RE: THE HANDLING OF BLOOD AND/OR BODY FLUIDS

As a result of discussions with the Medical Officer of Health and the Supervisor of Communicable Disease we have received written direction as to how staff should handle blood or body fluids, including the disposal of sanitary napkins, and diapers regardless of a child's/individual's medical status.

Disposable gloves are to be made available in schools. (Inventories of gloves must be maintained by the school principal in the health area; all staff must be made aware of location).

The inventory of chlorine bleach and plastic bags must be maintained, along with disposable gloves, by the Principal in the office or health area. A small (1 litre) container of household chlorine bleach (Javex) is recommended. These items will be charged to school budgets.

As stated in the Ministry of Health Guidelines, the household bleach should be diluted to a 1:100 concentration. The solution should be freshly made, as the shelf life for chlorine solutions is short.

Principals, Superintendents, Supervisors and Managers, are required to communicate this information to all staff. A periodic and regular review of this directive by supervisors is expected on an ongoing basis.

UNIVERSAL PRECAUTIONS

Apply to blood, other body fluids containing visible blood, semen and vaginal secretions.

These fluids should always be handled as if they could be infectious and, in the event of injury or bleeding, every student or patient should be handled in a way that minimizes exposure to blood and body fluids.

The viruses associated with HIV and Hepatitis B are blood borne. It is recommended that all staff practice universal precautions at all times while handling all body secretions. Other, less harmful infections are transmitted through body fluids.

Steps:

Wear protective barriers:

• disposable waterproof gloves (latex, vinyl or nitrile) should be worn when in contact with blood, blood products, other body fluids, open wounds or sores (non-intact skin) and items soiled with blood or other body fluids.
• if gloves are punctured or cut, they should be removed as soon as practicable, hands should be washed thoroughly and new gloves used.
• cuts or sores on hands should also be covered with a waterproof dressing.
• Clean contaminated surfaces.
• Spills of possibly infected material should be immediately cleaned up with detergent and water, using disposable towels.
• The area should then be disinfected with a bleach solution and left to dry (custodial staff have the necessary cleaning materials and are trained in this process and the disposal of blood and body fluids).
• Disposable towels used for clean-up process should be disposed of by the custodial staff in the regular garbage.
• Linen and clothing which have been soiled with blood or other body fluids should be changed as soon and with as little handling as possible and may be washed with regular laundry. If a cold rinse by hand is required, gloves should be worn.
• Wash hands.
• Remove gloves by peeling off from the cuff, turning the glove inside out, to contain the other glove and any contamination within it, then wash hands.
• Use plain soap and vigorously rub together all surfaces of lathered hands for at least 10 seconds. Rinse under a stream of water.
• Avoid the use of abrasive soaps and brushes. Hand lotion can be used to prevent drying of the skin.
• Hands (and any skin surface) contaminated with blood or other body fluids should be washed thoroughly as soon as practicable.
• Splashes to mucosal membranes such as the lips, mouth, eyes or nose, should be flushed with water as soon as practicable.
• Good handwashing is an important measure to reduce transmission of disease.

Universal Precautions are intended to supplement rather than replace hand-washing.

Other considerations:

• Staff who have open wounds or weeping dermatitis should refrain from contact with blood or other body fluids.
• Pregnant staff should be completely familiar with and particularly careful to observe all precautions, to minimize the risk of transmission of any communicable disease.

SPECIAL CONSIDERATIONS FOR TEACHING ASSISTANTS

Teaching Assistants may be directly involved with students who are developmentally delayed or physically challenged and special considerations may need to be noted in order to best protect themselves and the students they work with from communicable diseases that are potentially life threatening e.g. Hepatitis B, or Human Immunodeficiency Virus (HIV)

Universal Precautions should be adhered to at all times but the following should also considered:

• Institutional settings provide additional threat of exposure simply through continuity of care. All developmentally challenged students who may have been institutionalized for any period of time may have been exposed to the Hepatitis B virus.
• Risk of transmission exists when open sores or broken mucous membrane come into contact with blood or other body fluids of an infected person. This is more likely to occur where diapers are changed, objects are mouthed or children bite each other or the people handling them i.e. children with "special needs" (intellectual, autistic, behavioural, physical exceptionalities) Such children may lack control of their body secretions or may exhibit aggressive behaviour such as biting or striking.
• Personal hygiene may be poor or inconsistent and may need to be taught and continually reinforced.
• As a result of poor personal hygiene or lack of control (drooling, nose-secretions) the risk of transmission of viral infections may be greater when working with "special needs" children. Teaching Assistants who are pregnant or may become pregnant should educate themselves as to the possible risks (e.g. TORCH infections such as rubella or herpes virus may cause malformations)
  

Reference: Region of Peel Health Department - Universal Precautions

Sect 2.26.4
Approved 1995
Revised 1997
Revised 2002