Handling Hazardous and Infectious Materials: NCLEX-RN
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of handling hazardous and infectious materials in order to:
- Identify biohazardous, flammable and infectious materials
- Follow procedures for handling biohazardous materials
- Demonstrate the safe handling techniques to staff and client
- Ensure safe implementation of internal radiation therapy
Hazardous materials are defined as those things that are not biological but still remain hazardous to human beings including patients and staff. Examples of hazardous materials are chemicals and radiation.
The US Occupational Safety and Health Administration mandates that information about all hazardous materials is readily accessible to workers including those who work in the health care environment. Information about hazardous materials is found on Material Safety Data Sheets which are published and distributed to the users of their products to fulfill the mandates of OSHA and to protect workers.
Material Safety Data Sheets (MSDS) include the name of the product, information about the product's risks, measures, such as washing the skin, that must be taken when a person has been exposed to some risk relating to the product and information about the procedures for using, handling, disposing of and storing the particular product.
Biohazardous waste is defined as biological waste that can be hazardous to humans. Items such as sharps and bed linens that are contaminated with blood or other bodily fluids, such as feces, are considered biohazardous medical waste.
The careful handling and disposal of all hazardous materials protects staff, clients, and visitors from harm.
Biohazardous materials are heavily regulated at the national, state and local levels. All health care facilities, therefore, are legally mandated to have complete and appropriate policies and procedures relating to the labelling, storage, use and disposal of biohazardous, or biomedical, materials.
Biohazardous materials place clients, staff and visitors at risk for exposures to bloodborne pathogens and pathogens transmitted with bodily fluids.
Flammable and Combustible Materials
Examples of some of the flammable and combustible materials that are commonly used within health care settings and facilities are medical gases, such as oxygen and nitrous oxide, flammable and combustible liquids such as those contained in some cleaning fluids and aerosol cans.
Biohazardous materials threats can be decreased and eliminated with a combination of administrative controls, work related controls and engineering controls.
Established policies and procedures are examples of administrative controls to decrease the dangers associated with biohazardous materials risk; the utilization of proper and safe practices such as handwashing is an example of a work related control that decreases the threats associated with biohazardous materials; and engineering controls aim to decrease the dangers associated with biohazardous materials and these controls include such things like the selection of and placement of impervious red containers in all client rooms to collect disposable, contaminated sharps.
Some of the other preventive measures relating to biohazardous exposures include:
- The use of single patient disposal supplies and equipment such as a disposable, single use blood pressure cuffs
- Needleless systems
- Proper handwashing
- Standard and special transmission precautions
- Red biohazardous waste containers and bags
- The use of personal protective equipment
- The use of a neutral zone in surgical areas and other areas where invasive procedures are done
- The safe disposal of sharps not only in health care facilities but also in the client's home and their community
The U.S. Environmental Protection Agency mandates the safe disposal of needles, syringes and other sharps in all areas of the community, in addition to their proper and safe disposal by health care facilities.
The proper and safe disposal of biohazardous material in the community includes:
- Community Drop Boxes and Supervised Collection Sites: The client can dispose of used needles in many doctors' offices, hospitals, pharmacies, health departments, and fire stations.
- At-Home Needle Destruction Devices: At home needle destruction devices destroy used needles and, as such, make them safe for household disposal. Clients in the home should be instructed to contact their solid waste disposal company for specific local information and resources relating to sharps disposal.
- Syringe Exchange Programs: Sharps users can also safely exchange used needles for new needles by contacting the North American Syringe Exchange Network at (253) 272-4857 for no cost. The site is www.nasen.org
- Mail-Back Programs: Sharps can also be disposed of by mailing them in a special container to a collection center for a fee.
Flammable and combustible medical gases can be stored in individual canisters or provided to the client care area with a centralized medical gas delivery system. Emergency shut off valves are mandated for centralized medical gas delivery system in the case of an emergency.
