| FAQ - Office Design & Management - Archived Through 2012
When a patient vomits, since this is OPIM, it should be discarded with our infectious waste, correct? Is there any documentation of this?
Under OSHA's Bloodborne Pathogens Standard 29 CFR 1910.1030 only blood and certain body fluids are considered regulated waste or other potentially infectious materials. It should be noted that under Universal Precautions OSHA does not list vomit as OPIM. However, OSHA states that it is the employer's responsibility to determine the existence of regulated waste.
Disposal of all regulated waste shall be in accordance with applicable regulations of the United States, States and Territories, and political subdivisions of States and Territories.
The Standard defines the following terms:
Universal Precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens. (1)
Regulated Waste means liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials. (1)
Other Potentially Infectious Materials means (1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV. (1)
According to the authors of Infection Control & Management of Hazardous Materials for the Dental Team, the prevailing view is that no epidemiologic evidence suggests that most medical waste is any more infective than residential waste. Also, no epidemiologic evidence indicates that current medical/dental waste handling and disposal procedures have caused disease in the community. Therefore, identifying wastes for which special precautions are necessary is largely a matter of judgment concerning the relative risk of disease transmission. (2)
What now is agreed commonly is that only a limited amount of medical waste needs to be regulated (requiring special handling, storage, and disposal methods). For dentistry, these items include bulk blood or blood products, pathology waste, and sharps. Often the blood and blood products group is expanded to include liquid or semi-liquid blood (and any other potentially infectious materials), contaminated items that release liquid or semi-liquid blood or other potentially infectious materials when compressed items caked with dried blood or other potentially infectious materials that could be released during handling, and pathologic or microbiologic wastes that contain blood or other potentially infectious materials. Usually other body fluids are exempt. However, the CDC considers saliva to be infectious waste because it often is tainted with blood during treatment. Fortunately for dentistry, the generation of infectious waste items is modest. (2)
Based on CDC's Standard Precautions, all blood and body fluids, including secretions and excretions (except sweat), should be considered as potentially infectious in all patients.
With regard to the clean up of vomit, blood, saliva, body fluids, and OPIM (other potential infectious materials), we will refer you directly to the Centers for Disease Control and Prevention's Infection Control Guidelines for Dental Healthcare Settings. Although the guidelines do not specifically address vomit, the following is applicable:
The relevance of universal precautions to other aspects of disease transmission was recognized, and in 1996, CDC expanded the concept and changed the term to standard precautions. Standard precautions integrate and expand the elements of universal precautions into a standard of care designed to protect HCP and patients from pathogens that can be spread by blood or any other body fluid, excretion, or secretion (11). Standard precautions apply to contact with 1) blood; 2) all body fluids, secretions, and excretions (except sweat), regardless of whether they contain blood; 3) nonintact skin; and 4) mucous membranes. Saliva has always been considered a potentially infectious material in dental infection control; thus, no operational difference exists in clinical dental practice between universal precautions and standard precautions. (3)
Cleaning and Disinfection Strategies for Blood Spills
The majority of blood contamination events in dentistry result from spatter during dental procedures using rotary or ultrasonic instrumentation. Although no evidence supports that HBV, HCV, or HIV have been transmitted from a housekeeping surface, prompt removal and surface disinfection of an area contaminated by either blood or OPIM are appropriate infection-control practices and required by OSHA. (3)
Strategies for decontaminating spills of blood and other body fluids differ by setting and volume of the spill. Blood spills on either clinical contact or housekeeping surfaces should be contained and managed as quickly as possible to reduce the risk of contact by patients and DHCP. The person assigned to clean the spill should wear gloves and other PPE as needed. Visible organic material should be removed with absorbent material (e.g., disposable paper towels discarded in a leak-proof, appropriately labeled container). Nonporous surfaces should be cleaned and then decontaminated with either an EPA-registered hospital disinfectant effective against HBV and HIV or an EPA-registered hospital disinfectant with a tuberculocidal claim (i.e., intermediate-level disinfectant). If sodium hypochlorite is chosen, an EPA-registered sodium hypochlorite product is preferred. However, if such products are unavailable, a 1:100 dilution of sodium hypochlorite (e.g., approximately ¼ cup of 5.25% household chlorine bleach to 1 gallon of water) is an inexpensive and effective disinfecting agent. (3)
Carpeting and Cloth Furnishings
Carpeting is more difficult to clean than nonporous hard-surface flooring, and it cannot be reliably disinfected, especially after spills of blood and body substances. Studies have documented the presence of diverse microbial populations, primarily bacteria and fungi, in carpeting. Cloth furnishings pose similar contamination risks in areas of direct patient care and places where contaminated materials are managed (e.g., dental operatory, laboratory, or instrument processing areas). For these reasons, use of carpeted flooring and fabric-upholstered furnishings in these areas should be avoided. (3)
1) OSHA: Bloodborne Pathogens Standard 29 CFR 1910.1030
2) Infection Control & Management of Hazardous Materials for the Dental Team, 3rd. Edition. By
Miller and Palenik. Elsevier/Mosby Publishers. Copyright 2005.
3) Centers for Disease Control and Prevention's (CDC) Infection Control Guidelines for Dental