Spill Management Protocol (Blood/ Body Fluids/ BMW)
- Minimize traffic around the spill area. Use caution board.
- Wear Personal Protective Equipment.
- Use forceps and pick up broken glass/sharps/ vacutainer and place them in kidney tray and later discard it into the appropriate container.
- Confine and contain the spill by using paper towels or disposable absorbent material to absorb the bulk of the blood or body substances.
- Prepare 10% Sodium Hypochlorite solution by diluting the 100ml of 400ml of tap water.
- Pour onto the spilled fluid (quantity of the solution to be approximately equal to the quantity of the spillage) and leave it for 20 minutes.
- After 20 minutes, remove the absorbent paper and discard it in the YELLOW color bag. Use additional absorbent paper till the site looks visibly dry.
- Clean the spill site with a neutral detergent and water.
- Mop the site dry.
- Discard the PPEs used as per the Bio-Medical Waste segregation protocols
Spill Management Protocol (Mercury Spill):
- Minimize traffic around the area that has been contaminated with mercury. Use caution board. Ventilate the area if possible.
- Put on a face mask in order to prevent breathing of mercury vapor.
- Remove all jewellery from hands and wrists so that the mercury cannot combine (amalgamate) with the precious metals.
- Wear on appropriate personal protective equipment (rubber gloves, goggles, mask and apron).
- Locate all mercury beads carefully.
- Fill 1/3rd of the container with tap water.
- Use cardboard sheets to collect the spilled beads of mercury one by one. Or use a syringe without needle to draw the beads.
- Place the Mercury beads carefully in the container with water.
- Never use a broom or a vacuum cleaner.
- Discard contaminated portion of cloth, carpet, mat, etc which is difficult to clean. Do not send them for wash.
- Handover the container to the Biomedical Engineer for re-use of mercury
Spill Management Protocol (Cytotoxic Drugs):
- Minimize traffic in the area. Use caution board.
- Assess the situation and determine whether it’s a small or big spill. If spill (in areas other than CDMR) is more than 100 ml consider it as major spill and get the spill kit from CDMR. Otherwise access the common spill kit.
- Double glove. Wear a mask. For major spills wear N95 mask
- Wipe liquids with absorbent paper.
- Clean spill area three times using an alkaline detergent solution followed by clean water
- Place used absorbent papers and any non-cleanable contaminated items in Cytotoxic Waste (Black with Cytotoxic Symbol) disposal bag.
Management of Exposure to Personnel:
- Remove and replace contaminated gowns.
- In the event of skin contact with any cytotoxic drug, thoroughly wash the affected area with soap and water. Do not abrade the skin.
- If eyes are exposed, remove contacts, if present, and leave them out until further notice. Flush the affected eye(s) with copious amounts of water for at least 20 minutes, while holding back the eyelid(s).
- Staff exposed to Cytotoxic drugs also report the incident to their supervisor, who is responsible for completing the Incident Reporting Form.
- Staff should be sent to the ICU/ any other identified area for timely treatment and proper documentation.
- Staff should report any health problems that might be related to cytotoxic drug exposure to Supervisor.
Spill Management Protocol (Silver Nitrate – used for Fumigation):
- Small amounts of dilute silver nitrate solution can be flushed down a sink with a large quantity of water.
- Wear safety glasses. Rubber or heavy-duty gloves may be helpful in preventing silver stains on the skin.
- Poisonous if swallowed or inhaled
- Skin contact with silver nitrate solid or solutions is likely to leave silver stains on the skin. These develop slowly over a period of hours and are initially brown, but darken gradually to black. Once the stains become apparent, they cannot usually be removed with soap and water, but gradually disappear as new skin grows.
- Inorganic nitrates are oxidizers and may react vigorously with reducing agents.
Eye contact:
Immediately flush the eye with plenty of water. Continue for at least ten minutes and call for medical help.
Skin contact:
Wash off with soap and water. Remove any contaminated clothing.
