Management of spills

In a hospital, hazardous substances such as body fluids, drugs, cleaning fluids and other chemicals are in very close proximity to hundreds of people each day. Thus in hospital spillage of blood, body fluids or chemicals can occur at any time due to broken or faulty equipment or human error. Any such spill poses risk to the staff, visitors and patients who are extremely susceptible to infection.

Spill Management

Small volumes (few drops) of Spills

1. Wear workman’s gloves and other PPE appropriate to the task.
2. When sharps are involved use forceps to pick up sharps, and discard these items in a puncture-resistant container.
3. Cover the spill with a newspaper, blotting paper / paper towel or dry mud.
4. Wipe the spill with a newspaper moistened with hypochlorite solution (1% dilution containing minimum 500ppm chlorine). Discard the paper as infected waste. Repeat until all visible soiling is removed.
5. Wipe the area with a cloth mop moistened with 1% hypochlorite solution and allow drying naturally.
6. All contaminated items used in the clean-up should be placed in a bio-hazardous bag for disposal.

Large volumes (>10 ml) of Spills

1. Confine contaminated area
2. Wear workman’s gloves and other PPE appropriate to the task
3. Cover the spill with newspaper or appropriate absorbent material to prevent from spreading
4. Flood the spill with 10% hypochlorite solution. While flooding the spill with 10% hypochlorite solution it is to be ensured that both the spill and absorbent material is thoroughly wet
5. Alternatively, chlorine granules can be sprinkled on the spill first and then the paper put over it
6. Wait for five minutes.
7. Remove and discard the paper as infected waste
8. Wipe the area with paper moistened with 10% hypochlorite again if required until all visible soiling is cleaned
9. Wipe the area once with 10% hypochlorite and a cloth mop and allow drying naturally
10. All contaminated items used in the clean-up should be placed in a bio-hazardous bag for disposal.

Chemical Spill Management

Neutralising Acid Spills

Acid spills can be neutralised with sodium bicarbonate, sodium carbonate, or calcium carbonate.

Process

• Contain the liquid first•
• Sprinkle powder over the spill slowly, starting from the outside
• Acid is neutralised if effervescence ceases in the presence of excess bicarbonate
• Avoid breathing in the fine powder and the gas evolved (carbon dioxide).

Neutralising Alkali Spills

Alkali spills can be neutralised with sodium bisulphite, boric acid or oxalic acid. Many alkalis can result in serious burns to skin and eyes, so it is necessary to proceed with extreme caution.

Process

• Ensure that there is adequate ventilation
• Eliminate all sources of ignition as neutralisation of alkali can produce heat. This includes removing all combustible materials that are close to the spill
• Right any overturned containers where the spill originated or stop leak at source only if safe to do so
• Avoid handling fluid even with nitrile gloves
• Liberally apply the alkali neutraliser around the perimeter of the spill to limit the extent of spreading and continue sprinkling it towards the centre. This should be done until the entire spill is covered and there is no free liquid or liquid migration. The neutralisation reactions should occur 1-5 minutes after application
• Stand clear as splattering of reaction products might occur. The heat and vigour of the reaction will depend on the type and concentration of the alkali being neutralised
• The alkali will be neutralised when the reaction has stopped and there is no more fizzing from the liquid.
• Caution
• Neutralised alkalis may produce heat. Wait until mixtures have cooled before sweeping up spilled material
• Avoid handling spilled material until absorption is complete
• Use non-metal, non-sparking tools such as a broom, scoop or scraper to clean up neutralised spill. Take care not to overly disturb the neutralised spill.

Liquid Spills Process

Other than flammable liquids

• Spread absorbent pads over the spill starting with the edges first. This will help to contain the spill to a smaller area. Enough pads should be used to completely cover the liquid
• Pick up the contaminated pads with tongs or a scoop and place into a chemical resistant bin
• If the chemical is water soluble, wipe the area down with a paper towel, followed by wet mop and detergent
• Appropriately dispose off used paper towel.

