HCV and Menstruation

12 12 2011

When girls first start menstruating, one of the less-talked about side effects is the messiness. A practical mom of an HCV+ teenage girl contacted us to find out just how to deal with potential blood and body fluid exposures in the home and in public areas.

We thought the answers to her questions might serve many families, so we’re posting them here, with thanks to several infection preventionists who pitched in to provide answers!

In no particular order, here are the questions and answers.

Q: What cleaning products can we use to kill the hepatitis C virus?

Hepatitis C is not an easy bug to kill. Store-bought products (such as Lysol®, Clorox® Clean-up® Cleaner with Bleach, or Mr. Clean®) are not effective.

Bleach is questionable with regard to killing HCV. The proper dilution and the state of the HCV will vary the efficacy. If HCV is in a dried state, it is harder to kill than if it’s in a liquid state.  With all blood or infected body fluids, the area needs to be physically cleaned first and then disinfected with 1:10 dilution of bleach (one part bleach, 10 parts water), although studies (see references below) are varied on efficacy.

Ethanol in studies does not show efficacy. Hand Hygiene Alcohol MSDS sheets do not list HCV as a bug that is killed by an alcohol hand rinse.

Moving to hospital grade disinfectants—quaternary ammonium chloride such as Coverage® Spray HB Plus Ready-To-Use One Step Disinfectant kills HCV. Lysol® Brand I.C. Quaternary Disinfectant Cleaner (concentrate), soon to be available on Amazon.com, kills HCV.

Super Sani-Cloth Wipes to be used on environment, a quaternary in a cloth/wipe form, kills HCV. Although I would like to emphasize that cleaning the environment must occur before any of these products are effective. Clorox® Germicidal Wipes, bleach wipes for the environment, kills HCV.

For any product, the label must be read. If the label states that it kills HCV, then follow the manufacturer’s guidelines with regard to kill time.

For skin that is contaminated with blood, the hands or skin can be cleaned with soap and water. Wet the skin, suds and use friction on  the area with soap for 20 seconds or more, and thoroughly rinse the skin with warm water. This is not to kill the virus but an action to rinse the virus off the skin.

Answering these questions was a very useful refresher on bloodborne pathogens. Breaking the chain of infection is key in preventing transmission to others. Each link must be present and in sequential order for an infection to occur. The links are: infectious agent, reservoir, portal of exit from the reservoir, mode of transmission, and portal of entry into a susceptible host.

References:

  • Resistance of Surface-dried virus to common disinfection procedures, FG Terpstra, Elsevier Ltd, June 29th 2007
  • The Effect of Blood on the antiviral activity of sodium hypochlorite, a phenolics and Quaternary compound, Weber and Rutala, ICHE, 1999 20: 821-827
  • Recommendation or Prevention and Control of Hepatitis C virus, MMWR, October 16,1998
  • Guidelines on prevention of transmission of Hept C virus infection in the workplace: do they work in practice; Oxford University Press on behalf of Society of Occupational Medicine 2007
  • Efficacy of Sodium Hypochlorite in Eradication Hep C from peritoneal effluent of PD patients , peritoneal Dialysis International, 2010, volume 30, pp 644-659
  • How Stable is Hep C? Environmental Stability of HCV and its Susceptibility to Chemical Biocides, JID, 2010:201 June 15th
  • Lysol Brand IC Quaternary Disinfectant Cleaner (concentrate – MSDS)
  • Coverage Spray HB ready to use One – Step disinfectant – MSDS
  • Professional Lysol Brand Disinfectant Foam Cleaner for Multiple Surfaces MSDS
  • Clorox Germicidal Wipes, Label

Cathy Doern Stone, BSMT,CIC, ASCP Infection Prevention  Coordinator Good Samaritan Regional Medical Center, Corvallis, Or 97330

Q: How does one handle and dispose of soiled sanitary pads, underwear, or tampon applicators? What about the mess that soiled hands leave behind?

There are a variety of products on the market for the disposal of tampons and sanitary napkins (search the internet “products for tampon/sanitary napkin disposal”).  The products may have some advantages over a plastic baggie that can be difficult to seal with potentially soiled hands in a restroom stall.

