regard to the Health and Social Care Act 2008: code of practice for health and adult social care on the prevention and control of infections and related guidance.
- Staff should be trained in managing blood and body fluid spills and splashes, including the use of chlorine-releasing agents.
With the publication of the revised infection control code of practice in 2015, it is even more important to ensure your procedures for managing body fluid spillages are effective.
In a care home or domiciliary care setting, spillages of body fluids, such as blood, faeces, vomit and urine, are not only un-sanitary but can also present an infection risk. All such substances may contain micro-organisms that can spread disease.
To minimise risk and comply with health and safety law, regulatory requirements and infection control guidance, effective cleaning and decontamination procedures and policies must therefore be in place.
Appropriate risk assessments should be carried out in all care services to identify any risks from spillage hazards.
Body fluids, such as blood, faeces, vomit and urine, constitute substances hazardous to health. As such, the risks from them must be assessed and controlled in compliance with the Control of Substances Hazardous to Health (COSHH) Regulations 2002.
The COSHH Regulations also cover substances used to control the risks, such as disinfectants and detergents.
Spillages of blood must be decontaminated with an appropriate disinfectant to make them safe. The most popular disinfectants are chlorine-releasing chemicals, which can also be hazardous if not used according to the manufacturer's instructions. Adverse health effects from these products include irritation, dermatitis and breathing problems. These risks also need to be controlled under COSHH regulations.
Infection control regulatory guidance
Care providers in England must comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in order to maintain their registration with CQC. The regulations require providers to have regard to the Health and Social Care Act 2008: code of practice for health and adult social care on the prevention and control of infections and related guidance, often referred to as 'the Hygiene Code'.
The Code states that:
- Clear procedures should be in place for dealing with spillages.
- A policy on how to clean all areas of the environment, fixtures and fittings should be available that includes what to do and what products to use if there is a spillage of blood or body fluids.
- Staff should be trained in the management of blood and body fluid spills and splashes, including the use of chlorine-releasing agents.
All care home and domiciliary care services should have an agreed policy on the cleaning of body fluid spillages.
Spillages must be dealt with as soon as possible and not left. Care staff should be trained to clear up spillages and should have suitable equipment available.
In care homes, cleaning may be carried out by suitably trained cleaners but staff managing a spillage should not wait for them to be available. If there is any delay in dealing with a spillage, for example because staff with appropriate training are not readily available, the spillage should be safely isolated and/or the room locked. If the spillage is in a public area of a care home it must not be left unattended by staff.
Equipment provided should include:
- suitable disinfectants
- general purpose detergent
- disposable towels
- personal protective equipment – disposable gloves, aprons, splash-proof eye protection, etc.
- clinical waste bags.
Commercially produced 'spillage kits' are available that contain all the required equipment and are ready for staff to use at short notice. These might be placed in suitable points of a care home or carried with domiciliary care staff if a risk is identified.
All spillages should be treated as potentially infectious and appropriate precautions should be taken.
To protect against blood-borne viruses blood spillages should be decontaminated using the correct disinfectant at the correct concentration. The most commonly used substance is a 10,000ppm hypochlorite solution (1 part chlorine to 10 parts water) or chlorine-releasing granule type cleaners.
Staff cleaning a blood spillage should:
- assemble the equipment they need
- open a window and ventilate the area
- put on disposable gloves and an apron and wear eye protection wherever there may be a danger of splashing
- prepare the hypochlorite solution (diluted solutions are unstable and should be freshly prepared)
- use paper towels to soak up and mop up excess fluid and dispose of these in a clinical waste bag
- cover the spillage with more towels soaked in hypochlorite or with granules and leave for two to three minutes
- carefully wipe up all organic matter and dispose of it in the waste bag
- clean the area with hot water and detergent and then dry the area with more paper towels
- dispose of the protective equipment and waste and wash hands in soap and water.
In a care home or a communal setting, staff should use a 'wet floor' warning sign where there is a danger that people may slip on the floor while it is drying. An alternative would be to exclude people from the area until dry.
Strong solutions of chlorine-releasing agents, such as hypochlorite, react with acidic body fluids such as urine and may cause a rapid release of toxic levels of chlorine. They should therefore not be used directly on such spillages.
Where blood is not visible, staff cleaning a spillage of urine or faeces should follow the same procedure as above. However, after using paper towels to soak up fluids and mop up organic material, they should clean the area with hot water and detergent and then dry it with more paper towels rather than use hypochlorite immediately.
If blood is visible, after removing the spillage and washing the area with detergent, it is safe to disinfect the surface with sodium hypochlorite aqueous solution before washing again with hot water and detergent.
During outbreaks of diarrhoea, viral gastroenteritis or norovirus, for instance, surfaces should be disinfected following initial cleaning.
COSHH risk assessments must be carried out for all chemical disinfectants in use, such as hypochlorite. These should identify the precautions to be taken, for which staff should be appropriately trained and equipped.
Staff should use chemicals according to the manufacturer's instructions and as specified in the safety data sheet supplied with the substance.
Care of furnishings
Chlorine-based solutions may bleach and cause damage to carpets and other materials such as sofas and curtains. If body fluids are spilled on soft furnishings and carpets, staff should mop up organic matter with paper towels or disposable cloths and then clean the surfaces thoroughly using a general purpose detergent and water solution. Carpets can be domestically cleaned using a carpet suction cleaner after the spillage has been treated. Furniture/curtains should be steam-cleaned thoroughly.
If an item remains soiled it should be condemned and replaced. However, staff should be sensitive to the ownership of possessions. Furniture that is the property of the service user should be dealt with according to their wishes.
Training and supervision
It is the service manager's responsibility to ensure that staff are appropriately trained and competent to safely carry out the procedures required of them.
All new staff should attend basic infection control awareness training and read the policy on infection control. Induction should include information on managing body fluid spillages, as well as hand hygiene and using disinfectants safely.
Staff should attend updates as required, with records of attendance kept.
Use the following item in the Toolkit to help you put the ideas in this article into practice:
About the author
Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care.