MANAGING EXPOSURE TO BLOOD AND BODY FLUIDS

Transcription

1 MANAGING EXPOSURE TO BLOOD AND BODY FLUIDS Health and Safety Services Health and Safety Services Issue 1 November 14 1

2 1. Introduction This policy outlines the measures which should be present in all local management procedures throughout the University, where risks arise from exposure to blood and body fluids and provides the basis for an emergency action plan in the event that accidental inoculation occurs. In 2013, the Health and Safety (Sharp Instruments in Healthcare) Regulations came into force. Although the University is not included in the list of employers which must comply with these regulations, the principles contained within them form a reference tool for risk assessment when considering possible exposure to blood and other body fluids. Additionally, many of the vocational courses which we offer as a University, are educating students to go into the healthcare professions which are directly governed by these regulations, therefore the promotion of the same standards within University practices make sense from a consistency perspective. This policy is aimed at activities which take place within the control of the University. Clinical academic staff working as doctors on other sites registered for medical practice should follow the policies and procedures in force within those establishments. 2. Definitions A list of definitions is included in Appendix Responsibilities Individual Students and Employees Individuals are responsible for: Following the standard operating procedures within their areas of work, and using equipment provided for reasons of health and safety appropriately. This includes the use of safe sharps wherever possible, where these are provided. Reporting any incidents of sharps injury promptly and following emergency procedures in place. Heads of School and Departments Heads of Department are responsible for: Setting up suitable local arrangements to safely manage risks associated with exposure to blood and body fluids and to comply with the requirements of this policy Ensuring that only competent people with suitable training and experience conduct procedures which may expose them to risks associated with blood and body fluids. Ensuring that any new member of staff or student who works with blood or body fluids is referred to Occupational Health so that appropriate immunisation can be offered Ensuring that appropriate vetting is undertaken on any external or internal clinician/ practitioner who is providing training, and supervision for staff within the Department to ensure they are suitably trained and experienced to be able to offer the higher level of understanding required to deliver a competency based assessment for those undertaking the qualification. 2

3 Health and Safety Services Health and Safety Services are responsible for: Investigating any sharps injuries which are reported Providing advice on suitable systems of work to employ to manage risk associated with exposure to blood and body fluids Director of Estates The Director of Estates is responsible for: Ensuring that provision is made for emergency clean-up of any body fluid which is found on campus following an accident or illness of a student or a member of staff Occupational Health Occupational Health are responsible for: Providing appropriate screening of staff and post graduate students who work with blood and body fluids, including where appropriate immunisation regimes Managing the testing of source clients following any sharps injury which occurs, and providing liaison with the recipient via their GP if necessary Co-ordinating any counselling required following sharps injury Providing advice and guidance on the management of sharps injuries within the University 4. Documentation Required The following documentation must be available prior to any work being carried out where there is a risk of a sharps injury or other accidental inoculation of a person with blood or a body fluid: Current risk assessment Standard Operating Procedure Accidental Inoculation injury Procedure Up to date training record for any person involved in undertaking a relevant procedure (e.g. venepuncture) or who may be exposed to the blood or body fluid during the course of their work (e.g. cleaner or security guard who may be inadvertently exposed) Completed Client Questionnaire, in cases where samples are taken directly from a volunteer Source sample screening status, where samples are obtained externally to the organisation Additionally, the project should be entered onto the Biological Agents Register held by the University Biological Hazards Safety Officer. 4.1 Risk Assessment The most important part of managing risk associated with exposure to blood and body fluids is the existence of an activity specific, well thought out risk assessment which is effectively communicated to all those who engage in relevant activities. The standard principles of risk assessment are very relevant to the likely exposure of an individual to blood or body fluids. In terms of risk evaluation the following activities should be seen as high risk: Use of winged steel needles (butterfly), hypodermic needles, phlebotomy needles during venepuncture 3