If swallowed:
Call for immediate medical help.
Spill Management Protocol (Chemicals – in General):
- Determine if there is an immediate health threat to you or your neighbours If so, alert neighbors, isolate the area
- LOCATE MSDS AND READ THE INSTRUCTIONS
- Assess the toxicity, flammability, or other properties of material (see label and MSDS)
- For flammables, remove or turn off all ignition sources such as motors, pumps, fridges, stored inflammable gases, etc.
- If the spill is minor, begin cleanup procedure
- Wear on gloves, eye protection, lab coat, etc.
- Contain and absorb spill using absorbents appropriate for the material
- Protect floor drains from contamination, by putting absorbents or barriers around them
- Package and label waste. Include contaminated clothes, rags, equipment, etc.
You should NOT clean up a spill if:
- You don’t know what the spilled material is
- You lack the necessary protection or equipment to do the job safely
- The spill is too large to contain
- The spilled material is highly toxic
- You feel any symptoms of exposure
HAZMAT CONTROLLER – Reporting the incident:
- In the event of any spill, the first responder raises the alarm or calls for help – the second responder can also raise the alarm
- The affected area will be cordoned off – entry will be restricted
- If it’s a radiation hazard – Operator will call the FSO(In case Radiation Spill then Call to the RSO) assigned for that particular area immediately
- If it’s other hazardous material spillage, Telephone Operator calls up the “HAZMAT – controller” on duty directly
- Then the second call will be made to the Safety Officer or 2nd & 3rd line command center
- Departmental personnel will start the clean up procedure, only if they are sure & confident of the same
- HAZMAT Controller will arrive at the spot and directs the cleanup procedure (except for radiation, where RSO will take care of the entire process of decontamination)
- There will not be any announcement made on the PAS if the extent of the spill is restricted to an area less than 100 sq.ft
- Makes sure affected personnel are given appropriate first aid & medical help depending on the exposure
- In the end, s/he will fill up the “Spill Management – Report Form” & submits it to QI Team, later will be discussed in an appropriate committee meeting
Hazardous biomedical waste disposal program
- Detailed policies and procedures on handling Biomedical Waste are explained in the Infection Control Manual, which will be made available in the concerned areas. However
- The purpose of this policy is to ensure hazardous waste is collected, segregated and transported to a storage area in a safe manner.
- The color coding used in the hospital is as per the BMW guidelines 2016 (Refer SOP for Biomedical waste management)
- Appropriate colored bags are provided in all the areas of the hospital.
- Waste thus collected is stored in the waste storage room until it is collected by the agency.
ETHYLENE OXIDE – Safety Measures:
Ethylene Oxide (EO, ETO) is the chemical used in the Sterilization Process in the Central Sterile Supply Department (CSSD).
Storage & Handling Requirements:
- Ethylene oxide is stored in a cool, well-labelled, well-ventilated, fireproof area, and kept away from all sources of ignition and heat as well as incompatible materials
- When long storage times are anticipated, a lower temperature range is recommended to minimize
- Prolonged storage in small containers where there is a high surface to volume ratio should be avoided, because the polymerization rate is increased by the presence of any metal.
- Mixtures of ethylene oxide and water should not be left dormant for any length of time, and the temperature and pressure of vessels containing these mixtures should be carefully monitored.
Spillage
- Since the storage quantity is lesser the plan for spillage is limited.
- Use personal protective devices – mask, gloves.
- Restrict persons not wearing protective devices from the area of spill or leak until cleanup is complete. Avoid skin and eye contact.
- Remove all ignition sources and evacuate the danger area. Provide Optimum ventilation, which should be explosion-proof.
- Dilute small spills with water to form non-flammable mixtures. Allow it to evaporate for 4 Hours and use the absorbent paper to wipe off and dispose it into Yellow Color Bag.
- Avoid run-off into drains or sewers (explosion hazard).