Medical gas containers must be designed, constructed, and labeled according to OSHA regulations. The following color labels are used for the following gas canisters.
- White: The international color for oxygen
- Yellow: Air
- Green: Oxygen
- Light Blue: Nitrous oxide
- Red: Ethylene
- Orange: Cyclopropane
- Brown: Helium
- Brown and Green: Helium and oxygen
- Gray: Carbon dioxide
- Gray and Green: Carbon dioxide and oxygen
Oxygen safety in the health care setting and within the home environment includes the use of a "No Smoking" signs, avoiding all synthetic fibers and fabrics near the oxygen because fabrics and fibers other than cotton can create static electricity, and not using any flammable liquids like acetone near the oxygen source.
In the health care facility and also within the home oxygen canisters must be safely secured and transported.
The registered nurse, as an educator, must assess the learning needs of clients and staff members in terms of their ability and competency related to the safe handling and management of biohazardous materials and materials that are flammable or combustible.
For example, clients and staff should have a thorough understanding of and knowledge about types of things that are considered biohazardous and they should also demonstrate the proper, safe and correct techniques related to the correct handling and disposal of sharps and other biohazardous waste.
Radiation therapy can be broadly categorized as external and internal radiation therapy.
Radiation safety is based on the three safety principles of time, distance and shielding. In other words, the risk of exposure to internal and external radiation can be decreased when the nurse, and other health care personnel such as an X ray technician, minimize and decrease the amount of time that they are exposed to and in close proximity with radiation; they must also maximize the distance between themselves and the source of the radiation, and, they must also shield themselves from the radiation using things like a lead apron and gloves when they are near the source of radiation.
The risk for exposures to radiation decreases when the duration of the time exposed to the radiation is decreased and when the distance from the radiation and the shielding is maximized.
External ionizing radiation is used for diagnostic testing and also for therapeutic care. For example, a chest x ray uses radiation for diagnosis and therapeutic external radiation, sometimes referred to as teletherapy, is done by using a linear accelerator that delivers electron and gamma ionizing radiation for a minute or so to treat and reduce the size of a tumor.
Therapeutic internal radiation, which is also referred to as brachytherapy, internal radiation, interstitial radiation and intracavity radiation, is a therapeutic procedure that entails the internal placement of some radioactive material into or near the client's tumor. Therapeutic internal radiation entails the delivery of high doses of radiation using a needle, wire or radioactive seed.
Brachytherapy is most often delivered to clients who are affected with tumor and cancer of the prostate, lungs, esophagus, cervix, endometrium, rectum, breast, head and neck.
Special radiation precautions are initiated when a client is receiving brachytherapy in order to protect visitors and health care staff from the harmful effects of the radiation. Some of these special internal radiation precautions include:
- The minimization of the duration of time that health care providers are in the client's room to deliver care and services to the client
- The placement of the client receiving internal radiation in a private room
- The prohibition of the client's activities outside of their room
- The initiation of complete bed rest for the client until the treatment is discontinued
- The provision of education to the family members and other visitors that includes information about their need to limit the time of their visits to at least less than 1 hour, to stay at least 6 feet away from the client and to not enter the room if a visitor or family member is pregnant.
- The need for health care staff to minimize the amount of time spent in the room, to decline to enter the room if they are pregnant, to retain all supplies and equipment including things like bed linens in the client's room until they are deemed safe for disposal by a person who is competent to make this decision, and how and when to report concerns about the client's treatment such as when implanted seeds inadvertently leave the client's body.
- Accident/Error and Incident Prevention
- Emergency Response Plans
- Ergonomic Principles
- Handling Hazardous and Infectious Materials (Currently here)
- Home Safety
- Reporting Incident/Event/ Irregular Occurrence/Variances
- Safe Use of Equipment
- Security Plans
- Standard Precautions/Transmission Based Precautions/Surgical Asepsis
- Use of Restraints/Safety Devices