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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

    The Management of Occupational Exposure to Blood-borne Viruses

    (Including the Safe Handling and Disposal of Sharps) Policy Doc. Ref. No. Infection Control Folder

    The Management of Occupational

    Title of Document Exposure to Blood-borne Viruses (including

    the safe handling and disposal for sharps)

    Policy

    Author’s Name Wendy Briggs

    Infection Prevention and Control Specialist Author’s job title Practitioner

    Dept / Service Bristol Community Health Doc. Status Final Version

    Signed off by Bristol Community Health Committee Publication Date July 2009

    Next review date July 2011

    Infection Control Group

    Health, Safety, Security & Welfare

    Distribution Committee

    Locality Managers

    Occupational Health

    Consultation

    Version Date Consultation

    VO.1 April & May 2009 Infection Control Group

    Health, Safety, Security &

    Welfare Committee

    Locality Managers

    Occupational Health

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

Checklist for Approving Committee / Board

Has an equality impact assessment No been compiled?

Has legal advice been sought No

Has the policy been assessed for its NA impact on Human rights?

Have training issues been Yes considered?

Have any financial issues been Yes considered?

Will implementation be monitored? Yes

Is there a cascade mechanism in

    place to communicate the policy?

     yes - with staff

    - with patients

    - with the public

Are there linked policies / Yes procedures?

Has a review date been set? Yes

Is this related to the core standards Yes for better health?

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

    The Prevention of Occupational

    Exposure to Blood-borne Viruses

    (Including the Safe Handling and

    Disposal of Sharps) Policy

Date approved by the Bristol Community Health Committee: July 2009

Date of Implementation: July 2009

Date of Review: July 2011

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

June 2009

    Wendy Briggs

    If report has been jointly produced include this information in place of this text

    If you need further copies of this document please telephone Ginny Woodford on 0117 900 2645

If you need this document in a different format

    please telephone Ginny Woodford on 0117 900 2645

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

    Contents

    1 Purpose .......................................................................................................6 2 Associated Policies ....................................................................................6 3 Definition and Scope ..................................................................................6 4 Background .................................................................................................7 5 Post-exposure Procedures ........................................................................11 6 Post-exposure prophylaxis........................................................................12 7 Training .......................................................................................................12 8 Accident/Incident Reporting ......................................................................12 9 Audit ............................................................................................................12 10 References ..................................................................................................13 11 Appendix 1 ..................................................................................................14 12 Appendix 2 ..................................................................................................15 13 Appendix 3 ..................................................................................................16

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

1 Purpose

Bristol Community Health is committed to the provision of high quality services in

    environments that are safe for patients, staff and visitors including contractors.

    Preventing inoculation and contamination injuries prevents occupational exposure to

    blood borne diseases, and consequent infection of healthcare workers.

    The purpose of this policy is to define the process and local arrangements for minimising

    the risk from inoculation/contamination injuries.

    This Policy is applicable to all staff working within Bristol Community Health and NHS

    Bristol (Bristol Primary Care Trust)

The arrangements support the organisation in meeting its obligations as defined in:

    ? Core Standards for Better Health

    ? Care Quality Commission

    ? The Health and Social Care Act 2008: Code of Practice for the NHS on the

    prevention and control of healthcare associated infections and related guidance

    ? The Health and Safety at Work Act (1974) and Management of Health and Safety

    at Work Regulations (1992, amended 1999)

    ? Control of Substances Hazardous to Health (C.O.S.H.H.) Regulations (1999)

    ? The Provision and Use of Work Equipment (PUWER) (1998)

    ? The Personal Protective Equipment at Work Regulations (1992)

2 Associated Policies

    ? Infection Control

    ? HPA Infection Control Guidelines

    ? Hand Hygiene

    ? Waste Management

    ? Uniform Policy

    ? Health & Safety Policy (2008)

    ? Incident Reporting Policy (2008)

    ? Transmissible Spongiform Encephalopathy (TSE), Creutzfeld-Jacob Disease

    (CJD) and Variant CJD (VCJD) Policy 3 Definition and Scope

     Occupational exposure to blood-borne viruses is a potential hazard for healthcare

    workers. It usually follows a contamination or inoculation incident.

    3.1 High risk contamination/inoculation injuries

    These include:

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

    Percutaneous

    ? Inoculation with a sharp instrument such as a needle or scalpel blade,

    used in clinical care, which may have been contaminated with blood, or

    a “high-risk” body fluid.

    ? A human bite, if the skin is broken

    ? Contamination of broken skin with blood or body fluid

    Mucutaneous

    ? Contamination of non-intact skin or mucous membranes (eye, mouth,

    nose) with blood, or another “high-risk” body fluid

3.2 Bodily fluids

    The following body fluids are considered a high-risk for the transmission of

    blood borne viruses:

    ? blood and blood products

    ? cerebrospinal fluid

    ? semen and vaginal secretions

    ? peritoneal fluid

    ? pericardial fluid

    ? synovial fluid

    ? pleural fluid

    ? amniotic fluid

    ? breast milk

    ? any other body fluid containing visible blood

    ? any unfixed organs or tissues

    In relation to blood-borne infections urine, faeces, vomit, sweat, tears,

    skin and sputum are not considered high risk unless visibly

    bloodstained.

    This policy covers all such incidents involving staff, students, patients and

    visitors.

    4 Background

    Exposure to blood and body fluids may result in the transmission of blood borne

    viruses such as HIV, Hepatitis B (HBV) and Hepatitis C (HCV).

    Infection with these pathogens may be serious. Even where no infection is

    acquired, the emotional impact of such an injury may be severe and they have the

    potential to result in costly litigation.

    The highest risk of transmission of blood borne viruses is from patients to

    healthcare staff via percutaneous exposure.