- If the source of the leak is the cartridge move it to a safe place outdoors and allow venting until empty.
Disposal
Ethylene oxide can be disposed of by evaporation in an open area or by burning after ignition from a safe distance.
HEALTH HAZARD
- Avoid body contact and inhalation
- Liquid and vapour cause irritation and burns.
- The liquid can be absorbed through the skin and can damage internal organs.
- Do not depend upon your sense of smell for warning. If you smell EO you are overexposed.
- Leave the area at once
- Inform your supervisor immediately.
- If body contact or clothes are contaminated, go to the washroom and pour water thoroughly
- Remove contaminated clothing. Move to the open area for fresh air. If required artificial breathing may be started.
Fire and Reactivity Hazard
- Highly flammable violently reactive
- Keep away from sparks, flames and heat.
- If the fire spreads, use alcohol foam type fire extinguisher.
- Be prepared for re-ignition.
- Shut off the supply if possible and safe to do so.
Cylinder safety policy
- The purpose of this policy is to ensure the proper transport and storage of cylinders in the hospital.
- Cylinders shall be secured at all times.
- Transport cylinders correctly. Cylinders shall be moved by means of a suitable hand cart and secured in place with a strap.
- DO NOT ROLL CYLINDERS to move from one area to another.
- Cylinders shall be correctly stored always on an upright position.
- Cylinder valves must be protected. Large cylinders, when not in use, shall have cylinder valve protective cap in place and cylinder valve shall be in the off position.
- Never drop cylinders or allow them to strike each other violently.
- Keep cylinders away from sources of heat.
- When empty, mark or label cylinders EMPTY or MT.
Contaminated Cylinders:
Cylinders externally contaminated with blood or other potentially infectious materials shall be examined prior to servicing or shipping and shall be decontaminated in accordance with the cleaning protocol established by the Infection Control Committee. (Refer Infection Control Manual)
SILVER NITRATE – SAFETY MEASURES:
Usage of Silver Nitrate:
Silver Nitrate is used in the hospital for the fumigation in the form of a solution (0.01% Silver Nitrate + 10% of Hydrogen Peroxide).
Handling and Storage:
- Keep in a tightly closed container, stored in a cool, dry, ventilated area. Protect against physical damage and moisture.
- Isolate from any source of heat or ignition. Avoid storage on wood floors. Separate from incompatibles, combustibles, organic or other readily oxidizable materials. Protect from light.
- Containers of this material may be hazardous when empty since they retain product residues (dust, solids); observe all warnings and precautions listed on the container.
Principal hazards:
- Poisonous if swallowed or inhaled
- Skin contact with silver nitrate solid or solutions is likely to leave silver stains on the skin. These develop slowly over a period of hours and are initially brown, but darken gradually to black. Once the stains become apparent, they cannot usually be removed with soap and water, but gradually disappear as new skin grows.
- Inorganic nitrates are oxidizers and may react vigorously with reducing agents.
- Eye contact: Immediately flush the eye with plenty of water. Continue for at least ten minutes and call for medical help.
- Skin contact: Wash off with soap and water. Remove any contaminated clothing.
- If swallowed: Call for immediate medical help.
Reference to other Important Topics under Hazardous Materials
- Handling, Storage, Usage & Spill management of Chemotherapy Drugs – Refer Management of Medication Manual
- Universal Precautions, Needle Stick Injury Management – Refer Infection Control Manual
Handling radioactive incidents/emergencies
- Detailed explanation on Radiation Spillage/ Incidents and disposal of radioactive waste is given in the Radiation Safety Manual (which will be made available in all the areas which are exposed to / has a risk of radiation). This manual only gives a brief outline on these issues for the general understanding of all the staff in the hospital.
- Incidents may occur during the use of radioactive materials, such as spills, accidental releases into the air, contamination of the staff or the work area, and numerous other possible problems.
