GUIDELINES ON PROTECTION AGAINST BLOOD BORNE VIRUSES. Section Subject Page. 1 Blood borne viruses 2. 2 The Health & Safety Legislation 2

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1 PROTECTION AGAINST BLOOD BORNE VIRUSES OCCUPATIONAL HEALTH & SAFETY GUIDELINES DATE ISSUED: February 04 GUIDELINES ON PROTECTION AGAINST BLOOD BORNE VIRUSES Section Subject Page 1 Blood borne viruses 2 2 The Health & Safety Legislation 2 3 Routes of Transmission 3 4 Risk Assessment 3 5 Safe Working Practices 3 6 Immunisation against Hepatitis B procedure 4 7 Record Keeping 4 8 Leaving Hertfordshire County Council or 5 changing jobs 9 Actions taken after accidental Sharps and 5 splash injury 10 Universal precautions 6

2 GUIDANCE ON PROTECTION AGAINST BLOOD-BORNE VIRUSES This Guidance is to provide advice to staff employed by HCC on the prevention of occupational acquired infection from blood-borne viruses. 1. Blood-borne viruses 1.1 Blood borne infections occur where infected blood is transferred into the body by another individuals blood. 1.2 The Hepatitis Viruses (Hepatitis B, C and D) which cause liver disease, and HIV that causes AIDS, can sometimes be found in certain groups of the population. A person may be a carrier of a virus without realising as they may have not shown any of the symptoms. They can however still pass the virus on through accidental exposure to another person s blood or other infected blood fluids. 1.3 Most people recover from Hepatitis B after a period of 6 months. About 10% of people who get the infection develop a chronic condition where there is more risk of damage to the liver. They may also become long-term carriers of the infection. 1.4 Hepatitis A and E viruses are normally transmitted by faecal-oral route. They do not present a significant risk of blood-borne infection. 2. The Health and Safety Legislation Introduction 2.1 Under the Health and Safety at Work Act 1974 and the Management of Health and Safety at Work Regulations, Hertfordshire County Council has a legal duty to protect the health of employees who may be affected by their work. Hertfordshire County Council must ensure that employees are aware of the risks in their workplace and are familiar with the safety measures and procedures in place. 2.2 Specific legislation on biological hazards such as blood-borne viruses is contained in the Control of Substances Hazardous to Health (COSHH) Regulations. Employers have a legal duty to assess the risk of infection to employees and others affected by their work or who may be exposed to blood-borne viruses. 2.3 Occupations Recognised as being at risk:- Health Care workers including students / trainees. Staff and residents of residential homes for those with severe learning difficulties. Emergency Services in high risk situations Police / Ambulance / Fire and Rescue Services. Coroners / morticians. Haemophiliacs. Prison staff and prisoners. First Aiders. Families adopting children from countries with high prevalence of Hepatitis B. Dentists, Doctors, Nurses, Hygienists, Midwives Staff in special schools and those providing direct care to other high risk groups. 2

