CHILDREN S SERVICE. Local Code of Practice 7. Infection Control

Transcription

1 CHILDREN S SERVICE Local Code of Practice 7 Infection Control Revised Sept 2008 Page 1 of 23

2 Author: Service: Division John Kempster Resources Health & Safety Unit Intended Target Group: Educational Establishments Issued April 1994 Last Reviewed: Sept 2008 Page 2 of 23

3 Children s Service Local Code of Practice No 7 Infection Control 1. Introduction: 1.1 Under the Health & Safety at Work Act 1974, the London Borough of Barnet has a duty to ensure as far as is reasonably practicable the health, safety and welfare of its staff. The LA also has a duty to ensure, as far as is reasonably practicable, that other persons are not placed at risk by the authority s undertakings. 1.2 As part of the above duties the LA will, as far as is reasonably practicable, minimise any risk of infection to staff and others by ensuring sound infection control practices. 1.3 This document outlines the arrangements that are to be made throughout educational establishments to reduce minimise the risk of infection. 2.0 Responsibilities 2.1 The LA has a general duty under section 2 and 3 of the Health & Safety at Work Act 1974, as far as is reasonably practicable, to ensure the health, safety and welfare of employees and other persons using establishments within the LA s control 2.2 Governing Bodies have a statutory duty to ensure health & safety on premises under their control in practice, to comply with the LA s directions, and to co-operate with the LA so far as is necessary to enable the LA to comply with its statutory responsibilities. 2.3 As with other matters concerning the effective management of educational establishments, it is the responsibility of the head teacher to carry out the policies agreed and maintained by the LA and the Governing Body. 2.4 It is the responsibility of the head teacher to manage the day to day arrangements for infection control within the arrangements defined by the LA and the Governing Body. 2.5 Head teachers and governing bodies must be able to demonstrate via risk assessment and or COSHH assessments where there is a risk of cross infection, that systems and procedures have been introduced to remove or minimise the risk. 2.6 Head teachers must ensure that staff are made aware of relevant cross infection assessments and that they receive appropriate information, instruction, training and supervision to enable them to work safely. 3.0 Selecting a Cleaning Contractor When drafting specific infection control procedures you should ensure that the Contractor adhere to current best practice and this includes the following guidance: British Institute of Cleaning Science (BICS): Health Protection Agency (HPA): Page 3 of 23

4 3.0.3 Guidance on Infection Control and Communicable Diseases in Schools, Colleges and Nurseries fection%20control%20and%20communicable%20diseases%20in%20schools.pdf Guidance on Infection Control in School and other Child Care Settings Barnet Primary Care Trust: Guidance on Managing Health Care in Schools and Setting London Borough of Barnet LCOP 7 Infection Control 3.1 Purchasing LA Approved Contract Cleaners Through a tendering and procurement exercise the Corporate Procurement Team have established LBB approved cleaning contractors. These services are available to educational establishments. For further details of this Service contact Corporate Procurement Team spt@barnet.gov.uk. 3.2 Educational Establishments purchasing their own Cleaning Arrangements It is recommended that Appendix A be followed to select in conjunction with relevant parts of the LCOP 9 Contractor on Educational Establishments to appoint a Contractor. The LA requires that Cleaning staff are CRB checked. 3.3 Monitoring: Arrangements should be made to ensure monitoring systems are set up to ensure that the infection control procedures function correctly Provision and maintenance of protective clothing and equipment Provision and maintenance of suitable hand washing facilities which are separate to waste disposal and food preparation facilities Appropriate clinical waste disposal equipment Material Safety Data Sheets and COSHH Assessment are readily available at the premise location Emergency details for Cleaning Contractor Equipment, materials and areas are colour coded to mitigate against cross infection Locked facilities to store chemicals, equipment, materials Facilities and equipment to deal with a spillage Establishing safe systems for the collection, disposal and storage of clinical waste Provision and maintenance of cleaning and disinfecting equipment Establishing systems for hazard reporting General cleaning procedures Triggers that would initiate additional cleaning procedures For LBB approved Contractors follow the Corporate Cleaning Flow. This can be obtained from Corporate Procurement Team spt@barnet.gov.uk Cleaning is delivered to BICS Cleaning Standards Page 4 of 23