Flammable Liquid Spills Process

• Control all sources of ignition - turn off all electrical and heat generating equipment
• Spread the absorbent pads over the spill starting from the edge. Allow the pads to completely soak up the liquid
• Pick up the contaminated pads with tongs or scoop and minimise direct contact
• Place the waste into the chemical resistant bin
• Wipe the area down with a paper towel and copious amounts of water
• Dispose off paper towel into a chemical resistant bin and seal the bin so it is airtight
• Never use wet vacuum cleaner on flammable solvents.

Solid Spills Process

• Sweep solid material into a plastic dust pan and place in a sealed container. Care should be taken so as to minimise dust or the contaminated powder becoming airborne
• Use of a dust mask is advisable
• Wipe the area down with a wet paper towel and dispose off the used paper towel in a strong polyethylene bag. Seal the bag and ensure all waste is collected for proper disposal

Handling of mercury spills

In the event of any mercury spillage due to breakage of instrument the following measures are to be taken: -

Clean-up Instructions – Mercury Spill Management

• Evacuate area : As far as possible, keep people who are not involved in the clean-up away from spill area to limit exposures and to prevent the spread of contamination.
• Put on face mask : In order to prevent breathing of mercury vapour, wear a protective face mask as suggested in the component of the spill kit.
• Remove Jewellery : Remove all jewellery from hands and wrists so that the mercury cannot combine (amalgamate) with the precious metals.
• Wear gloves : Put on rubber or latex gloves. If there are any broken pieces of glass or sharp objects, pick them up with care. Place all broken objects on a paper towel, fold the paper towel and place in a puncture proof plastic bag or container provided with lid. Secure the plastic bag/container and label it as containing items contaminated with mercury.
• Locate mercury beads : Locate all mercury beads and look for mercury in any surface cracks or in hard-to-reach areas of the floor. Check a wide area beyond the spill. Use a flashlight to locate additional glistening beads of mercury that may be sticking to the surface or in small cracked areas. Cardboard sheets should be ‘used to push the spilled beads of mercury together’
• Use syringe without a needle/eyedropper and sticky tape : A syringe (without needle) shall be used to suck the beads of mercury. Collected mercury needs to be placed slowly and carefully into an unbreakable plastic container/glass bottle with an airtight lid half filled with water. After removing larger beads, use sticky tape to collect smaller hard-to-see beads. Place the sticky tape in a puncture proof plastic bag and secure properly.
• Commercially available powdered sulphur or zinc stains make mercury a darker colour which makes smaller beads easier to see (powder sulphur may be used because (i) it makes the mercury easier to see since there may be a colour change from yellow to brown and (ii) it binds the mercury so that it can be easily removed and suppresses the vaporisation of any missing mercury).

Collection in leak-proof bag or container

Place all the materials used during the clean-up, including gloves, mercury spills collected from the spill area into a leak-proof plastic bag or container with lid and seal properly and label as per these guidelines. Such collected waste should be stored in a designated area only.

Cleaning of the floor surfaces contaminated with mercury and cleaning of room surfaces

Sprinkle sulphur or zinc powder over the area which will quickly bind any remaining mercury. In case, zinc powder is used, moisten the powder with water after it is sprinkled and use a paper towel to rub it into cracks in the flooring. Use the cardboard and then dampened paper towels to pick up the powder and bound mercury. Place all towels and cardboard in a plastic bag and seal all the bags that were used and store in a designated area.

All the mercury spill surfaces should be decontaminated with 10% sodium thiosulfate solution. Keep a window open to ventilate after the clean-up. After ensuring all the mercury has been removed, resume normal vacuuming and utilise the cleaned area for routine operation.

Labelling

All the bags or containers containing items contaminated with mercury should be marked properly and labelled with following details: “Hazardous Waste, Handle with Care”, date of storage/generation, name and address of the hospital along with the contact number.

Storage

Following points should be considered for storage of mercury bearing waste within the HCFs: The storage place should be away from heat generating equipment. The storage room should be provided with Mercury Spill Kit provision, proper ventilation (preferably with exhaust fan). The storage room needs to have smooth tiled floor with adequate slope, and lighting arrangement.

Disposal

Collected mercury waste should be handed over to the CBMWTF or the identified agency of the CPCB.

Source: : Guidelines For Implementation Of "KAYAKALP" Initiative