4 Any activity with animals if they are within microbiologically contained facilities (CL3) The risk assessment should identify the potential source of exposure, the biological containment level which is required to work under, and all control measures which are, or need to be in place to allow controlled exposure so far as is reasonably practicable. It should identify who is likely to be exposed and in what circumstances exposure could occur. The risk assessment should identify any staff member or student who requires the offer of vaccination as a preventative measure. 4.2 Standard Operating Procedures Existing standard operating procedures should be used as a starting point for the risk assessment. They should be modified as a result of any improvements in procedure identified and then kept under regular review. Procedures should be detailed enough to give clear guidance to anyone who wishes to carry out the activity and cross reference with key elements from the risk assessment (e.g. Put on gloves) The following should prompt review: Changes in equipment Changes which have been identified as a result of incident investigation 4.3 Training and Supervision Requirements The following training is required for specific activities: Activity Training and Supervision Requirement Refresher requirement Delivery of training and The person who demonstrates and monitors the (Annual supervision of those who supervised procedures must be an experienced Update ) aim to be trained in and vetted clinical practitioner or validated Venepuncture facilitator. It is expected that this person will undertake vene-puncture on a very frequent basis, as part of their core duties, and have no less than 5 Venepuncture years experience undertaking these tasks. The person undertaking venepuncture must be: a member of staff, undergraduate medical students who have had their competence levels signed off in their record of achievement or post graduate students They should and have received theory training from a suitably vetted training provider. They must have completed 20 observed procedures and have carried out 20 directly supervised procedures. All those within a department who are authorised for venepuncture must undertake refresher training, unless they are practising clinicians. 3 yearly (if required) Cannulation A list of all those authorised to carry out venepuncture must be readily available within the Department. Cannulation is not normally permitted unless it is undertaken by suitably trained medical staff on NHS premises. In exceptional circumstances an individual with suitable experience, qualification and training may undertake such work if they are 4

5 Blood taking from animals Activities where there may be incidental exposure to animal or human blood or body fluids or infective agents within them. E.g. use of blood products and body tissues within laboratories, exposure due to sharps within the workplace, potential exposure due to cleaning and maintenance activities, exposure due to violence experienced at work e.g. biting, spitting, and punching. Those responsible for compiling risk assessments for managing biological risks. individually approved by application to Health and Safety Services. Anyone who takes blood from an animal must hold a suitable personal licence issued from the Home Office and must hold a suitable training record approved by the Named Training Officer within the Establishment. This will involve both observing procedures and supervised procedures until competency is established. Anyone involved with work which involves incidental exposure to human blood or body fluids must be suitably trained and be working under an activity specific risk assessment and standard operating procedure. They must have received an induction or toolbox talk which records the local emergency inoculation injury procedure in the case of inadvertent contact. Risk Assessment training, including the requirements of COSHH. - When the protocols associated with their work are changed. A full training record must be in place for each member of staff which details the training they have completed for health and safety reasons during their employment with the University. This should include all training - induction, all competency based training and refresher training. A mechanism must be in place to ensure that no procedures can be carried out unless they are undertaken by an authorised person with their refresher training in-date. In cases where taking blood has not been undertaken for longer than 6 months, a refresher course should be undertaken, which allows the observed and supervised elements of the training to be repeated. 4.4 Use of Questionnaires As a matter of course all source clients will complete a suitable questionnaire which will give them an opportunity to declare known infections, without being unnecessarily invasive. There are no valid health and safety grounds for attempting to seek to establish the risk status of a blood sample (prior to any incident occurring) via asking detailed questions on high risk behaviour of a client, although there may be valid reasons for establishing these facts for research purposes. Notwithstanding this process, all samples taken will be deemed to be infectious unless microbiologically confirmed as otherwise. All questionnaires should include details of the proposed use of the information supplied and to whom it will be circulated. The information may be sensitive and should be held securely within the laboratory or office. The questionnaire should ask if the source client would be willing to be tested in the event of accidental inoculation of the researcher and allow contact details to be supplied in the event of this occurring. Staff and students taking blood on NHS premises or other health facilities as part of their training will be exempt from this requirement as they will follow the relevant procedures at the establishment they are working from. 5