5 4.0 Points to consider if you suspect an infectious disease A child or adult who has contracted an infectious disease often feels generally unwell with symptoms that might include feeling cold and shivery, headache, vomiting, unusual tiredness and sore throat. This usually happens before the development of a rash or any other symptoms typical to the infection. If a child is unwell at school, the parent/carers should be contacted so that they can collect the child with a view to consulting their GP if necessary. In the meantime, the child should be taken to a quiet, warm area and kept comfortable. If symptoms appear very serious, head-teachers should call an ambulance for transfer to hospital where immediate treatment can be obtained for the child. A member of the school staff should normally accompany any child taken to hospital by ambulance. If an adult, whilst at school, feels unwell to continue their duties they must notify the Headteacher or nominated representative to arrange, if applicable, a replacement for the class. Initially, the adult may be taken to a quiet, warm place and kept comfortable. If symptoms persist the adult should go home or see their GP. First, ensure that the adult is safe to travel home unassisted. If symptoms appear very serious, then the head-teachers should call an ambulance for transfer to hospital where immediate treatment can be obtained. The School Nurse can provide information on infectious disease control and should be the first port of call for advice. HPA Guidance on Infection Control and Communicable Diseases in Schools, Colleges and Nurseries ( n%20control%20and%20communicable%20diseases%20in%20schools.pdf) provides a recommended period that children must be kept away from school or other settings for individual infections/diseases and infection control measures. This guidance is equally applicable to adults. If contact cannot be made with the School Nurse or his/her relevant base, the North East and Central London Health Protection Unit (NECLHPU) should be contacted. The Health Protection Team at NECLHPU should also be informed in the following circumstances: 4.1 An unexpected increase in the number of cases of any infectious disease in a class or throughout the school 4.2 Illness amongst staff and/or children associated with school trips 4.3 An unusually large number of absences due to illness in a number of children or staff, whether or not the cause is known 4.4 Advice should always be sought from the Health Protection Team (before issuing advice or information about meningitis). When contacting the Health Protection Team about a possible outbreak, it is helpful to have the following information to hand: o o o o o Name of infection (if GP/hospital confirmed) or description of main symptoms Number of cases involved (teachers, assistants and pupils) Who is affected i.e. a group, family, class or throughout school Date outbreak started or increase noted Measures taken to date to control the outbreak Page 5 of 23

6 Health Protection Agency Team North East & Central London Health Protection Unit 7th Floor Holborn Gate, 330 High Holborn, London, WC1V 7PP Tel: Direct line: Fax: In such circumstance the following should also be informed (Detail Appendix B) o LA Children s Service Information Service o LA Health & Safety Unit 5. Staff: 5.1 General Employees have a duty to take reasonable care of themselves and others who may be affected by their acts or omissions They are required to comply with this local code of practice and the LAs specific arrangements and procedures on infection control Report to the headteacher / manager any health and safety hazards or deficiencies in the infection control arrangements they identify Cuts on staff members' exposed skin must be covered with a waterproof dressing When a member of staff contracts a communicable disease, the same rules apply to them as to the children. Staff should not be at work until well from any communicable disease. 5.2 Considerations for pregnant staff: Some infections, if caught by a pregnant woman, can pose a danger to her unborn baby. Ideally women of child bearing age should be informed at the time of employment to ensure they are appropriately vaccinated. In general, if a pregnant woman develops a rash or is in direct contact with someone with a potentially infectious rash this should be investigated by a doctor. The greatest risk to pregnant women from such infections comes from their own child/children rather than the workplace Chickenpox Chickenpox can affect the pregnancy if a woman has not previously had the disease. If a pregnant woman is exposed early in pregnancy (the first 20 weeks) or very later (the last three weeks before birth) she should promptly consult her GP, midwife or obstetrician. A blood test can show if she is immune. Shingles is caused by a re-activation of the virus that causes chickenpox. It is possible for a person who has not had chickenpox before to catch chickenpox from someone who has shingles, but you cannot catch shingles from someone who has chickenpox or shingles. Page 6 of 23

