Blood Borne Virus Policy
The purpose of this policy is to clearly establish the key principles of the NHS Trusts‟ and HSE Boards‟ response to blood borne virus infection.
All Doctors engaged via Direct Medics Recruitment Agency
On commencement of employment, to make all Direct Medics employees aware of the risk factors for acquiring blood-borne diseases, and the legal and ethical duties to disclose any blood – borne infection or risk of infection to appropriate authorities. All employees should acquaint themselves with the content of this policy.
Transmission of Blood Borne Virus occurs when blood or body fluids from an infected person enters the body of a susceptible person (one who is not immune), eg:
- Via sexual intercourse;
- Via sharing injecting equipment (when „shooting‟ drugs);
- Via skin penetration by blood contaminated sharps objects such as used needles, instruments or glass;
- Via blood transfusion;
- Through childbirth; the mother may infect her child before or during birth or through breast-feeding.
Healthcare workers are at risk from occupational exposure through needlestick or cuts from sharp instruments contaminated with infected patients‟ blood. If an injury is sustained, then the Management of Clinical Sharps Injuries (Section M, Infection Control Policies) or the Post-exposure Prophylaxis procedure must be followed as appropriate. Refer to each hospital‟s Infection Control Policies
Hepatitis is inflammation of the liver; several viruses have been identified as causative agents of Hepatitis, the most important of which are Hepatitis A, B, C, D and E. Hepatitis A and E are mainly spread via the faecal-oral route and do not induce a carrier state and do not present a significant risk of blood-borne infection. Notification
Infectious Hepatitis is a statutorily notifiable infectious disease. You, as the doctor in charge of the patient have a duty to notify the proper officer of the local authority as
soon as possible. (Section B, Infection Control Policies) You will be informed of the details of the local authority for each hospital you will be placed to work.
Hepatitis B (HBV) infection is endemic in the United Kingdom but is more common in developing countries where children often acquire the infection from their mother. The clinical course of Hepatitis B infection is variable and unpredictable, ranging from sub-clinical cases to fulminant hepatitis and death.
Follows a variable incubation period from six weeks to six months. Symptoms that may present include, malaise, nausea, loss of appetite, abdominal discomfort, joint pains, dark urine, clay coloured stools and jaundice. The recovery period may take up to six months and some people experience post viral depression and fatigue.
Most people experience no symptoms or at worst a feeling of fatigue, malaise or unaccountable depression. However, they are still infectious and may be more likely to become chronic carriers. The infection may go undetected.
Chronic Infection (Carriers)
This is said to occur when Hepatitis B surface antigen (HBsAg) is still detectable in the blood after 6 months. All chronic carriers are potentially infectious to others. The risk of chronic carriage may increase when there is impaired immunity. There is also a likelihood of progression to permanent liver damage and other serious liver disorders e.g. cirrhosis or liver cancer.
Serological Markers of Hepatitis B Infection
- Hepatitis B surface antigen (HbsAg), sometimes referred to as Australian Antigen AA, can be detected in the blood early in an acute attack and then remains present in the blood of carriers.
- Hepatitis B „e‟ antigen (HBeAg) is present when the virus is actively replicating and
denotes high infectivity. Some carriers may be HbeAg positive. Hepatitis „e‟ antibody (HBeab) maybe detectable when „e‟ antigen is lost, and denotes much lower infectivity.
- Hepatitis B core antibody (anti-HBc), antibody to HBcAg is one of the more sensitive markers of prior exposure to HBV. Ante-HBcIgm is a marker of acute infection.
Diagnosis is confirmed by detection of the antigens or their antibodies. The precise mix of antigen/antibody detected will vary according to the stage of infection.
Infection Control Measures
- Follow Standard Precautions (Section C, Infection Control Policies).
- There is an effective vaccine against Hepatitis B and healthcare workers are required to follow the Hepatitis B Vaccine Policy.
- Pregnant ladies who are found to be Hepatitis BsAg positive will be counselled and offered Hepatitis B vaccine and Hepatitis B immunoglobulin for their babies as appropriate. Follow Obstetrics Procedure for Hepatitis B, within Antenatal Screening Policy.
There is no contra-indications to breastfeeding of babies born from Hepatitis B carriers when immunisation is given at birth and proceeds with a complete course of immunisation.
Hepatitis C (HCV) is the main cause of Hepatitis previously referred to as Non A, Non B, causing post-transfusion hepatitis. HCV is predominantly blood borne and routine screening of blood donors was introduced to prevent transmission. Up to 42% of injecting intravenous drug users are Hepatitis C antibody positive. The incubation period ranges from 2 weeks to 6 months and the acute phase of Hepatitis C is often asymptomatic or mild. If it proceeds to chronic disease, progress is usually slow and the most common complaint is fatigue. It is estimated that 80% of infected persons develop chronic infection, of which 70% develop chronic liver disease with a risk of progression to cirrhosis or cancer.