6 5. Sharps Disposal Bin Safety The following rules should be displayed in any rooms containing a sharps bin: Always: Never: Place a used sharp in a sharps bin as soon as possible after use Take the sharps bin to the point of use When performing venepuncture - have the sharps bin available on the same side, as the hand which will be used to hold the sharp, in an accessible place Carry them using the handle or in a container tray Carry out blood transfer procedures before disposal of the sharp Overfill the sharps bin (max 2/3-3/4 full) Place sharps in other bins intended for clinical waste disposal Try to retrieve anything out of a sharps bin 6. Accidental Inoculation procedures If you have been exposed to blood, serum or other body fluids: Immediate Action to be initiated within less than 1 minute Percutaneous injuries should be gently encouraged to bleed. The wound should not be sucked. The wound should be washed with soap and water, (not scrubbed) dried and covered with a dressing. Splashes to non-intact skin should be cleaned liberally with water Splashes into eyes, mouth and other mucous membranes should be irrigated with copious amounts of clean water. If contact lenses are worn eye irrigation should take place before and after removing lenses. The incident should be reported to the line manager Subsequent Action within 1 hour The exposure should be reported to the Occupational Health Manager on The affected person should report to the Accident and Emergency Department of Hull Royal Infirmary to obtain any required treatment and/ or prophylaxis, based on a risk assessment process undertaken at the hospital The Incident should be recorded on the University of Hull Incident Report Form In the case of a used needle stick injury, if the source client of the body fluid is known they should be asked to give their consent to be tested for blood borne infections, via Occupational Health. If the recipient was in Occupational Health, the same person should not take the blood sample. Follow up action in the days following the incident If counselling is required by the Recipient, following the incident, Occupational Health should be contacted on If the source client refuses to give permission for tests to be taken then Occupational Health will discuss this in person with the Recipient. 6

7 Follow up action in the weeks following the incident Following the incident, the results of the recipient s tests will be sent to the recipients GP. The recipient should share these details with Occupational Health if any cause for concern is identified. The results of the source clients tests will be disclosed to the recipient, if permission was given for tests to be taken. 7. Use of Safety Sharps and Prohibited Practice No re-sheathing of needles must occur, even if the needle is not used to take a body fluid. All needles in use should be safe sharps, if this is reasonably practicable to achieve, and the exposure risks associated with accidental inoculation are high. For venepuncture, all sharps in use must be safe sharps. Before selecting a safe sharp, it is good practice to look at a number of options and select the one which provides the best fit with the activity to be completed. 8. Spillage Procedures The accidental spillage procedures for dealing with accidental spillage of any body fluids should be developed as part of the risk assessment for the activity being undertaken. Biohazard Removal Kits (or equivalent) should be available for dealing with small spillages of blood and body fluids. Replacement kits including instructions for use are available from Safety Services on Cleaning staff are not expected to deal with any spillages of blood or any other body fluid which takes place within a laboratory environment. However there may be instances where an accident has occurred or someone has been taken ill in a public area and in these circumstances the following arrangements will apply:- Clean up of spillages inside buildings: Weekdays 7am - 1pm Contact Gill Shores, Cleaning Manager in Hull on or Elaine McAdam or Shaun Wadsworth in Scarborough on 6742 Weekdays after 1pm Contact Security at Hull and Scarborough on 6868 or 7266 Cleaning up outside areas The same arrangements apply for outside areas. However, once any surface matter has been removed, disinfection may be necessary through the use of a pressure wash/and or use of disinfectant and brush. Hull Weekdays pm - Contact the Grounds Maintenance Section via the helpdesk on 2509 After Hours and Weekends- Contact Security on 6868 Scarborough All times Contact the Caretakers or Security via