7 People with shingles should avoid contact with people at risk of serious chickenpox, including pregnant women (especially near the time of delivery), newborn babies and immuno-compromised individuals. If exposed, these people may require immunoglobulin treatment to help protect them against the infection German Measles (Rubella) If a woman who is not immune to rubella is exposed to this infection in early pregnancy her baby can be affected. If a woman who may be pregnant comes into contact with someone with rubella she should inform her GP, midwife or obstetrician immediately. The HPA recommends that all female staff under the age of 25 years, working with young children should have evidence of two doses of MMR vaccine Slapped Cheek Syndrome (Parvovirus B19) The following women should see their GP, midwife or obstetrician to consider having blood tests for Parvovirus B19. Women who, while in the first 20 weeks of pregnancy, either o have been in close contact with a case (defined as living in a household setting with a case; sharing a meal with a case; or being in the same room as a case for over an hour) or o work (in contact with children) in a school or nursery where there is an outbreak of slapped cheek syndrome (defined as two or more cases in the same class or year group, or three or more cases in the school or nursery, with onset separated by less than three weeks). There is no need to exclude pregnant women from work, even if there is an outbreak of slapped cheek syndrome, as nearly all transmission takes place before the child is unwell Measles During early pregnancy can result in early delivery or even loss of the baby. If a pregnant woman is exposed immediately inform GP, midwife or obstetrician to consider having blood tests. The HPA recommends that all female staff under the age of 25 years, working with young children should have evidence of two doses of MMR vaccine. 6. How some Infectious Diseases are Spread Knowledge of the different routes of transmission of infection enables sensible precautions to be taken to prevent cross infection. Modes of transmission are: 6.1 Direct contact - usually dirty hands, 6.2 Indirect contact o toilets/potties/changing mats o clinical waste e.g. used pads, dressings etc o classroom equipment and toys o clothing/linen/cloths/mats 6.3 Airborne such as coughs and sneezes Page 7 of 23

8 6.4 Skin punctures cuts, grazes and blood / body fluids on sharp instruments or needles 6.5 Sexual transmission 6.6 Vectors flies, etc 6.7 Food 7. Basic good hygiene Good infection control measures are essential to protect children and staff. This can only be achieved through education and awareness. The involves the assistance of everyone (teachers, nursery nurses, parents, welfare staff, school governors, cleaning staff and the health service) so that the possible spread of infection can be prevented or controlled and normal school and nursery activities maintained. This includes. Thorough washing and drying of hands after using the toilet, before handling any food, after handling animals and after dealing with any blood or bodily fluid secretions. Staff should use universal precautions (treating all blood and body fluids as being potentially infectious) when dealing with any blood or body fluid spills, sharps or splash injuries and performing first aid. Covering any cuts or open lesions on exposed areas of the body with a waterproof plaster prior to the start of the school day. Encouraging children to use a tissue when they cough or sneeze. The tissue should be disposed of appropriately in a waste bin and hands washed as soon as is practical after nose blowing. Ensuring that there is adequate ventilation of school and nursery classrooms. Ensuring basic hygiene is included in the relevant part of the curriculum. Ensuring that children who are unwell are sent home with the recommendation that they go to their GP if appropriate. Staff should be aware of the need to report and take appropriate precautions if they suspect or are confirmed as having an infectious disease. It may be necessary to liaise with their Occupational Health Department or GP for advice. All staff who are involved in the preparation or serving of food should have completed a basic certified food hygiene course. The educational establishment should contact Environmental Health Department at the L A for further advice. The key is to maintain good communication between all those involved in the control of infectious diseases. 8. Hand Washing Hands commonly transfer bacteria. Thorough hand washing is most important in infection control. If hands are properly washed soon after contact with potentially infective bacteria, these transient bacteria s will be easily removed. 8.1 When should you wash your hands? After using the toilet Before preparing, serving or eating food After handling pets and/or animals After any cleaning procedure including spillages Changing babies nappies Page 8 of 23