Serological tests are available which mostly become positive within 6 months. PCR may need to be carried out to confirm diagnosis. Antibody positive shows current or previous infection, HCV RNA positive means actively replicating the virus.
Infection Control Measures
Follow Standard Precautions (Section C, Infection Control Policies).
There is no vaccine available against Hepatitis C.
There is effective treatment available.
The transmission of Hepatitis C infection through breast milk has not been documented and there appears to be no evidence to suggest that breast-feeding will increase the incidence of transmission to the baby, which remains relatively low at 4% in both breastfed and bottle fed babies, except in the case of cracked nipples.
Hepatitis D (HDV) was previously know as Delta agent and is a defective virus, which requires the presence of HBV to allow it to replicate. Therefore, HDV only occurs in people who already have HBV or in people who acquire both viruses simultaneously. Acute Hepatitis caused by HDV is usually severe and patients with the double infection HB and HDV usually develop rapidly progressive disease.
Human Immunodeficiency Virus (HIV) is a retrovirus, which interferes with the body‟s immune response to infection and malignancy. A person infected with HIV
may experience an initial acute illness followed by a period in which there are no clinical features, although antibodies to the virus can be detected in the blood. People with HIV infection may remain well for several years. As the immune system becomes increasingly impaired so the chances of opportunistic infections and tumour are increased.
Acquired Immune Deficiency Syndrome (AIDS) is diagnosed when a person with HIV infection is found to be suffering from one or more of a number of specific diseases. These diseases include Pneumocystis Carinii Pneumonia (PCP), certain cancers, e.g. Kaposi‟s sarcoma and conditions thought to be due to the direct effect of HIV, e.g. HIV encephalopathy.
The HIV test is not a test for AIDS. It is a blood test to detect antibodies that are made once the body has been infected with HIV. A negative test means that antibodies have not been found in the blood. However, this does not necessarily exclude exposure to HIV as antibodies can take up to 6 months to appear (window period). Therefore, a person can be recently infected by HIV, and have a negative result but still be capable of transmitting HIV to another person. A positive result means that antibodies to HIV were detected and therefore an infection has occurred at sometime, this means that they are infectious and could pass the virus to other people via blood or body fluids. (The virus cannot be passed on by normal everyday contact).
Pregnant ladies - follow Antenatal Screening Policy.
Infection Control Measures
Follow Standard Precautions (Section C Infection Control Policies)
Patients may be nursed in an open ward but for the purpose of privacy a single room may be desirable. A single room may also be required if other infections are present or if the patient is immunosuppressed, or if there is uncontrolled bleeding.
The transmission of HIV infection through breast milk has been documented. Therefore mothers should be made aware of the risk of transmission via breast milk and encouraged to bottle feed the infant.
Standard Precautions must be followed for all patients at all times (Section C, Infection Control Policies) but is especially important in the care of patients with known blood borne viruses.
Specimens must be labelled with an infection risk sticker both on the specimen container and the request card. Refer to each hospitals Infection Control Policies
Death of a patient – An infection risk „sticker‟ should be placed on the outside of the cadaver (body) bag, on both wrist and ankle identification bracelets and on the death notice. Refer to each hospitals Infection Control Policies.
Pre and Post Test Counselling
Counselling is essential both before the test (to inform the individual of the nature and meaning of the test and the possible implications) and after the test (to reassure and for aftercare as appropriate) regardless of whether the test is positive or negative.
All employees of the NHS and HSE are reminded that in the course of their duties they may have access to confidential material about patients, members of staff or other health services business. On no account must information relating to identifiable patients be divulged to anyone without the patient‟s consent. Access to information should be restricted to those who need it because of their involvement in direct healthcare of the patient.
Direct Medics, the NHS Trusts and the HSE hospitals are committed to equality of opportunity in employment.
The Trust in exercising its commitment will ensure that employers do not experience discrimination on the ground that they have Hepatitis B, Hepatitis C or HIV or that they are suffering from AIDS and related conditions. There is an employment policy that restricts healthcare workers on performing exposure prone procedures when infected with blood borne viruses.
Advisory Committee on Dangerous Pathogens 2008.
Protection Against Blood Borne Infections in the Workplace: HIV and Hepatitis. HMSO, London.
Advisory Group on Hepatitis 1993.
Protecting Healthcare Workers and Patients from Hepatitis B.
Health Publishing Unit, Hywood.
AIDS/HIV Infected Healthcare Workers: Guidance on the Management of Infected Healthcare Workers and Patient Notification.
UK Health Department 1998.
CDR Morbidity and Mortality Weekly Report (1998)
Recommendations for Prevention and Control of Hepatitis C virus (HCV) Infection and HCV-related Chronic Disease
Guidelines for the Royal College of Nursing 1997 Hepatitis
Health Service Circular 1998/127
Screening of Pregnant Women for Hepatitis B and Immunisation of Babies at Risk Health Service Circular 1999/183
Reducing mother to baby transmission of HIV
HPA “Shooting Up” - Infections among injecting drug users in the UK 2007
Published October 2008