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

    Transmission requires inoculation of an infectious dose of infected body fluid into a susceptible recipient. Inoculation injuries are common. They affect some people more than others: nurses are the largest single group but they can happen to any healthcare worker and carers. The risk of transmitting blood borne viruses from patients to staff is greater than from staff to patients.

    The infecting dose may be as low as a visible drop of blood. However, individual factors affect the risk of transmission. Risk is dependent on the prevalence of the viruses in the population and on the transmission rate it is higher for HBV and

    HCV than for HIV.

    Injuries involving hollow bore needles contaminated with appreciable amounts of blood (and virus) carry most risk. There is a smaller risk of transmission from splashes to eyes, nose or mouth with infected blood or body fluid. Sharps injuries and other exposures to blood and body fluids are usually preventable. Many of these incidents result from failure to comply with recommended procedures.

    A simple injury, which does not break the skin or does not involve the inoculation of body fluids, is unlikely to lead to the transmission of infection. Human bites very often become infected. Human bite wounds should be closely monitored.

    Preventing exposure

    The most effective way of preventing contact with blood or body fluids is by wearing appropriate protection where there is risk of contact with body fluids and following risk assessment.

    Personal protective equipment (PPE) includes plastic aprons, disposable single use gloves, eye protection and face masks- but does not include uniforms. Staff must wear eye protection and masks where there is a risk of body fluid splashing onto the face, and wear appropriate disposable gloves for phlebotomy or administering injections.

    The use of sharps should be eliminated as far as possible.

    Safe sharps practice will minimise the risk of occupational exposure to blood borne viruses (Appendix 1).

    The introduction of hepatitis B vaccination has proven highly effective in reducing occupational hepatitis B transmission.

    All healthcare workers who have direct contact with blood or other potentially infectious body fluids or tissues should be immunised against Hepatitis B. (There is currently no available vaccine for HIV and Hepatitis C).

    Immunised staff should ensure that they attend Occupational Health for follow up tests after immunisation and boosters as indicated by the Occupational Health Service Responsibilities

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

    the Safe Handling and Disposal of Sharps)

    4.1 Trust Directors and Senior Managers

    Organisational Directors and Senior Managers will ensure that:

? Appropriate resources are allocated to control adequately the risks

    associated with these injuries as identified in the risk assessment

    process, including the provision of suitable information, instruction,

    training and supervision for staff;

    ? Procedures and guidelines identified in this policy are adhered to;

    ? Appropriate support arrangements are available to those who are

    involved in or affected by such incidents; (list the support provided e.g.

    counselling service etc.)

    ? All Bristol Community Health staff attend Induction training, which

    includes the handling and disposal of sharps. All clinical staff should

    access this policy and undertake any relevant training that is needed for

    them to undertake their clinical dudies.

    ? Infection Prevention and Control training, including induction and

    update courses.

    ? Within Bristol Community Health, all clinical staff need to access

    Infection Prevention and Control training yearly as part of their

    Statuary, Mandatory requirements. Some clinical staff may need to

    discuss their training needs with their line manager.

    ? Staff have access to an Occupational Health Service whose provision

    includes:

    o Management of exposure to Health Care Acquired Infections

    (HCAIs), which include provision for emergency out of hours

    treatment ( See Appendix 2)

    o Relevant immunisations: The current recommendations for

    immunisations for health care workers are as follows in accordance

    with the DOH Policy: Health clearance for TB Hep B hep C and HIV: New healthcare workers.

    ? Author: Department of Health ? Published date: 16 March 2007

    ? Primary audience: Health and social care professionals

    ? Gateway reference: 5514 ? Series number: 277280 ? Pages: 68

    ? Copyright holder: Crown ? Also evidence of having 2 x MMR or serological proof of immunity.

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    The Prevention of Occupational Exposure to Blood-borne Viruses (Including

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    ? Having arrangements in place for regularly reviewing the immunisation

    status of healthcare workers and providing vaccinations to staff as

    necessary and in line with “immunisation against Infectious Diseases”

    and other Dept. of Health guidance. This will be done via Occupational

    Health

    ? And other requirements as set out in the health and Social Care Act

    2008

    4.2 The Infection Prevention and Control Practitioner

Will:

    ? In liaison with the Occupational Health Service will ensure the

    availability of up to date guidance and advice on measures to avoid

    the transmission of blood borne viruses between patients and staff. ? Provide training and ongoing learning to support staff on standard

    precautions to include the Safe use and disposal of sharps and

    actions to be taken following a contamination/inoculation injury

    4.3 Managers

     Will ensure that:

    ? All staff will complete infection control training at induction and as an

    annual update. This will include standard infection control

    precautions, safe use and handling of sharps and the actions

    required following occupational exposure to potential blood borne

    viruses

    ? Safe systems of work are in place (including safe use and disposal of

    sharps, venepuncture systems and disposal of clinical waste). ? The appropriate level of precautions are taken for any procedure,

    determined by the likelihood of exposure to blood, body fluids and

    tissue and not by knowledge or speculation about the infectious state

    of the individual patient (See Standard Infection Control Precautions

    available on Bristol PCT website on the Infection Prevention and

    Control web pages)

    ? Incident forms must be filled in following any exposure/sharps

    incident and any relevant actions/learning carried through. Under the

    Reporting of Injuries, Diseases and Dangerous Occurrences

    Regulations (RIDDOR) incidents & accidents must be reported

    within the strict timeframe to the Risk management Team They have

    a legal duty to report RIDDOR classified incidents & accidents within

    10 working days to the HSE (Health & Safety Executive). (Appendix

    3)

     All clinical staff with patient contact have appropriate vaccination (as

    advised by Occupational Health) at the start of employment and updates

    required. Time must be given for staff to attend these appointments.

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