9 8.1.6 After handling soiled clothing After dealing with waste and chemicals When hands feel or look dirty 8.2 Correct hand washing procedure (when hands may have been contaminated or before carrying out a task where cleanliness is important) See Appendix C Remove rings where possible (keep safe). If rings cannot be removed move them up and down to allow the skin beneath to be washing thoroughly Turn on taps (consideration should be given to lever /foot operated taps in high risk areas) Wet hands up to forearms, apply soap/cleanser Smooth soap/cleanser evenly over hands for seconds, lather well Hold hands down so that the water from the finger tips drains into the sink Avoid splashing clothing or floor Rub hands together vigorously, use friction on all surfaces including between fingers and beneath rings Rinse hands thoroughly holding hands down Ensure taps are clean, by washing them in soap and rinse, if necessary, (this is particularly necessary where hands are used for turning on/off taps) Dry hands thoroughly, taking special care between fingers Paper towels or a hot air dryer should be used for drying. Appropriate provision should be made collection of used paper towels. 9. Sanitary Facilities Children develop good hygiene practices if they are provided with adequate facilities. These should be available at all times and not just in the event of an outbreak. Fear of vandalism should not be a reason for failing to provide sanitary facilities. 9.1 A hand wash basin with warm running water. 9.2 A mild liquid soap preferably in a wall mounted liquid soap dispenser with disposable cartridges. Bar soap should not be used. 9.3 Disposable paper towels should be conveniently sited next to the basins in wall mounted dispensers. Roller towels are not recommended and if used should be changed at least daily. Hot air hand dryers are not generally suitable for schools and nurseries as they may be frightening to children, cause hands not to be dried properly or delays on returning to classroom and spreads germs around the room. 9.4 Bins with foot operated lids, positioned near the hand wash basins. These should be lined with sealable disposable bags, which should be changed regularly. 9.5 Adequate supplies of toilet paper in each toilet cubicle. 9.6 Suitable sanitary disposal facilities should be provided in schools where there are female pupils aged nine or over (i.e. junior and senior age groups). Girls should have access to emergency supplies of sanitary protection. 9.7 Any school/nursery which accepts children: o who are still in nappies o being potty trained o with continence aids must have appropriate facilities and procedure in place. For further guidance refer to HPA Guidance on Infection Control and Communicable Diseases in Schools, Colleges and Nurseries Page 9 of 23

10 ( n%20control%20and%20communicable%20diseases%20in%20schools.pdf) 10. Personal Protective Equipment (Please refer to LCOP 15) All members of staff should wear appropriate CE marked protective equipment when handling body fluids or potentially contaminated materials. Adequate supplies of the following may be required depending on risk assessment: Non sterile latex/vinyl gloves Sterile latex gloves General household gloves for cleaning Single use disposable aprons Plastic protective goggles, spectacles or visors 10.1 Disposable Gloves Disposable gloves should be worn where there is a risk of infection particularly when dealing with body fluids. Cross contamination between staff and others is minimised by the wearing of gloves Sterile latex/vinyl gloves should be worn where there is a risk of transmitting infection through open wounds or broken skin e.g. during cleaning or dressing wounds Non sterile latex/vinyl gloves should be used for procedures involving contact with body fluids e.g. washing or changing of incontinent children or changing urine drainage bags Disposable gloves must be discarded after: Every single use; Direct contact with a person s body fluids Disposable Plastic Aprons Disposable plastic aprons should be worn when: Taking care of children if clothes or bed linen is likely to be soiled There is a risk of splashing of body fluids Aprons must be disposed of after every single use Eye and Face Protection Goggles or spectacles are only necessary when there is a risk of splashing body fluids Maintenance and replacement of Personal Protective Equipment (PPE) Please refer to LCOP Disposable PPE must be disposed of after use into a clinical waste bag and any items used for the mopping up If reusable PPE is used there must be: Page 10 of 23

11 o An effective system of maintenance to ensure that the equipment continues to provide the degree of protection for which it was designed. o Maintenance is required under the Personal Protective Equipment Regulations and includes details on appropriate cleaning, disinfection, examination, replacement, repair and testing. o The head teacher is responsible for ensuring that such maintenance is carried out and that written maintenance procedures are produced in accordance with the advice provided by the manufacturers. o These procedures together with any records of tests and examinations should be kept in a safe location and be available for inspection if required. o The head teacher should arrange for a competent person to check the personal protective equipment before it is issued to staff and to instruct staff on how to check their PPE before it is worn. o Correct PPE should be used when handling cleaning chemicals. This will have been identified in the COSHH assessment. See LCOP 6 Control of Hazardous, Explosive and Dagerous Substances. o (A competent person is someone with the relevant experience and technical knowledge of a subject. The manufacturer or supplier of the PPE may be able to fulfil this requirement). o All damaged PPE must be withdrawn from use immediately and replacement PPE issued General Cleaning for Infection Control Cleaning of the environment, including toys and equipment should be frequent, thorough, and follow national guidance e.g. use colour coded equipment, COSHH, correct decontamination of cleaning equipment. Monitor cleaning contracts and ensure cleaners are appropriately trained with access to PPE (see Section 10). The Cleaning Contractors Tender Documents should stipulate a regular programme of cleaning to be followed. Cleaning Standards for different surface have been published by BICS The cleaning regime should include: Thorough cleaning with hot water and detergent using disposable cloths, followed by adequate drying, to render the environment and items of equipment free of micro-organisms likely to cause infection Any spillages clean up immediately with hot water and detergent and ventilate the area. Disinfectant and sodium hypochlorite solution may discolour carpets. Spillages should be cleaned with a germ killing carpet cleaner or warm soapy water and then dried Disinfectants are not necessary for general environmental cleaning; they are expensive, can be toxic and resistance can develop. Use is recommended as detailed below and for Outbreaks Toilets and washbasins should be cleaned daily, and whenever there is visible soiling. A cleaning product that combines both a detergent and a disinfectant may be used for visible soiling, for wiping toilet/door handles, light switches, etc. During outbreaks of diarrhoea, vomiting etc it is recommended that a hypochlorite disinfectant should be used (see Outbreaks). Page 11 of 23