3 3. Routes of transmission 3.1 Blood-borne viruses can be transmitted by bodily fluids other than blood. These include urine, faeces, semen, vaginal secretions, saliva, sputum, tears, sweat and vomit. These present minimal risk of blood-borne infection unless they are also contaminated with blood. 3.2 Common routes of transmission are:- Unprotected sexual intercourse. Sharing injecting equipment. Skin puncture by contaminated objects, e.g. needle sticks, broken glass. Blood transfusion. Contaminated equipment during tattooing. acupuncture and body piercing. 3.3 Less common routes are:- Infection through open wounds and skin lesions such as eczema. Splashing mucous membrane of the eyes, nose or mouth. Human bites where blood is drawn. 4. Risk Assessment 4.1 Managers are responsible for carrying out risk assessments on the tasks of staff under their supervision. The COSHH Regulations, will apply in this case. Where exposure to the Hepatitis / HIV viruses is a recognised hazard, then action must be taken to minimise the level of risk to staff. From the risk assessment the most appropriate action can be decided by their managers. 4.2 When calculating the level of risk, the following factors must be considered:- i. Which blood-borne infection is likely to be present? ii. How severe are the consequences? iii. Where is the infection likely to be present (contaminated laundry, contaminated surfaces, needles, waste etc)? iv. Ways in which employees may be exposed (direct contact through using invasive medical procedures, dealing with accidents, handling contaminated items). 4.3 Estimate the level of exposure by considering:- i) How often are staff likely to come into contact with blood? ii) How many different people s blood are they likely to come into contact with? iii) Is the employee part of the a risk occupations listed? 4.4 How good are the existing measures (e.g. provision of protective clothing, standards of personal hygiene? Refer Risk Assessment Form - Appendix 1 5. Safe Working Practices 5.1 Since medical history and examination can not reliably identify all patients or clients infected with Hepatitis B or other blood borne infections, safe working practices should be followed in conjunction with universal precautions to prevent the spread of infection. 3

4 5.2 Safe working practices are the first line of defence against Hepatitis B. All blood products and other body fluids in the work place should be treated as potentially infectious. Always apply good basic hygiene practices, including thorough hand washing and drying after each working procedure. Prevent puncture wounds, cuts and abrasions in the presence of blood and bodily fluids. Avoid the use of or exposure to Sharps but if unavoidable take particular care with disposing of them. Protect all cuts to the skin with waterproof dressing / gloves. Dispose of all contaminated waste safely. Use protective clothing appropriate to the risk e.g. gloves and disposal aprons, Be vigilant at all times where there is a likelihood of a needle-stick injury. 6. Immunisation against Hepatitis B Procedure 6.1 By using the risk assessment process, staff who are at risk from contracting a blood-borne virus should be identified. 6.2 Managers should advise these employees who fall into the at risk group due to their occupation to consider a course of vaccination against Hepatitis B. 6.3 This provides effective protection but should not be regarded as a substitute to the above safe working practices. 6.4 There is only an 80% - 90% success rate from the vaccine. It can be less effective on those over the age of The course consists of three injections over a period of six months. The course must be completed. A follow-up blood test is important to determine immune status. A booster is recommended every five years. 6.6 The vaccines are available from the employee s own general practitioner. The GP may charge prescription charges and a few charge the full cost of the course of vaccinations. These costs will be refunded by the individual departments. 7. Record Keeping 7.1 The Occupational Health Unit will be responsible for keeping a record of all Hepatitis B immunisation status. There will be a recall system to remind employees in writing that their next vaccine or blood test is due. This will also ensure the Occupational Health Unit keep an accurate database. 7.2 Managers will be responsible for the issue of the Hepatitis B vaccination record card to new and existing employees. This should be based on the conclusion of the risk assessment on blood-borne viruses. 7.3 Managers must check the completed Hepatitis B vaccination record card with the individual for relevant information requested before forwarding the information to OHU. 7.4 Managers to return all completed Hepatitis vaccination record cards to Occupational Health Unit for data input. 7.5 Where employees do not wish to be vaccinated against Hepatitis B the manager must send relevant information to Occupational Health Unit for data input. 4

5 7.6 The Occupational Health Unit will then advise relevant managers on any necessary restriction to work practices in accordance to the Universal Precaution. Refer to Hepatitis B Vaccination Record Appendix Leaving Hertfordshire County Council or changing job 8.1 If an employee is moving to another post within the Hertfordshire County Council or leaving Hertfordshire County Council the manager must complete Leavers Form B2 and return to Occupational Health Unit. This will help the Occupational Health Unit to maintain an accurate database. Refer to Leavers Form B2 - Appendix Actions taken after accidental Sharps and splash injury NB: All blood products and other body fluids in the work place must be treated as potentially infected. If you accidentally have blood to blood or other body fluids contact with someone who is infected or a known Hepatitis B carrier, the following steps should be followed: 9.1 Wound should be squeezed to encourage bleeding, DO NOT suck the wound. 9.2 Wash the wound thoroughly using soap and water. 9.3 Cover the injured area with a waterproof plaster. 5

