Safe Work Procedure Sharps and Bio-hazardous waste handling and disposal

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1 Safe Work Procedure Sharps and Bio-hazardous waste handling and disposal Task/Activity: Acupuncture and Musculoskeletal therapy (MST) clinics and practical classrooms (Acupuncture & MST Skin Infection control and bio-hazardous waste handling and disposal) Task (briefly explain the task/process): 1. A Lecturer demonstrating a technique that involves the use of sharps ( needles ), sharps bins and/or bio-hazardous waste bins. 2. A student learning in a classroom environment how to perform a technique using sharps (i.e. acupuncture and/or dry-needling needles). 3. A student conducting a consultation / treatment on a client using sharps. Location: All campuses Hazard (briefly explain hazard/s associated with Task): 1. Use of: acupuncture needles and dry needles, cotton balls, alcohol swabs, latex gloves, tongue depressors and/or urine dipsticks disposable and non-disposable linen Task reference number/risk Assessment ID (from Risk Assessment form): MLBNSI12 Does this require a Permit to Work : No Authorised by: National HSE Committee Version: 5.0 Page 1

2 Prior to insertion of needles: 1 Client is booked for a session involving needles, or a class room practical is scheduled with needles. Room to be booked must be a sharps compliant room e.g. Noncarpeted with sharps containers and bio-hazardous waste bins and within a reasonable distance of washing facilities. If a room has been booked that is non-compliant then practical session IS NOT TO PROCEED. Ο During Ο After Student practitioner and supervisor to always wear closed-toe footwear; When booking a client, allow enough change-over time for rooms to be cleared out and made ready for the next session. 2 Clean disposable sheets placed on bed if not already done. Or if no disposable sheets, then white washable towels For clinic sessions - used disposable sheets should be discarded into a standard waste bin, or a dedicated recycling bin (if available). Used washable sheets or towels must be transferred directly into a laundry basket which is dedicated for soiled linen. For classroom practical sessions students are required to bring their own white washable towels which must be taken home and washed after every use. Ο During Authorised by: National HSE Committee Version: 5.0 Page 2

3 3 Student / Demonstrator must perform standard aseptic technique which includes the five moments of hand hygiene: Hand washing with soap and warm water or using alcohol-based hand sanitiser/gel (i.e. minimum European Standard EN1500; 60-80% v/v ethanol or equivalent): before touching a patient 1. Wash hands with warm soapy water; or 2. Where a wash basin is not available in room, EN1500 hand sanitiser gel is available in every room and should be used throughout the consultation. In this case, as soon as practicable after the consultation, students are to use warm soapy water hand washing facilities in a nearby appropriate sink (in room or hallway, hands-free sinks only). 3. If using the toilet, hands MUST be washed using warm soapy water immediately (compulsory practice). before a procedure after touching a patient and/or after touching a patient s surroundings 4. Hand hygiene using either of the methods outlined above must be performed: Before touching a patient Before a procedure After a procedure or body substance exposure risk After touching a patient After touching a patient s surrounds, and After the removal of gloves. (NHMRC 2010, pp.34-45) 4 Disposable latex gloves are to be Use disposable latex gloves if required. Ensure glove is put on before Disposable latex worn if student or client has broken contact with client or other student and there are no tears in glove gloves. skin, or is predisposed to cracking material. skin (e.g. eczema, psoriasis etc.). Authorised by: National HSE Committee Version: 5.0 Page 3

4 5 Alcohol swab is used on the spot of skin that a needle will be inserted into to disinfect the skin of the client. Alcohol swab to be used only once per body area and then disposed of directly into a normal waste bin (do not place used alcohol swabs in the bio-hazardous waste bins OR the sharps container). O Prior 6 Acupuncture needle insertion or needle insertion during dry needling in MST. Carefully remove single-use needle from its wrapper and check needle visually for patency (e.g. discoloration/multiple needles in wrapper/guide tube etc.) Count the number of needles that are inserted into the patient. Ο After Following insertion of needles: Authorised by: National HSE Committee Version: 5.0 Page 4