12 If there is contaminated broken glass, use a scoop dispose of fragments into a sharps box Tanks of water used for play activities should be drained and cleaned regularly (at least weekly) and when visibly dirty. Paddling pools should be cleaned, dried and stored deflated or inverted Washing of water bottles is the responsibility of the parents. Parent should be reminded to frequently clean their childs bottle and use bleach based solutions following an outbreak Water play equipment should be cleaned with detergent and dried after use All toys should be washable or easily cleaned. They should be washed at least weekly or more frequently if visibly dirty. Toys should be cleaned on a daily basis if used by very young children or if they put them in their mouths. Children should be discouraged from putting toys in their mouths All toys should be checked regularly and replaced if broken/damaged Sandpits should be covered for protection and the sand kept clean by regular sieving. Sand should be changed regularly (e.g. four weekly for indoor sandpits) Replace soft modelling materials and dough regularly Communal play activities (e.g. sand/water play, cookery) will need to be suspended to help prevent the spread of specific infections. (See Outbreaks) General house keeping and prevention of cross infection in the working environment All toilet and changing areas must be ventilated, adequately lit and specifically designed to facilitate cleaning For general hygiene purposes, separate gloves and cloths should be used for toilet/bathroom and kitchen cleaning. Colour coding these items, in accordance with national practice will help to reduce the risk of accidental contamination Colour coding: o It is recommended that the National Colour Coding Scheme for cleaning materials is adopted as standard in order to improve the safety of cleaning, ensure consistency and provide clarity for staff. The National Colour Coding Scheme is designed to standardise, and in some cases streamline, existing schemes. o Cleaning materials and equipment that should be colour coded - National Colour Coding Scheme: Page 12 of 23

13 Bathrooms, washrooms, showers, toilets, basins and bathroom floors General areas including classrooms, departments, offices Catering departments, kitchen areas and food service areas Isolation Areas Rubber household gloves should be washed in hot soapy water after use and dried in a ventilated area. Gloves should be examined before use to ensure that they remain in good condition. If punctured, torn or if they show signs of deterioration they should be discarded Control of body fluid spillage s Body Fluid Disposal Kits aid the effective cleaning and disinfection of the soiled area and reduces the risk of cross infection. These are available from the majority of health & safety and first aid providers e.g. St John Ambulance All spillages of blood, faeces, saliva, vomit, nasal and eye discharges should be cleanedup immediately and PPE MUST BE WORN. When spillages occur, clean using a product which combines both a detergent and a disinfectant. Use as per manufacturers instructions and ensure it is effective against bacteria and viruses, and suitable for use on the affected surface. NEVER USE mops for cleaning up blood and body fluid spillages use disposable paper towels and discard as clinical waste. A spillage kit should be available for blood spills. The following protective clothing and equipment must be available for staff use as part of the spillage kit: Page 13 of 23