8 Appendix 1 Definitions Sharps common term used to refer to needles such as those used to obtain blood or deliver injections, but includes all sharp objects that may be contaminated with body fluids Sharps Injury sharps injuries occur following a cut or puncture wound to the skin, most often from a needle but also possibly from a scalpel or other medical device Splashes common term used to describe blood or body fluids coming into contact with non intact skin and mucous membranes. Exposure a percutaneous injury or mucocutaneous exposure Exposure risk the relative risk of a blood borne virus being transmitted following an occupational exposure incident Source client - a known client from whom blood or body fluids may have been in contact with a member of staff or student either via a percutaneous injury or mucocutaneous exposure Recipient where an occupational exposure has taken place the staff member or student who has been exposed or injured Blood and Body fluids- A list is given of potential body fluids in appendix 2 Sharps Container- a container designed for the disposal of needles and other sharps, designed to BS 7320 (1990) Percutaneous injury injury from used needles, bite and other wounds from sharp item Mucocutaneous exposure exposure/splashes into the mouth eyes or onto broken skin, cuts or eczema Vacutainer system the system used for obtaining blood during venepuncture 8

9 Appendix 2 Body fluids that may transmit blood borne viruses Group 1 Blood Saliva associated with dentistry Cerebro-spinal fluid Pericardial fluid Peritoneal fluid Pleural fluid Synovial fluid Unfixed human tissue and organs Exudate or tissue fluid from burns/wounds Vaginal fluid Semen Amniotic Fluid Human breast milk Any other body fluid if visibly blood stained Group 2 -Low risk body fluids if not visibly stained with blood Urine Vomit Faeces Sputum Saliva not associated with dentistry 9

10 Appendix 3 Obtaining Consent for Testing Source Clients for Blood Borne Viruses and Patient Information Testing information for patients A member of staff has been accidentally exposed to your blood or body fluids during the course of their work. We are requesting to test your blood in order to assist the member of staff. There are three specific viruses that are covered in this information sheet. All three viruses can be present in your body without your knowledge. We ask patients in this situation if we can test them for: HIV (Human Immunodeficiency Virus): A virus that can be transmitted through blood, body fluids, and sexual exposure. Examples include sharing needles, syringes or equipment for drugs, tattoos, body piercing, through unscreened blood transfusions, and from mother to baby. Hepatitis B: A virus that affects the liver and is passed on in the same way as HIV. Hepatitis C: A virus that affects the liver and is usually passed on through blood or sharing needles or other equipment during recreational drug injecting. Other examples include tattoos, body piercing, and unscreened blood transfusions. What does the test involve? A 5 ml sample of blood will be taken from your arm. If any of the results are positive, the test will be repeated to confirm the result. Who will know my test result? The result will be given to you in confidence and your own doctor will be informed with your permission. The doctor looking after the member of staff affected will be informed, unless you request otherwise. What if I am found to have one of these viruses? If the test shows that you have one of these viruses, you will be offered care, support, and treatment through Occupational Health. What are the benefits of having these tests now? You can have these viruses with or without any symptoms. If you have Hepatitis B or Hepatitis C virus, treatment can often help to cure you and reduce the damage to your liver. New treatments are available for individuals with HIV. The treatment for HIV may be more effective if it is given before any serious illness develops. How can this help the member of staff who has been exposed to my blood? If you are carrying a blood borne virus the member of staff affected can be followed up to see if the virus has been transmitted to them and treated if necessary. 10

11 Will having the HIV test affect my chances of getting life insurance? Doctors do not need to report negative HIV tests when writing insurance reports. Insurance companies should no longer ask whether you have had an HIV test, they should only ask whether or not you are HIV positive (As agreed by the Association of British Insurers 1994). What are the drawbacks of having the HIV test? If you do have HIV, the benefits of knowing usually outweigh the disadvantages, which may include difficulties in relationships with family and friends or, for some, employment issues. Travel to some countries is currently restricted for people who know they have HIV. CONSENT If you have any further questions, please do not hesitate to ask a member of staff. When you have read this information sheet and asked any questions please sign below. You may have a copy of this information sheet I fully understand the information given to me and have had the opportunity to ask questions regarding the tests. I agree/do not agree to have my blood tested for HIV, Hepatitis Hepatitis B, and Hepatitis C. Signed... Date... 11