5 7 Needles are removed from client. Student practitioner to put a disposable latex glove on his/her nondominant hand prior to removing needles from the patient (i.e. the one that will hold the cotton ball). Remove needle with dominant hand and press clean cotton ball onto skin over area where needle was inserted. Hold for 5-10secs and check that no excessive bleeding once cotton ball is removed. Continue to monitor each needle removal site for any further bleeding as you continue the above process for each inserted needle, paying special attention to areas of high and/or superficial venous return, such as the face and scalp. Count the number of needles taken out of the person and ensure it is the same number that was put in. As each needle is taken out, put it in the sharps container (do not place needles in the bio-hazardous waste bins). Dispose of soiled cotton balls in the bio-hazardous waste bins (do not place cotton balls in the sharps container). Dispose of the used alcohol swabs in the normal waste bin (do not place used alcohol swabs in the bio-hazardous waste bins OR the sharps container). Ensure there is a sharps container available for disposal of needles. Authorised by: National HSE Committee Version: 5.0 Page 5

6 8 Student / demonstrator washes instruments in basins after use and properly dispose of non-reusable treatment items; bed liners, needles, gloves, alcohol swabs/wipes in appropriate manner. Needles to be disposed immediately in sharps containers after they have been taken out. All other items to be disposed of together in an appropriate bin. It is recommended that sharps containers be placed out of reach of children (i.e. min 1.4 metres from the floor). Cups, spoons and all other non-disposable equipment must be washed thoroughly with warm soapy water immediately after use, unless exposed to bodily substances. If exposure to bodily substances occurs, these items must be disposed of as hazardous waste; the student should speak to the supervisor as soon as practicable after exposure occurs (no longer than 30 minutes). Needles to be disposed of into the designates sharps container ONLY up till the mark on the outside of the container, or ¾ full whichever comes first. If white towels used on bed, these are to be taken directly to the dirty laundry container after each use. Removal of full sharps containers and bio-hazardous waste bin liners: Authorised by: National HSE Committee Version: 5.0 Page 6

7 9a Student/Supervisor/Clinic Manager Sharps Containers: Disposable latex identifies if sharps container and/or It is the responsibility of all students using clinic rooms that contain a gloves (double- bio-hazardous waste bin has sharps container and/or bio-hazardous waste bin to make a regular layered) reached ¾ of capacity and if so they visual check of the levels of the containers/bins. are to arrange for removal to the designated area on site and replace as outlined. Once they have reached the ¾ full mark, a supervisor or clinic manager must be notified and they will then nominate a person ( the attendant ) to remove the sharps container (i.e. a student from that A sharps container is considered to modality, a Supervisor, a member of the clinic Operations team, or a be full when the needles inside have facilities staff member). reached the line marked on the outside of the container, or it is ¾ full whichever comes first. The process for removing sharps containers and removing them from the clinic is as follows: Before removing the sharps container the attendant should wear 2 pairs of disposable latex gloves (i.e. doublelayered ) as a minimum precaution (note, thicker suede/rubber/leather gloves may be worn if preferred, but they will affect manual dexterity); Securely lock the lid on the top of the container; Immediately take the sealed, upright, sharps container and place it in an upright position in the designated 240L, lockable bio-hazardous waste bin provided in the clinic (NOTE, do not empty the contents of the sharps container into the bin, place the whole container in the bin); Collect a new empty, sharps container and place it back in the treatment room; Authorised by: National HSE Committee Version: 5.0 Page 7