There are towelettes that can kill HCV, but they are not meant for cleaning of skin, just cleaning of surfaces (it takes 3-4 minutes for HCV to be killed on a surface with these products).

Towelettes for hand sanitizing can be used to clean hands prior to leaving the stall— they are available in small packets that can be kept in a purse.  Hand washing with soap and water is important before leaving the bathroom, even if towelettes are used to wipe the visible blood off of your fingers, because the towelettes won’t kill HCV, they will just wipe off some of the blood.

When an HCV+ woman is having her menstrual period, she needs to be prepared to dispose of her sanitary napkin/tampon in a way that decreases exposure of her blood to the environment.

When entering a public restroom, she needs to practice procedure that flows from dirty to clean. This means that prior to entering the restroom stall, she needs to have the items to complete this process—napkin/tampon, disposal bag, disinfectant wipes, and hand cleaning wipes.

She should then get the items out of her purse if there is a place/shelf to put them. If there is not a place, then she should at least put them at the top of her purse, so she is not digging around for them when she needs to use them. Next step is to open the items she needs, such as disposal bag.

Remember, if she is in a public restroom with the designated metal disposal box with leak proof bag she does not have to put her napkin/tampon in a separate bag unless it is very soiled and leaky (that is to reduce contamination of the metal box as it is placed in it). The rationale for this is that the special metal containers are meant for everyone’s napkin/tampon, and all items should be treated as potentially infectious, not just one individual’s napkin/tampon.

The restroom cleaning person’s job description to empty and clean that container falls under the OSHA mandate to receive education and training for bloodborne pathogens. They should know how to properly handle this by using proper personal protective equipment.

While she is removing her napkin/tampon, it might be best to use her less dominant hand so she will have her dominant hand with better control to reach for the disposal bag on top of her purse.

If she has any soiled underwear, she should replace it at this time using a separate disposal bag since she will bring it home to wash. After removing and replacing the napkin/tampon, she needs to clean the environment of any visible blood with the disinfectant wipes. Put the used disinfectant wipes in either the special metal box, if available, or the disposal bag that contains her used napkin/tampon.

If she has visible blood on her hands, she should use the hand cleaning wipes. Also, put the used hand wipes in either the special metal box, if available, or the disposal bag that contains her used napkin/tampon.

Once she leaves the stall, she needs to do hand hygiene at the sink with soap and water. Research has shown that we need to pay attention to cleaning our thumbs, between fingers, around our wrist, and our dominant hand. Also, once she is finished with water, soap, and drying her hands, she should use a paper towel to turn off the faucet and to open the bathroom door, since so many people open the door without doing hand hygiene.

As for her soiled clothes, if she is away from home she should remove them and place them in a plastic bag with the intent of removing the items as soon as she gets home. If it will be awhile before she will return home, she might want to add some water to the bag to keep it moist.

Once she is home, she should place the soiled item in a designated bucket to soak. If someone else is handling her soiled clothes, they should wear gloves. Also, remember to not hold the soiled items next to your clothes. If there is excessive blood or blood clots, they should be mechanical removed either with gloved hands or brush. Next step is to spray some stain remover on the area. OxiClean® is one product that works on red stains. Remember to follow the manufacturer’s instructions. For OxiClean®, spray it on the stain until it’s saturated, rub in, and let stand for up to 10 minutes. Do not let OxiClean® dry on fabric.

Erin Coke, Infection Preventionist/Employee Health, Ashland Community Hospital, Ashland, OR 97520

(Another infection preventionist contributed quite a bit to this answer, but due to her workplace, she asked that we not share her name.)

Q: What precautions should be taken around the house?

Standard precautions (acting under the assumption that all blood and body fluids are potentially infectious) can and should be followed at home, especially for people living with HCV, in order to prevent the transmission of the virus to others.

Casual contact, such as sharing household items (dishes, cups, and glasses) is not a risk. But blood, body fluids, and items that come in contact with blood are possibly infectious.

Cleaning up blood spills and not sharing household grooming equipment (such as razors, nail clippers, and toothbrushes) will keep people and their families safe from HCV and other infections.