14 Disposable latex sterile and non sterile latex gloves Disposable plastic aprons Eye and face protection Sodium hypochlorite / b/each solution (Milton, Ha-tablets, Presept or equivalent product) Paper towels Yellow (Clinical waste bags) Detergent Plastic bucket/bowl 12.1 Spillage of body fluids, not visibly contaminated with blood e.g. faeces, vomit, urine and sputum Always wear disposable gloves and a plastic apron. Goggles should be worm for cleaning large spills It is advisable to open window(s) when cleaning up vomit and keep other people away from the spill until it has been cleaned up Use paper towels to soak up the spillage, discard directly into a clinical waste bag Clean contaminated area with sodium hypochlorite solution (one part sodium hypochlorite to 10 parts water) or hot water mixed with disinfectant and dry thoroughly to avoid slipping accidents Carpets and fabrics should be cleaned with carpet cleaner and dried Dispose of paper towels, waste and disposable PPE in a plastic bag and securely tie to prevent any leakage. Small amounts of such waste can be disposed of with domestic waste but where large amounts are likely to be generated arrangements should be made for supply and collection of clinical waste bags with the LA Wash goggles in hot soapy water Blood Spills Wear disposable gloves and plastic aprons. Goggles should be worm for cleaning large spills Ventilate room by opening nearby windows. Cover spillage with sodium hypochlorite solution and leave at a minimum of 2 minutes. If the spillage is urine and is visibly contaminated with blood, use neat Milton solution or suitable alternative Clear up the spillage with paper towels or a plastic scoop if available and discard directly into a clinical waste bag Wash contaminated area with hot water and detergent Place aprons, gloves and all items used for the cleaning into a clinical waste bag for incineration Wash goggles in hot soapy water. Page 14 of 23

15 12.3 Urine Spillage Do not use any chlorine releasing agents (Domestos or Titan) as chlorine gas may be released If not visibly contaminated with blood, follow the guidelines in If visibly contaminated with blood: o Wear disposable gloves and plastic aprons. Goggles should be worn for cleaning large spills. If used wash in hot soapy water. o Use paper towels to soak up the spillage o Clean the contaminated area with neat Milton solution or equivalent 13.0 For spills on carpets and upholstery Hypochlorite (bleach) can corrode metal and damage fabrics, particularly if used at the wrong concentration. Hypochlorite solution will damage fabrics and soft furnishings (e.g. carpets, curtains, toy). Spillages on these should be dealt with as below but General Purpose Detergent and hot water used instead of hypochlorite. It may be necessary to arrange for the soft furnishing or carpets to be steam cleaned to prevent/remove staining or particularly following an infection/disease outbreak. Your cleaning service contractors should be able to provide this service or know who can Wear latex gloves and disposable apron 13.2 Clear away excess with disposable paper towels and dispose of as clinical waste 13.3 Clean area with cold water 13.4 Clean area thoroughly with detergent and hot water 13.5 Allow to dry thoroughly 13.6 Once dry, go over area with mechanical cleaner 14.0 Laundry Laundry should be dealt with in a separate dedicated facility. Soiled linen should be washed separately at the hottest wash fabric will tolerate. Wear PPE when handling soiled linen. Soiled children s clothing should be bagged to go home, never rinse by hand Clinical waste. Always segregate domestic and clinical waste in accordance with local policy. Used nappies/pads, gloves, aprons and soiled dressings should be stored in correct clinical waste bags in foot operated bins. All clinical waste must be removed by a registered waste contractor. All clinical waste bags should be less than 2/3rds full and stored in a dedicated, secure area whilst awaiting collection. Further advice: Local Code of Practice No 5 First Aid in Schools Corporate Policy Arrangement No 17 Infection Control 16.0 Infections and Diseases Outbreaks If any criteria outlined in Section 4 Points to consider if you suspect an infectious disease is met then the following must be contacted immediately: Page 15 of 23

