Cleaning up a blood spill in a hospital follows a specific two-step process: first clean the visible material, then disinfect the surface with an intermediate-level disinfectant. Every spill should be addressed immediately, and the exact approach varies depending on whether the spill is small (a few drops) or large (more than about 10 mL). The goal is to eliminate bloodborne pathogens like HIV, hepatitis B, and hepatitis C from the surface so it’s safe for handling and use.
Contain the Spill First
Before touching anything, restrict access to the area. Place a warning sign near the spill so foot traffic doesn’t track contaminated material through the facility. If the spill is spreading, confine it by surrounding the edges with absorbent paper towels, cloths, or absorbent granules that solidify the blood on contact. This keeps the contaminated area as small as possible and prevents it from reaching drains or high-traffic zones.
Put On PPE in the Right Order
Personal protective equipment goes on in a specific sequence: gown first, then face mask and eye protection (goggles or a face shield), and gloves last. Gloves go on last because they’re the layer most likely to contact the spill, and putting them on after everything else prevents you from contaminating your other equipment while dressing.
For blood spill cleanup, you’ll typically need waterproof utility gloves (heavier than standard exam gloves), a face shield or splash goggles, shoe covers, and a gown or disposable coveralls. If there’s any chance of sharps in the spill, such as broken glass or needles, the heavier utility gloves are essential.
Handle Sharps Before Cleaning
Never pick up broken glass, needles, or scalpel blades with your hands, even gloved hands. Use mechanical tools: a brush and dustpan, tongs, or forceps. Place recovered sharps directly into a puncture-resistant sharps container. If a sharps injury is possible during cleanup, the surface should be decontaminated with a stronger bleach solution (1:10 dilution) before you begin the full cleaning process. This reduces your infection risk if you do get cut.
Clean, Then Disinfect
This is the core of the process, and the order matters. Do not use a combined detergent-disinfectant product. The two steps are separate.
Step 1: Clean. Wipe up the visible blood with absorbent paper towels or cloths. For a large spill, lay absorbent material over the entire area and let it soak up the bulk of the fluid. Dispose of all contaminated absorbent material into a biohazard bag. Then wash the surface thoroughly with a neutral detergent (regular cleaning solution) and warm water. This removes organic matter that would otherwise interfere with the disinfectant’s effectiveness.
Step 2: Disinfect. Apply a facility-approved intermediate-level disinfectant to the cleaned surface. The most common and widely recommended option is a sodium hypochlorite (household bleach) solution, but the concentration depends on the spill size.
Bleach Dilution Ratios by Spill Size
For small spills of just a few drops on a nonporous surface, a 1:100 dilution of standard household bleach (5.25% to 6.15% sodium hypochlorite) is sufficient. That works out to roughly 525 to 615 parts per million of available chlorine, which is enough to kill HIV and hepatitis viruses on a clean surface.
For large spills of more than about 10 mL, use a 1:10 dilution for the first application. This stronger concentration accounts for the higher volume of organic material and reduces infection risk during cleanup. After that initial decontamination, follow up with a second application at the 1:100 dilution as a final disinfection step.
Instead of bleach, you can use any disinfectant registered with the EPA as effective against bloodborne pathogens. These products have been tested and verified to kill HIV, hepatitis B, and hepatitis C. Check that the product label specifically includes directions for use against these viruses. The EPA maintains a searchable list of registered products (List S) if your facility is evaluating options.
Contact Time Is Critical
Whatever disinfectant you use, it has to stay wet on the surface for its full required contact time. For bleach solutions, this is typically 10 minutes. Don’t wipe it up early. If the solution dries before the contact time is reached, it may not fully inactivate pathogens. After the contact time, rinse the area with clean water to remove disinfectant residue if the product requires it.
Dispose of Waste Correctly
All absorbent towels, cloths, gloves, and disposable coveralls used during cleanup go into labeled biohazard bags. Blood-soaked materials are considered regulated medical waste in most states, though the exact threshold for “blood-soaked” varies by state regulation. Sharps go into puncture-resistant sharps containers, never into regular trash or biohazard bags.
Any reusable equipment you used during cleanup, such as mops, cleaning cloths, or dustpans, must be sent for reprocessing (cleaning and disinfection) immediately after the spill is resolved. Don’t set them aside for later or return them to a supply closet.
Remove PPE in Reverse Order
Taking off contaminated equipment is where many exposure incidents happen. The general sequence is the reverse of how you dressed: gloves come off first (since they’re the most contaminated), then face shield or goggles, then gown, then face mask. Perform hand hygiene immediately after removing gloves and again after all PPE is off. Some facilities train staff to remove gloves and gown together in one step, which is also acceptable.
What Your Facility Needs to Have in Place
OSHA requires every healthcare employer with workers who may be exposed to blood to maintain a written Exposure Control Plan. This plan must spell out the cleaning schedule, decontamination methods, and specific procedures for different areas of the facility. It’s reviewed and updated at least once a year, and employers are required to get input from frontline, non-managerial staff who do direct patient care when selecting safety controls and equipment.
A well-stocked blood spill kit should be readily accessible in areas where spills are likely. A standard kit includes: disinfecting solution, sharps-handling tools (forceps, tongs, or an autoclavable broom and dustpan), absorbent paper towels, biohazard bags, waterproof utility gloves and nitrile or latex gloves, face protection, shoe covers, disposable coveralls, a warning sign, a bucket, and a printed copy of your facility’s standard operating procedure for spills. Having all of these in one grab-and-go kit eliminates the delay of hunting for supplies while a spill sits exposed.
All surfaces that come into contact with blood must be decontaminated immediately or as soon as feasible, after any spill, and at the end of the work shift if contamination may have occurred since the last cleaning. That three-trigger standard applies across the facility, not just in patient rooms.