A nurse working in a ward notices that blood has spilled on the floor during blood collection. The spill covers an area of more than 20 cm. The nurse asked the housekeeping staff to clean the spill on the floor. What would the recommended disinfectant used for handling this spill be?

1. A

   1:100 dilution of 5% sodium hypochlorite

2. B

   1:2 dilution of 2% bleach solution

3. C

   1:5 dilution of 5% bleach solution

4. D

   1:10 dilution of 5% of sodium hypochlorite

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

• The question describes a blood spill larger than 20 cm, which is classified as a large biohazard spill.
• Large spills contain a high organic load that can inactivate disinfectants, requiring a stronger concentration than routine cleaning.
• Standard infection control protocol for large blood spills recommends a 0.5% sodium hypochlorite solution.
• This concentration is achieved by making a 1:10 dilution of standard 5% sodium hypochlorite (household bleach).

Why Other Options Were Wrong

• Option A: This 1:100 dilution creates a 0.05% (500 ppm) solution, which is insufficient for the high organic load of a large blood spill.
• Option B: This creates a 1% solution. While a strong disinfectant, it is not the standard recommended concentration for the initial management of a large blood spill according to most guidelines.
• Option C: This also creates a 1% solution (5% divided by 5). As with the other 1% option, it deviates from the specific 0.5% protocol for large blood spills.

Related Visual

• Visual 1: Infographic: Step-by-step guide for cleaning a large blood spill, including PPE, containment, application of disinfectant, contact time, and disposal.
• Visual 2: Chart: A comparison chart showing disinfectant types (e.g., sodium hypochlorite, alcohol, glutaraldehyde) and their appropriate uses, concentrations, and contact times in a hospital setting.

Clinical Relevance

• Nursing practice connection: Knowing Infection control and management of large biohazard spills helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• A nurse's primary responsibility is patient safety, which includes preventing nosocomial (hospital-acquired) infections. Proper spill management is a critical component of this.
• Incorrectly cleaning a biohazard spill can lead to the transmission of bloodborne pathogens like HIV, Hepatitis B, and Hepatitis C to patients and healthcare workers.
• Nurses must not only know the correct procedure but also be able to supervise and ensure that housekeeping or other staff follow the correct protocol.

How to Approach the Question

• First, identify the key clinical information in the stem: 'blood spill' and 'more than 20 cm'.
• Recognize that the size ('more than 20 cm') is the crucial factor that classifies this as a 'large spill'.
• Recall the principles of infection control, specifically that the management protocol differs for small versus large spills due to the organic load.
• Access your knowledge of standard disinfectant concentrations. For a large blood spill, the required strength is 0.5% sodium hypochlorite.
• Evaluate each option by calculating the final concentration: (Stock % / Dilution Factor).
• Option A: 5% / 100 = 0.05%. Option B: 2% / 2 = 1%. Option C: 5% / 5 = 1%. Option D: 5% / 10 = 0.5%.

Concept Tested & Keywords

• Concept Tested: Infection control and management of large biohazard spills.
• Stem keywords: blood spill, floor, disinfectant, more than 20 cm
• Lead-in keywords: What would the recommended disinfectant
• Clinical cues: The spill size 'more than 20 cm' is the critical detail that classifies it as a large spill, dictating the required disinfectant strength.

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