16 16.1 HPA Team 16.2 LA Children s Service Communications Team; 16.3 LA Health & Safety Unit (See Appendix B for contact details); and 16.4 Cleaning Contractor In such circumstance it is recommended that the measures below are followed: 16.5 Adhere to the guidance provided by HPA and LA; 16.6 In partnership with the Cleaning Contractor review cleaning practice with that specified in the this LCOP; 16.7 Consult HPA Guidance on Infection Control and Communicable Diseases in Schools, Colleges and Nurseries ( %20Infection%20Control%20and%20Communicable%20Diseases%20in%20S chools.pdf). This lists Common Infectious Diseases and provides guidance on how to identify, how it spreads, school exclusion and Do and Don t points; 16.8 Increase the frequency of the cleaning regime using a bleach based disinfectant (1 part bleach (hypochlorite): 10 parts water). Care should be taken to avoid mixing bleach with other cleaning materials as a chemical reaction may occur releasing chlorine gas. This should be assessed as part of the COSHH assessment. Access to the COSHH assessment should be available at all times While washing of water bottles is the responsibility of the parents, Parent should be reminded to clean their childs bottle using bleach based solutions Communal play activities (e.g. sand/water play, cookery) will need to be suspended to help prevent the spread of infections during outbreaks Toiletry items should not be shared and systems should be in place to control this The HPU will be able to provide additional advice on this that will include increasing the frequency for cleaning Cuts, Bites and Needlestick Injuries 17.1 Dealing with cuts and nose bleeds When dealing with cuts and nosebleeds, staff should follow the usual school s first aid Procedure (See LCOP 4) Staff must wear disposable gloves when dealing with all bleeding wounds. Staff or Children who are known to be HIV positive, hepatitis B positive or other blood disease do not need to be treated differently Intact skin provides a good barrier to infection, and staff should always wear waterproof dressings on any fresh cuts or abrasions on their hands Staff should always wash their hands after dealing with other people s blood even if when gloves have been worn or they cannot see any blood on their hands Disposable gloves should be disposed of immediately after use, even if they look clean. Page 16 of 23

17 17.2 Human bites Human mouths are inhabited by a wide variety of organisms, some of which can be transmitted by bites Human bites resulting in puncture or breaking of the skin are potential sources of exposure to blood borne infections therefore it is essential that they are managed promptly There is a theoretical risk of transmission of hepatitis B from human bites. Therefore, those individuals identified at risk or the injured person should be offered a vaccination Although HIV can be detected in saliva of people who are HIV positive there is no documented evidence that the virus has been transmitted by bites. o If a bite does not break the skin: Clean with soap and water No further action is needed o If a bite breaks the skin: Clean immediately with soap and running water Record incident in accident book Seek medical advice as soon as possible (on the same day) to treat potential infection to protect against hepatitis B for reassurance about HIV 16.3 Animal bites Most animal bites are less likely to become infected than human bites, but they should still be taken seriously There is no rabies in the UK, so vaccination against rabies is not required in this country. Children who are bitten on school trips abroad to countries where rabies is known to occur should seek immediate medical attention In the UK, bites, which do not break the skin, should be washed with soap and water If a bite breaks the skin, wash with soap and water then seek medical advice about the possible need for treatment to prevent infection. If someone becomes generally unwell or the bite looks infected they should seek medical advice Sharp injuries Occasionally children or staff may injure themselves on sharps e.g. used hypodermic needles, knife blades, nails, pins etc Ensure the injured person obtains the necessary care and disposed of safely of the sharp to avoid this happening to someone else This can be done by contacting the LA or by placing the sharp in a rigid container If someone pricks or scratches themselves with a used hypodermic needle:- Wash the wound thoroughly with soap and water Cover it with a waterproof dressing Record it in the accident book and complete the accident form Seek immediate medical attention from a General Practitioner or the Accident and Emergency Department about the possible need for immunisations (e.g. tetanus, hepatitis B) or for treatment if the wound becomes infected. Page 17 of 23

18 There have been no documented cases of people acquiring HIV or hepatitis B from discarded needles. Nevertheless, hepatitis B immunisation is recommended in these incidents so it is important to seek medical advice within 24 hours of sustaining the injury. 17 Employees working with pupils who have physical or mental disabilities in schools and special units. The prevalence of Hepatitis B and possibly Hepatitis A (due to poorer personal hygiene) is higher in special needs groups. Vaccination is recommended particularly for Hepatitis B but it is not a substitute to full compliance with the infection control procedures. Vaccination will however, provide added protection in the event of accidental injury such as a scratch or bite. The risk of Tetanus through human bites is also higher and vaccination is recommended There is also a risk of Polio to previously un-immunised staff through the close contact with recently vaccinated children and the handling of soiled materials. Vaccination is recommended to staff that have not been previously immunised Physical education teachers and staff regularly involved in outdoor pursuits and educational visits. Due to the regular exposure to soil, tetanus vaccination should be considered and boosters received at the appropriate intervals. Those involved in water sports and biology field trips may also be at risk from Leptospirosis 19.0 Other teaching staff In most cases the risk of microbiological hazards are low. Tuberculosis (TB) vaccination is recommended to staff who have been exposed to known cases of TB. Page 18 of 23