8 Remove double-layer disposable latex gloves and dispose of in the general waste bin; Thoroughly wash hands with warm soapy water NOTE: If at any time during the above or below process you feel that you may have been exposed to a potential or actual needlestick injury or any blood exposure, please raise this with a Supervisor or Manager immediately (i.e. within 30 minutes). 9b A bio-hazardous waste bin is Bio-hazardous waste bins: Disposable latex considered to be full when it is ¾ full Once a bin is close to ¾ full, the related Supervisor or Clinic Manager gloves (double- of bio-hazardous waste (i.e. used should be notified. They will then nominate a person ( the attendant ) layered) cotton balls and any other blood- to empty the waste bin (i.e. a student from that modality, a Supervisor, stained materials/products, and used a member of the clinic Operations team, or a facilities staff member). urine dipsticks). The process for emptying bio-hazardous waste bins and removing them from the clinic is as follows: Before emptying and bio-hazardous waste bins the attendant should don 2 pairs of disposable latex gloves as a minimum precaution (note, thicker suede/rubber/leather gloves may be worn if preferred, but they will affect manual dexterity); Open waste bin and lightly tie-off the yellow bin liner with gloved hands; Do not try to remove the air from the bag before tying it off, as any sharps items that may have been inadvertently placed in the bin may pierce the liner; Authorised by: National HSE Committee Version: 5.0 Page 8

9 Hold the liner by the tied-off end and gently remove from the waste bin, taking care to keep the liner away from your body; Immediately take the liner to the dedicated bin/area for disposing of bio-hazardous waste (in most clinics, this will be a 240L, locked wheelie bin with a yellow lid and yellow liner); Keeping the liner away from your body, open the bin and place the bio-hazardous liner into the bin and close/lock the lid; Return to the treatment room and place a new liner in the biohazardous waste bin; Remove double-layer disposable latex gloves and dispose of in the general waste bin; Thoroughly wash hands with warm soapy water. Other related matters: 10 Use of balms in clinic (eg. MST/Tuina/Massage) Use a new tongue depressor/ice-cream stick to remove balm from the container EVERY time. Fingers must not be used to remove balm as this greatly increases the risk of cross-infection between patients. Use good hand hygiene processes as outlined in Clause 3 above, before and after each patient treatment. O During 11 Pillows are to be stored back on bed Pillows which are defective must be replaced. O During Authorised by: National HSE Committee Version: 5.0 Page 9

10 12 Beds and basin wiped down with a Disposable latex gloves to be worn during this process. Disposable latex clean cloth and hot, soapy water (as Ο During gloves. a first choice), or ph neutral anti- bacterial wipes at the end of each day. 13 Tongue depressors Practitioner to use standard aseptic technique as outlined above. Wooden depressor to be used once, then disposed of in bio-hazardous waste bin. Ο During Plastic wrapper to be disposed of in standard waste bin 14 Urine dipsticks Practitioner to use standard aseptic technique as outlined above. Used urine dip stick and any used absorbent paper towelling to be disposed of in bio-hazardous waste bin. Ο During Disposable latex gloves. Authorised by: National HSE Committee Version: 5.0 Page 10

11 Additional Information: National Health and Medical Research Council, Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010): Chinese Medicine Board of Australia, Infection prevention and control guidelines for acupuncture practice, October 2013: NSW Government, Department of Health, Generic Waste Management Plan For Health Care Facilities, January 1 st 1999: Biohazard Waste Industry, Industry Code of Practice for the management of clinical and related wastes, 6 th Edition 2010 (see pp of 90): World Health Organisation, Safe management of wastes from healthcare activities, 1999: Training required (including informal and formal): Sharps-related training: This safe work procedure is to be incorporated into any academic inductions and student orientations for students studying Acupuncture or Musculoskeletal Therapy. Bio-hazardous waste handling: This safe work procedure is to be incorporated into any academic inductions and student orientations for students studying Acupuncture, Musculoskeletal Therapy, Naturopathy or Nutrition. Safe Work Procedure sign off: Approved via consultation between Academics, Clinics, Compliance and National HSE Manager. Authorised by: National HSE Committee Version: 5.0 Page 11

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