3.5 Cleaning, Disinfection & Sharps Disposal

3.5 Cleaning, Disinfection & Sharps Disposal

Accidental needlestick injuries present the single greatest occupational bloodborne hazard to phlebotomists. In response to persistent healthcare-associated injuries, the U.S. Congress passed the Needlestick Safety and Prevention Act of 2000, which formally directed OSHA to revise the Bloodborne Pathogens Standard (29 CFR 1910.1030).

Key Provisions of the Needlestick Safety and Prevention Act

The 2000 Act established strict statutory mandates aimed at reducing percutaneous injuries through technological advancements and administrative oversight:

1. Mandatory Use of Safety-Engineered Devices: Healthcare facilities must evaluate, adopt, and utilize Sharps Objects with Engineered Sharps Injury Protections (SESIP). Standard, non-safety blood collection needles are legally prohibited unless specific clinical contraindications are documented.
2. Frontline Employee Involvement: Employers must directly involve non-managerial, frontline healthcare employees—including practicing phlebotomists—in the annual evaluation and selection of safety-engineered sharps devices. Frontline staff feedback must be formally documented in the facility's Exposure Control Plan.
3. Maintenance of a Confidential Sharps Injury Log: Facilities employing 11 or more workers must maintain a detailed, confidential Sharps Injury Log to track all percutaneous injuries. The log must record:
   • Type and brand of device involved in the incident.
   • Department or work area where the exposure occurred.
   • Detailed explanation of how the incident occurred.
4. Annual Exposure Control Plan Review: The Exposure Control Plan must be updated annually to reflect advances in safety technology that eliminate or reduce exposure to bloodborne pathogens.

Sharps Devices with Engineered Sharps Injury Protections (SESIP)

Safety-engineered devices feature built-in safety mechanisms designed to enclose or blunt the sharp point immediately after use.

Common SESIP Devices in Phlebotomy:
├── Hinged Safety Shield Needles (Safety-Lok / eclipse needles)
├── Push-Button Retractable Butterfly Needles
├── Self-Sheathing Vacutainer Tube Holders
└── Retractable Safety Lancets for Capillary Punctures

Operational Rules for SESIP Devices

• Immediate One-Handed Activation: The safety feature must be activated IMMEDIATELY upon removing the needle from the patient's vein, prior to setting the assembly down. Activation must be accomplished using a single-handed technique (e.g., pushing the safety shield forward with a thumb or against a hard surface, or pressing a push-button retraction trigger).
• Two-Handed Activation Prohibited: Never use a second hand in front of the needle tip to engage a safety shield, as a slip can result in a direct percutaneous puncture.

3.5 Cleaning, Disinfection & Sharps Disposal

Proper containment and disposal of used phlebotomy sharps are essential to safeguard phlebotomists, environmental services personnel, and waste processing workers.

Strict Rules for Handling Used Needles and Sharps

OSHA standards strictly regulate the handling of used sharp instruments. The following rules must be observed without exception:

• NEVER Recap Needles by Hand: Two-handed recapping of contaminated needles is strictly illegal under OSHA standards. (If recapping is unavoidable during rare specialized procedures, a mechanical recapping device or a one-handed "scoop" technique must be used).
• NEVER Bend, Shear, or Break Needles: Bending, shearing, or manually breaking used needles causes blood micro-aerosolization and severe percutaneous injury risks.
• NEVER Remove Needles from Holders by Hand: Used needles attached to evacuated tube holders must be disposed of as a single combined unit directly into the sharps container.