19 APPENDIX A Selecting your own Contractor For different reasons and purposes you may wish to approve a contractor yourself. You must assess in advance the competence of the contractor. Although the extent of the assessment will depend upon the nature of the work involved, the same principle applies whether the contract is simple and verbal or more substantial contracts. Larger scale or more hazardous operations you may need to seek specialist advice. On recognising the need to appoint a contractor, the Project Manager must carefully consider the scope of the work and only appoint contractors who can demonstrate the skills and experience required and will give preference to appoint contractors who are on the: LA approved list: Contractors Health & Safety Scheme (CHAS) Where this is not possible other potential indicators are: Past performance Work undertaken elsewhere (in other similar premises) Membership of trade bodies Accreditation by trade bodies e.g. IEE, Corgi, BICS registration Once a potential contractor has been identified as a guide the suitability and sufficiency of the following technical, quality, environmental and health & safety information should be checked. 1 Technical information and expertise The training, qualification and experience of the contractor who intends to do the work must match with the specific tasks to be done. Are they a member of a trade body or accredited body e.g. BICS, Corgi, ECA etc 2 Quality management Are they accredited to ISO 9001:2000 or any other accreditation scheme that provides a measure of their quality management? Do they have a quality policy/system? Are they committed to recognised quality codes of practice and standards? Alternatively establish your own criteria to assess quality. 3 Environmental management Are they accredited to ISO 14001:2000 or any other accreditation scheme that provides a measure of their environmental management? The contractor should provide an environmental policy to be assessed. Any contractor which meets a minimum Environmental Policy criteria set: o Typical Minimum Environmental Policy criteria: o Endorsement by top management o Commitment to seek continual improvement in environmental performance o Commitment to prevention of pollution o Commitment to comply with relevant environmental legislation relating to your activities, products and services Page 19 of 23

20 Any contractor who is certified to either ISO14001 or EMAS is automatically deemed to have met minimum environmental requirements. They should still provide an environmental policy for records. The contractor must inform of any previous environmental prosecutions in the past 3 years and provide details 4 Health & Safety Minimum requirements: Health and safety policy (5 or more employees) Copies of registration certificates (if applicable) Copies of recent risk assessments (applicable to the nature of works) this would include COSHH assessments Information on procedures for risk assessment and report of accidents Example of typical method statement Full assessment of Contractor Competence: Experience of the type of work required; Formal qualifications and skills of the people doing the practical work; Memberships of trade or professional bodies; Accident history over the last three years; The contractor s selection process for assessing the competency of their subcontractors; Health and safety training and supervision given to their operatives; The assessment of their competence by any independent third party. Documentation provided must include: H&S Policy, which, should be complete with organisation and arrangements; A list of H&S Training, which, should be comprehensive covering specific areas of the contract; Risk assessments, which, should adopt a standard 5 Step approach, identifying: Tasks, Hazards; People who might be harmed; Evaluation of risks for each hazard; Control measures and assessment of the adequacy of the controls; COSHH assessment Method statements, which, follow the hierarchy of controls; A procedure for protection from imminent danger for themselves, others who might be affected and the environment; A procedure for selection and supervision of sub-contractors; A list of prosecutions against them for health and safety offences in the last 3 years and a summary of effective corrective measures applied to prevent a recurrence; A list of enforcement notices issued against them for health and safety offences in the last 3 years and a summary of effective corrective measures applied to prevent a recurrence; Accident statistics over the last 3 years Excellent <1 RIDDOR /100 employees / Year Good 1 3 RIDDOR /100 employees / Year Poor >3 RIDDOR /100 employees / Year How the contractor intends to provides adequate First Aid support; Page 20 of 23

21 How the contractor will ensure the provision of adequate welfare arrangements; How the contractor will provide suitable and sufficient personal protective equipment free of charge; Details of the contractor s emergency procedures. Page 21 of 23

22 APPENDIX B IMPORTANT CONTACTS Health Protection Agency Team North East & Central London Health Protection Unit 7th Floor Holborn Gate, 330 High Holborn, London, WC1V 7PP Tel: Direct line: Fax: LA Children s Service Information Service London Borough of Barnet NLBP Oakleigh Road South London N11 1NP Tel: Fax: Health & Safety Unit London Borough of Barnet NLBP Oakleigh Road South London N11 1NP Tel: Fax: Page 22 of 23

23 APPENDIX C HAND WASHING Wet hands, apply soap (preferably liquid) and use the following procedure With thanks to The Royal College of Nursing - July 2006 Page 23 of 23