safe work procedure sharps and bio-hazardous waste ... documents... · australian college of...

Australian College of Natural Medicine Pty Ltd (ACNM) trading as Endeavour College of Natural Health, FIAFitnation, College of Natural Beauty, Wellnation

Safe Work Procedure - Sharps and Bio-hazardous waste handling and disposal - PR-043 Effective Date: 5 February 15 Authorised by: National HSE Committee Version: 5.0

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)

Location: All campuses

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.

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



# Specific Step in Process Safety Instructions – Endeavour standards To be completed:

PPE to be used (if any)

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. Non-

carpeted 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.

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.

X Prior

Ο During

Ο After

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.

X Prior

Ο During

X After





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

before a procedure

after touching a patient

and/or

after touching a patient’s

surroundings

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).

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)

X Prior

X During

X After

4

Disposable latex gloves are to be

worn if student or client has broken

skin, or is predisposed to cracking

skin (e.g. eczema, psoriasis etc.).

Use disposable latex gloves if required. Ensure glove is put on before

contact with client or other student and there are no tears in glove

material.

X Prior

X During

X After

Disposable latex

gloves.





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

X During

X After

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 Prior

X During

Ο After

Following insertion of needles:





7 Needles are removed from client.

Student practitioner to put a disposable latex glove on his/her non-

dominant 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).

Ο Prior

X During

X After

Ensure there is a

sharps container

available for

disposal of

needles.





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.

Ο Prior

X During

X After

Removal of full sharps containers and bio-hazardous waste bin liners:





9a Student/Supervisor/Clinic Manager

identifies if sharps container and/or

bio-hazardous waste bin has

reached ¾ of capacity and if so they

are to arrange for removal to the

designated area on site and replace

as outlined.

A sharps container is considered to

be full when the needles inside have

reached the line marked on the

outside of the container, or it is ¾ full

– whichever comes first.

Sharps Containers:

It is the responsibility of all students using clinic rooms that contain a

sharps container and/or bio-hazardous waste bin to make a regular

visual check of the levels of the containers/bins.

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

modality, a Supervisor, a member of the clinic Operations team, or a

facilities staff member).

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. “double-

layered”) 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;

X Prior

X During

X After

Disposable latex

gloves (double-

layered)





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 needle-

stick 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

considered to be full when it is ¾ full

of bio-hazardous waste (i.e. used

cotton balls and any other blood-

stained materials/products, and used

urine dipsticks).

Bio-hazardous waste bins:

Once a bin is close to ¾ full, the related Supervisor or Clinic Manager

should be notified. They will then nominate a person (“the attendant”)

to empty the waste bin (i.e. a student from that modality, a Supervisor,

a member of the clinic Operations team, or a facilities staff member).

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;

X Prior

X During

X After

Disposable latex

gloves (double-

layered)





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 bio-

hazardous 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.

X Prior

O During

X After

11

Pillows are to be stored back on bed Pillows which are defective must be replaced. Ο Prior

O During

X After





12 Beds and basin wiped down with a

clean cloth and hot, soapy water (as

a first choice), or pH neutral anti-

bacterial wipes at the end of each

day.

Disposable latex gloves to be worn during this process. Ο Prior

Ο During

X After

Disposable latex

gloves.

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.

Plastic wrapper to be disposed of in standard waste bin

Ο Prior

Ο During

X After

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 Prior

Ο During

X After

Disposable latex

gloves.



Additional Information:

National Health and Medical Research Council, Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010):

http://www.nhmrc.gov.au/book/html-australian-guidelines-prevention-and-control-infection-healthcare-2010

Chinese Medicine Board of Australia, Infection prevention and control guidelines for acupuncture practice, October 2013:

http://www.chinesemedicineboard.gov.au/Codes-Guidelines/FAQ/Infection-prevention.aspx

NSW Government, Department of Health, Generic “Waste Management Plan” For Health Care Facilities, January 1st 1999:

http://www0.health.nsw.gov.au/pubs/1999/pdf/generic_wmp.pdf

Biohazard Waste Industry, Industry Code of Practice for the management of clinical and related wastes, 6th Edition 2010 (see pp 11-12 of

90):

http://www.epa.sa.gov.au/xstd_files/Waste/Code%20of%20practice/Code%20of%20Practice%206th%20Edition.pdf

World Health Organisation, Safe management of wastes from healthcare activities, 1999:

http://www.who.int/water_sanitation_health/medicalwaste/wastemanag/en/

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.

http://www0.health.nsw.gov.au/pubs/1999/pdf/generic_wmp.pdf

http://www.epa.sa.gov.au/xstd_files/Waste/Code%20of%20practice/Code%20of%20Practice%206th%20Edition.pdf

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