6 9.4 Splashes to mouth or eyes; rinse thoroughly under a running tap or use an eye irrigation set, if available. 9.5 Report incident / accident immediately to appropriate authority / line manager / school head. 9.6 A Hertfordshire County Council Injury or Dangerous Occurrence Report Form must be completed. 9.7 If known, include the source person on the incident form. 9.8 Even If you have been vaccinated and the source person is known to be, or is likely to be, of high risk, you will require URGENT advice regarding treatment. Contact your GP / local hospital immediately. 10. Universal Precautions 10.1 Introduction it is not always possible to identify people who may spread infection to others, therefore, precautions to prevent spread of infection must be followed at all times. These routine procedures are called Universal Precautions. Universal precautions is the term used to describe practices taken to reduce the spread of blood borne viruses relating to the handling of contaminated equipment and material in such a manner as to prevent the transmission of infection to patients and healthcare workers. The Universal Precautions is in accordance with the principles expressed in the Health and Safety at Work Act 1974 and the Control of Substances Hazardous to Health (COSHH) Regulations. All employees have a responsibility to follow Hertfordshire County Council Guidelines on Protection Against Blood Borne Viruses and safe working practices at all times. Universal Precautions mean assessing the task to be undertaken in terms of the likely risk of blood or body fluid splash and wearing protective clothing accordingly e.g. gloves for taking blood, gloves and aprons for cleaning up blood, vomit and urine. Latex / vinyl gloves and disposable apron should always be worn when dealing with excreta, blood and body fluids Risk analysis HIV and the Hepatitis B and C viruses can be transmitted by the following contaminated body fluids:- - Blood. - Semen. 6

7 - Vaginal secretions. - Any other body fluid or excrement containing visible blood i.e. saliva in connection with dentistry. Although saliva has not been implicated in HIV transmissions, it has been implicated in Hepatitis B transmission, so to minimise the risk with emergency mouth to mouth resuscitation, disposable mouthpieces should be made available for use The components of Universal Precautions are:- - Hand washing. - Skin care, which includes protection of cuts and abrasions. - Protective clothing. - Action taken after accidental sharps and splash injury. - Waste management Hand Washing Hand washing is recognised as the single most effective method of controlling infection. Hands should be washed between each client activity. The wearing of gloves is NOT a substitute for hand washing. Where possible a designated sink should be used for hand hygiene only i.e. not for washing contaminated instruments. Types of hand washing methods: Method Solution Task 1 Social Liquid soap (anti-bacterial are not For all routine necessary for social hand hygiene). tasks 2 Hygienic hand Antiseptics, e.g. chlorhexidine or In high risk areas disinfection alcohol hand rub after social clean and during outbreaks How to wash your hands: The areas of the hands that are often missed are the wrist creases, thumbs, fingertips, under the fingernails and under jewellery, which should for this reason, be kept to an absolute minimum. A plain band only, no wristwatches and no nail varnish. Artificial fingernails also present several problems and must be avoided in accordance to Infection Control Guidance. - They harbour fungi and bacteria that can not be effectively removed, even with nailbrushes. - Micro-organisms can dwell and even thrive between the natural and artificial nail. - Artificial nails can cause tears to gloves as the cling to the glove surface and not give adequate protection to employees performing procedure. Hands must be dried using disposable paper towels, as wet hands can be a source of infection. The mechanical action of drying the hands also helps to remove any dead skin cells and bacteria. Other methods of hand drying may increase the number of bacteria on the hands, i.e. shared towelling towel and dirty or incorrectly maintained hot air dryers. Hand washing should be performed as follows: - Wet your hands up to the wrists before applying hand cleanser or liquid soap. - Apply the cleanser / liquid soap. 7