- When an incident occurs, the staff must first make a judgment as to whether the incident is a minor incident, major incident or emergency. Subsequent actions are based on this decision, which is as follow:
- A minor incident with radioactive materials is an abnormal occurrence involving low amounts of radioactive materials, where the worker handling the spill knows how to clean it up, has the decontamination materials on hand, and can respond without incurring the risk of exposures or spreading within a reasonably short time.
- A major incident is an abnormal occurrence involving high amounts of radioactive materials, high-risk nuclides, large areas contaminated contamination of the skin, airborne radioactivity, or any situation where contamination may have been spread outside the authorized area. Major spills must be reported to the Radiation Safety Officer or his/her designee immediately, as required by law.
- An emergency is an incident, which involves serious injury or death, fire, explosion, or significant release of a health or life-threatening material, which is or may be coupled with a minor or major radiological incident.
In the event of a MINOR incident, these procedures should be followed:
- Notify the Radiation Safety Officer and persons in the area that an incident has occurred.
- Contain the spill. Cover with absorbent paper or dike with absorbent.
- Isolate the area to prevent the unnecessary spread and personnel exposures.
- A survey using the appropriate monitoring equipment in order to evaluate the presence of contamination on an individual’s skin and clothing and on lab equipment. {If skin or clothing contamination is present, a major spill has occurred.}
- Use disposable gloves, carefully fold up the absorbent paper and pad and deposit in an appropriate radioactive waste container.
- Survey the area of the spill to determine the extent.
- Decontaminate the spill using decontaminant detergent (available from General Stores), and resurvey.
- Continue the above 3 steps until the area is decontaminated completely.
- Document spill in the records as mentioned in the Radiation Safety Manual.
In the event of a MAJOR incident, the following procedure should be instituted:
- Notify all persons in the area that a major spill or incident has occurred and Evacuate unnecessary personnel. Notify the Radiation Safety Officer.
- If possible, prevent the spreading of the radioactive material by using absorbent paper.
- Do not attempt to clean it up. Confine all potentially contaminated individuals in order to prevent the further spread of contamination.
- If possible, shield the source, but only if it can be done without significantly increasing your radiation exposure.
- Leave the affected room and lock the doors in order to prevent entry. Attempt to prevent further contamination or spreading to unrestricted areas.
- Remove all contaminated clothing and await instructions concerning cleanup from the Radiation Safety Officer.
- If skin contamination has occurred, measure levels of contamination with a survey meter, record, and begin decontamination by gentle washing with warm water and soap, washing downwards towards extremities, not upwards.
Radioactive waste disposal program
- The purpose of this policy is to ensure radioactive waste is collected and transported to the storage area in a safe manner.
- Waste disposal of radioactive material will conform to all regulations were given by AERB (Atomic Energy Regulatory Board) guidelines.
- Any material or instrument with detectable traces of radiation will be considered radioactive and must be disposed of by the Radiation Safety Office.
- Remove or obliterate all radiation labels before placing material in waste containers.
- Radioactive waste will be separated by physical form.
- Needles or materials which are sharp and may break or puncture the skin must be placed in sharps containers labelled “Radioactive Material.”
- Waste will be held in the department in a shielded container/ area until release to the Radiation Safety Office. Shielded container/ areas for waste disposal will be secure and clearly marked with appropriate radiation markings.
- The waste thus collected from the user departments is stored in the Waste Storage Room and left it for deactivation of radioactivity at least for 2 months’ time.
- The radiation safety officer will decide on the date of disposal and also the material to be disposed of. The materials are disposed in the black coloured bag and the sharps if present in the puncture-proof container.
- The Radiation Safety Officer will maintain final disposal records.
The radioactive material used for therapeutic and diagnostic purposes is separately identified. The precautions required to store, handle such materials formulate the regulatory requirements. RSO is to look after the requisite regulatory requirements as per the AERB and BARC guidelines
Instructions are made and displayed at stores, PET CT, radiology department, nuclear medicine and laboratories indicating the method of managing the spills.