LAUNDRY:

  • Clothes may be washed together with regular detergents
  • Use gloves when handling any clothes stained with blood, semen, or vaginal fluids
  • Wash blood-stained items in hot soapy water using one cup of bleach per load
  • If items cannot go into the wash, wipe them dry and take them to the dry cleaners

Per HIV Edmonton, 9702 111 Ave. NW Edmonton, AB  T5G 0B1 (877)-388-5742, (780) 488-5742, Fax (780) 488-3735, contact@hivedmonton.com

Wash contaminated items with hot water and detergent for at least 25 minutes. Presoaking may be required for heavily soiled clothing. The most important factor in laundering clothing contaminated is elimination of potentially infectious agents by soap and hot water.

Per VA Department of Health

PRECAUTIONS FOR BLOOD SPILL CLEAN-UP

When cleaning up blood spills, the following steps are important for preventing the spread of bloodborne infections like HCV:

  • Wear gloves—torn gloves will not protect the hands from coming into contact with the blood.
  • Carefully remove any sharp pieces, such as broken glass, and put them in a sturdy plastic container like one used for detergents.
  • Wipe up the blood using paper towels or disposable rags and cloths.
  • Disinfect the area with a solution of at 1 part bleach to 9 parts water. [note the difference in solution compared to Cathy’s in the first Q/A – perhaps take your pick?]
  • Wipe up the bleach solution using paper towels or disposable rags and cloths.
  • Dispose of the gloves, paper towel, rags and cloths into a durable bag.
  • Wash hands thoroughly

Wendy Griffin, RN, BSN, MSPH, Infection Preventionist, Oregon Health and Science University, Portland, Oregon.





The Stink About Public Bathrooms

31 03 2010

Public restrooms!  Dirty, wet, odorous endurance trials—never fun, sometimes necessary.

Most of us detest public restrooms and we all have certain rituals we perform when we have to use them: piling on a liberal amount of toilet seat covers, hovering over the seat, using an elbow to open and close doors. Sometimes we just “hold it” until a more appealing option comes along.

Public restrooms are said to harbor an unhealthy mix of microbes. This may be true, but we were surprised to find those germs waiting in unlikely places.

Myth #1: Toilet seats are the germiest places in a public restroom.

Not so, say the experts. The germiest place in a public restroom is the floor. Also in the running are routinely touched objects: latches and sink handles.

Myth #2: The womens’ restroom is usually cleaner than the men’s restroom.

While it may smell better (due to the lack of urinals) and be more appealing (due to male grooming habits), women’s restrooms usually have higher bacteria counts than men’s restrooms, due to women spending more time in the restroom and often bringing their children with them to take care of business.

Bonus disgusting fact: germs are transported from the restroom when women set their bags and purses on the restroom floor and then take them back outside. What do the experts suggest? Use a hook or, if possible, have a traveling companion on the outside hold onto it for you.

Myth #3: The farther away a stall is from the door, the less used it is.

Actually, most people believe this and use the stalls that are farthest from the door. The cleanest stalls are usually the ones closest to the door.

Myth #4: Air dryers are more sanitary because you don’t have to push a lever/button.

Surprisingly, not so! Air drying machines blow germy air directly onto your hands, your clothes, and into the air you breathe.

Myth #5: Squatting is safer than using a cover or just using a bare seat itself.

Maybe, but squatting doesn’t allow the bladder to be fully emptied, putting you at risk for a urinary infection.

Myth #6: I can hold it, I guess! No big deal.

Holding it for too long also puts you at risk for a urinary infection.

Myth #7: Bathrooms harbor germs you don’t find in normal settings.

Bathrooms have the same germs you come into contact with everywhere else by shaking hands, touching rails, and opening doors.

Myth #8: All my rituals are useless and unnecessary.

There’s nothing wrong with turning off the faucet and opening the door with paper towels. No one is going to laugh at you for using a paper toilet seat cover. Rituals are there for comfort and do contribute to your health. You don’t need to pretend a public restroom is the same as the one you have at home, but it might be easier to “go” if you aren’t thoroughly disgusted by your surroundings. Just be sure to lather those hands after you’re done!

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