8 - Smooth it evenly all over your hands, including the thumbs and in between the fingers, and lather well, rubbing vigorously. - Rinse off every trace of lather. - Dry really thoroughly, taking special care between the fingers. More than one paper towel may be necessary. - Alcohol hand rub should be used at this stage of working in a high-risk area, or involved in an outbreak of infection. In the absence of adequate / suitable hand washing facilities, i.e. in an individuals home; an alcohol hand rub or wet wipe may be used but only if the hands are visibly clean i.e. free from dirt / grime. However, the hands should be washed thoroughly before attending another client. Manufactures of alcohol hand rub recommend that it should only be used a maximum of seven consecutive times, by which time the hands need to be washed with soap and water. Hands should be washed at least: - Before and after each work shift or work break. Remove jewellery (rings) and wristwatches as they can harbour germs. - Before and after physical contact with a client. - After handling contaminated items such as dressings or personal care. - Before and after use of protective clothing i.e. gloves and aprons. - After using the toilet, blowing your nose, covering a sneeze or cough. - Whenever hands become visibly soiled. - Before eating, drinking or handling food and before and after smoking Skin Care All cuts and abrasions should be covered with a waterproof dressing. Blue dressings must be used if contact with food is likely. If suffering from chronic skin lesions on hands e.g. weeping dermatitis / eczema, this must be reported to the appropriate manager and if necessary the advice of the Occupational Health Unit should be sought Protective Clothing The selection of protective clothing depends on the anticipated risk of exposure to blood or body fluid during the particular activity. In short think about what the task involves and wear the appropriate protective clothing to protect against exposure to any body fluids you will come in contact with. Always dispose of protective clothing as clinical waste. Gloves unpowdered latex (or vinyl) gloves should be worn for any activity where blood or body fluid may contaminate the hands. Hands should be washed immediately after removal of gloves as the gloves may be punctured and because hands are easily contaminated when gloves are taken off. To prevent transmission of infection, gloves must be discarded after each procedure / client contact. Gloves should NOT be washed between clients as they are for single use only, the integrity of the glove will be compromised by washing it and if punctured unknowingly, may cause body fluid to remain in direct contact with skin for prolonged periods. Water-repellent aprons and gloves Water-repellent protection should be worn for procedures anticipated to cause contamination of skin or clothing with blood or body fluid and should be changed 8

9 between each client. This will protect the skin and clothing of the health care worker from contamination by potentially infected body fluid and reduce the risk of cross infection to other clients via clothing. These should be readily available in all areas and are single use only, to be discarded after the task is completed they are not to be re-used Safe disposal of Sharps All sharps must be correctly and safely disposed in a leak-proof, puncture resistant, lockable container. The container should not be filled more than twothirds then sealed and disposed as per departmental procedure. All health care workers should take precautions to prevent needle stick injuries and other sharp instruments or devises during procedures. - Do not re-sheath, bend or break used needles. - Dispose of used needles and syringes as one unit. Spillage s Managing spills spillage must be cleaned cleaned up immediately. A body of fluid spillage kit should be available for spillage s of blood and other body fluids. PROTECT YOURSELF AND OTHERS PRACTICE SAFETY 10.8 Waste Management The Safe Disposal of Clinical Waste Act 1992 requires that clinical waste which is generated as a result of care given by a health care worker in an individual s home is disposed of by incineration. This is considered to be the responsibility of the provider of the health care. Therefore clinical waste has to be either: - Transported back to the base of the health care worker, i.e. the health centre, clinic or general practice, by the health worker. This would require each worker to be provided with a solid plastic box (no less than 1 cm thick) with a snap on lid to carry the clinical waste safely or - Collected from each home by a collection service. This service will need to be arranged by the health care worker it should not be left to the client to organise. Clinical Waste When generated on health care premises, or as a result of health care, the following must be disposed of in yellow bags for incineration: - Soiled swabs and all other contaminated waste following a procedure. - Material other than linen from cases of infectious disease. - Used disposable urine containers, incontinence pads and stoma bags, even from non-infected clients. Sophie Birch Occupational Health Nurse Manager Revised

