Neither HBV, HCV, nor HIV has ever been transmitted from a housekeeping surface (i.e., floors, walls, or countertops). Nonetheless, prompt removal and surface disinfection of an area contaminated by either blood or body substances are sound infection-control practices and OSHA requirements.
Studies have demonstrated that HIV is inactivated rapidly after being exposed to commonly used chemical germicides at concentrations that are much lower than those used in practice. HBV is readily inactivated with a variety of germicides, including quaternary ammonium compounds. Embalming fluids (e.g., formaldehyde) are also capable of completely inactivating HIV and HBV. OSHA has revised its regulation for disinfecting spills of blood or other potentially infectious material to include proprietary products whose label includes inactivation claims for HBV and HIV, provided that such surfaces have not become contaminated with agent(s) or volumes of or concentrations of agent(s) for which a higher level of disinfection is recommended. These registered products are listed in EPA’s List D – Registered Antimicrobials Effective Against Hepatitis B Virus and Human HIV-1, which may include products tested against duck hepatitis B virus (DHBV) as a surrogate for HBV. Additional lists of interest include EPA’s List C –Registered Antimicrobials Effective Against Human HIV-1 and EPA’s List E – Registered Antimicrobials Effective Against Mycobacterium spp., Hepatitis B Virus, and Human HIV-1.
Sodium hypochlorite solutions are inexpensive and effective broad-spectrum germicidal solutions. Generic sources of sodium hypochlorite include household chlorine bleach or reagent grade chemical. Concentrations of sodium hypochlorite solutions with a range of 5,000–6,150 ppm (1:10 v/v dilution of household bleaches marketed in the United States) to 500–615 ppm (1:100 v/v dilution) free chlorine are effective depending on the amount of organic material (e.g., blood, mucus, and urine) present on the surface to be cleaned and disinfected. EPA-registered chemical germicides may be more compatible with certain materials that could be corroded by repeated exposure to sodium hypochlorite, especially the 1:10 dilution. Appropriate personal protective equipment (e.g., gloves and goggles) should be worn when preparing and using hypochlorite solutions or other chemical germicides.
Despite laboratory evidence demonstrating adequate potency against bloodborne pathogens (e.g., HIV and HBV), many chlorine bleach products available in grocery and chemical-supply stores are not registered by the EPA for use as surface disinfectants. Use of these chlorine products as surface disinfectants is considered by the EPA to be an “unregistered use.” EPA encourages the use of registered products because the agency reviews them for safety and performance when the product is used according to label instructions. When unregistered products are used for surface disinfection, users do so at their own risk.
Strategies for decontaminating spills of blood and other body fluids differ based on the setting in which they occur and the volume of the spill. In patient-care areas, workers can manage small spills with cleaning and then disinfecting using an intermediate-level germicide or an EPA-registered germicide from the EPA List D or E. For spills containing large amounts of blood or other body substances, workers should first remove visible organic matter with absorbent material (e.g., disposable paper towels discarded into leak-proof, properly labeled containment) and then clean and decontaminate the area. If the surface is nonporous and a generic form of a sodium hypochlorite solution is used (e.g., household bleach), a 1:100 dilution is appropriate for decontamination assuming that
a. the worker assigned to clean the spill is wearing gloves and other personal protective equipment appropriate to the task,
b. most of the organic matter of the spill has been removed with absorbent material, and
c. the surface has been cleaned to remove residual organic matter.
A recent study demonstrated that even strong chlorine solutions (i.e., 1:10 dilution of chlorine bleach) may fail to totally inactivate high titers of virus in large quantities of blood, but in the absence of blood these disinfectants can achieve complete viral inactivation. This evidence supports the need to remove most organic matter from a large spill before final disinfection of the surface. Additionally, EPA-registered proprietary disinfectant label claims are based on use on a pre-cleaned surface.
Monday, January 9, 2023
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