Biohazard Sharps Disposal Container Standards

All contaminated sharps (needles, lancets, butterfly sets, capillary tubes, contaminated glass slides) must be discarded immediately into designated sharps containers. OSHA and NIOSH mandate specific structural and operational standards for sharps containers:

┌──────────────────────────────────────────────────────────┐
│             BIOHAZARD SHARPS CONTAINER STANDARDS         │
├──────────────────────────────────────────────────────────┤
│ 1. RIGID & PUNCTURE-RESISTANT: Heavy-duty plastic.      │
│ 2. LEAK-PROOF: Sealed bottom and sides.                  │
│ 3. COLOR & LABELS: Red or translucent yellow with       │
│    universal Biohazard Symbol & lettering.               │
│ 4. FILL CAPACITY: Close, seal, and replace when container│
│    reaches 2/3 to 3/4 FULL (66% – 75% capacity).         │
└──────────────────────────────────────────────────────────┘

The 2/3 to 3/4 Fill Capacity Rule

Sharps containers must NEVER be allowed to overfill. Overfilled containers lead to sharp protruding tips near the opening, causing severe puncture hazards for staff attempting to drop additional items.

• Containers must be closed, locked, and replaced when contents reach 2/3 to 3/4 full (66% to 75% capacity).
• Once closed and locked, containers must never be forced open, emptied, or reused.

3.5 Cleaning, Disinfection & Sharps Disposal

Maintaining a sterile, decontaminated work environment is vital to interrupt disease transmission between consecutive patients.

Environmental Surface Decontamination Protocols

Phlebotomy drawing chairs, work counters, mobile trays, and centrifuges must be decontaminated:

• At the start and end of every work shift.
• Immediately when visibly contaminated with blood or body fluids.
• Between routine patient collections when contamination is suspected.

Decontamination Agents & Bleach Dilutions

Blood Spill Cleanup Procedure

1. Don appropriate PPE (gloves mandatory; gown/face shield for large spills).
2. Cover the blood spill with absorbent paper towels or spill-absorbing powder.
3. Carefully pour freshly prepared 1:10 sodium hypochlorite solution over the towels, working from the outer perimeter inward to avoid spreading the spill.
4. Allow a minimum wet contact time of 10 minutes to ensure total inactivation of HBV, HCV, HIV, and bacterial spores.
5. Wipe up decontaminated slurry with paper towels and dispose into biohazard waste bags.
6. Re-wipe area with disinfectant and allow to air dry.

The Chain of Infection Model

The Chain of Infection describes the six continuous links required for a communicable disease to spread from an infected source to a new individual. If any single link in the chain is broken, infection cannot occur.

┌──────────────────────────────────────────────────────────┐
│ 1. INFECTIOUS AGENT (Pathogen: HBV, HIV, C. diff)        │
└───────────────┬──────────────────────────────────────────┘
                │
┌───────────────▼──────────────────────────────────────────┐
│ 2. RESERVOIR (Infected patient, blood, water, surfaces)   │
└───────────────┬──────────────────────────────────────────┘
                │
┌───────────────▼──────────────────────────────────────────┐
│ 3. PORTAL OF EXIT (Puncture site, blood spill, cough)     │
└───────────────┬──────────────────────────────────────────┘
                │
┌───────────────▼──────────────────────────────────────────┐
│ 4. MODE OF TRANSMISSION (Direct contact, needle stick)    │
└───────────────┬──────────────────────────────────────────┘
                │
┌───────────────▼──────────────────────────────────────────┐
│ 5. PORTAL OF ENTRY (Needlestick puncture, non-intact skin)│
└───────────────┬──────────────────────────────────────────┘
                │
┌───────────────▼──────────────────────────────────────────┐
│ 6. SUSCEPTIBLE HOST (Unvaccinated phlebotomist, patient)  │
└──────────────────────────────────────────────────────────┘

Breaking the Chain of Infection in Phlebotomy

Phlebotomists target specific links in daily practice to halt disease transmission:

• Breaking Mode of Transmission: Performing hand hygiene between patients and disinfecting drawing chairs between procedures.
• Breaking Portal of Entry: Engaging safety needle shields immediately and wearing gloves to prevent blood contact with non-intact skin.
• Protecting Susceptible Host: Receiving the Hepatitis B vaccination series and maintaining immune health.