10 REFERENCES 1. Protection against blood borne infections in the Workplace. HIV and Hepatitis (ACDP), HMSO. 2. Safe Working and Prevention of Infection, HSAL, HMSO. 3. Immunisation against Infectious Disease, HMSO, UK Health Department. 4. Safe Disposal of Clinical Waste. 5. Code of Practice for the Safe Use and Disposal of Sharps. 6. Guidance on Infection Control in Primary Care. 10

11 RISK ASSESSMENT RECORD APPENDIX 1 ESTABLISHMENT/WORKPLACE: WORK ACTIVITY: Potential contact with Blood-borne viruses DESCRIPTION OF ACTIVITY: PEOPLE AT RISK: Employee who has contact with persons Employee who may have blood-borne viruses Work colleagues Clients/Young People Family members Members of the public FREQUENCY: DURATION: SIGNIFICANT HAZARDS: Contaminated laundry Open wounds/soiled dressings Syringes with contaminated needles Contaminated waste Contaminated surfaces Blood transfusions Bites, Puncture wounds where blood is drawn Skin punctured by contaminated objects Body fluids where contaminated blood is present ADVERSE EFFECTS Cross infection of blood-borne viruses: Hepatitis, HIV EXISTING CONTROL MEASURES: Health and Safety at Work Act 1974 Management of Health and Safety at Work Regulations COSHH Regulations HCC Policy on Protection against Blood borne viruses Departmental Policies and Procedures Occupational Health Department advice and guidance Use of Universal Procedures Use of Personal Protective Equipment Staff knowledge, understanding, experience and training Client and Young Persons background knowledge and/or Care Plan Safe disposal of hazardous waste/and sharps Induction process for permanent and temporary staff Advised on inoculations against blood-borne viruses 11

12 RISK FACTOR = ACTION AND TIMESCALE(S) : Managers must ensure where a member of staff has been identified at potential risk of blood-borne viruses, the above control measures MUST be implemented Review risk assessment regularly ( at least annually ) or sooner if any significant change ASSESSED BY SIGNATURE - DATE- REVIEW DATE- 12

13 APPENDIX 2 For queries or advice please contact: Occupational Health Unit County Hall Open: Monday Friday Hours: Hertfordshire County Council Occupational Health Unit Hepatitis B Vaccination Record Name Date of Birth Job Title Department Payroll No. NI No. Work Telephone No Home Telephone No 13

14 Have you completed the full course of Hepatitis B vaccinations consisting of THREE vaccinations and a blood test for titre levels? YES / NO B Vaccination Course Details: 1st Vaccination Date Hepatitis 2 nd Vaccination Date 3 rd Vaccination Date Blood Test Date Titre levels Further Boosters If you do NOT wish to be vaccinated against Hepatitis B please complete the following: I confirm that I have read and understood the County Blood Borne Virus Policy. Due to the nature of my duties I have been advised to have the Hepatitis B vaccination and testing for immunity from my general practitioner. I have made the informed decision NOT to be vaccinated against Hepatitis B. I am aware of the need to use universal precautions. I am aware of the possible risks to my health and that of others should I contract the Hepatitis B infection. Signature Date 14

15 APPENDIX 3 HERTFORDSHIRE COUNTY COUNCIL Occupational Health Unit Leavers Form B2 To Managers: This form MUST be completed for employees moving/leaving and who are at risk Name Payroll no Department Job Title Work tel Moved from (dept/unit) Moved to/left organisation (dept/unit) Date of move/leaving Manager s name (please print) Manager s signature Please return this completed form to the Occupational Health Unit at County Hall within ONE WEEK of employee s departure Tel: