Occupational Health Policy on Communicable Diseases

1 2 3. Introduction............................................................................................................ Responsibilities ................................................................................................... 2 General information ............................................................................................. 4

APPENDIX A: Basic Standard Precautions ................................................................ 5 APPENDIX B: Specific Infections ............................................................................... 7 APPENDIX C: General Risk Assessment For MRSA ............................................... 10 APPENDIX D: Sharps Injury Questionnaire.............................................................. 12
Author and contact: Personnel & Training/Occupational Health and Safety, Reviewed 10/2009

Good personal hygiene precautions are crucial to prevent the spread of all infections, and hand washing is the single most important intervention in the control of crossinfection. A risk assessment approach will be taken to manage the hazards associated with exposure to foreseeable communicable diseases, to determine the appropriate control measures required which will include educating, informing, instructing, and where necessary, training staff in the appropriate safe working practices.

Key points
• • • •

This Policy has been introduced to ensure that the required standards are met to protect staff who may be at risk from communicable diseases at work. Managers and staff must ensure that the appropriate personal hygiene precautions are observed, particularly in the provision of direct personal care. Responsibilities fall on Chief Officers, Managers and employees Detailed information and guidance on specific communicable diseases is given in Appendix B Copies of all the Health and Safety Policies can be found on the Intranet:

Health and Safety Team

paths@eastsusssex.gov.uk

Autumn 2009

Page 1 of 12

to be appropriately advised and encouraged. by virtue of their job and working environment. including procedures for dealing with laundry 2.2 LMG and other Line Managers must ensure that: 2. Introduction This Policy describes the arrangements to ensure that those employees who.Occupational Health Policy on Communicable Diseases 1.2.2. Diseases and Dangerous Occurrences Regulations Health and Safety Team paths@eastsusssex. 2. etc appropriate to implement this Policy.1. 2. or any other communicable diseases. eg in Adults and Children’s Services.2 any employee who refuses immunisation recommended by the County Council. and note that additionally some diseases that could result from these injuries may be reportable under The Reporting of Injuries.uk Autumn 2009 Page 2 of 12 .4 appropriate and effective cleaning procedures must be implemented.2. Specific risk assessments must be carried out sensitively.1 their staff. volunteers.2. leaflets. including safe methods of work.2. and • emphasise that on a generic risk assessment approach. are identified in order to:• confirm who may be harmed and how. code of practice. • determine the level of risk. or otherwise their refusal recorded on their personal file.3 safe and appropriate waste disposal procedures must be implemented 2.5 records are kept of those service users known to have MRSA. may be exposed to a small risk of contracting certain infectious and communicable diseases. The County Council cannot assume responsibility for action on diseases to which the community at large is at risk and which are not work-related.1 Responsibilities Chief Officers must ensure that: 2.gov.6 the Occupational Health Adviser and the Personnel and Training (PAT) Safety Advisers are notified of any needlestick injury. 2 2. and the necessary control measures. 2. issue and application of specific departmental procedures.2. etc and the infectious/communicable diseases to which they may be exposed specifically as a result of their work. have their health safeguarded. • implement the appropriate control measures. recorded in their individual care plans. and informing and instructing all their staff (potentially) affected. and arrange for the production. 2. including agency staff. effective hand washing/disinfecting is the most effective control measure to protect (care) staff against foreseeable communicable diseases.1 this Policy is implemented in their departments.

4.uk Autumn 2009 Page 3 of 12 . which could be attributable to their work. human and animal body fluids as well as sharps. 2. 2. 2. contracted by a staff member.4. 2.gov.6 adhere to the basic standard personal hygiene precautions detailed in Appendix A. Hepatitis B. in a proprietary sharps container. taking the completed Sharps Injury Questionnaire (page 11) with them.8 an outbreak of infection is managed effectively and advice is sought on specific safe working practices and/or potential diseases from the Occupational Health Unit.4 safely dispose of discovered/discarded sharps.4.7 a PAT Safety Adviser is informed of any infection. 2.9 refer to Appendix B containing information specific to Tuberculosis.2. eg needles and syringes.4.4. eg from biting.1 report all sharps incidents to their manager and attend their nearest Accident and Emergency Department for appropriate treatment and advice as soon as possible.8 adopt the agreed safe methods of work for dealing with biological agents e.4. Sussex Local Health Protection Unit (01273 403597).3 ensure that incident reports are completed in relation to the above incident types. whenever they suspect they may have contracted an infectious disease at work. Health and Safety Team paths@eastsusssex. spitting or scratching by a third party.5 use any personal protective clothing provided.4. which should then be dealt with as clinical waste. 2. 2. Norovirus and sharps. 2. 2.4 Employees must: 2. contaminated waste.3.Occupational Health Policy on Communicable Diseases 1995 (RIDDOR). District/Borough Council Environmental Health Officers and/or the Consultant in Communicable Diseases Control.2 attend their GP surgery or Hospital Minor injuries Unit (or out of hours their nearest Accident and Emergency Department) for appropriate treatment and advice. 2. 2.2.7 thoroughly decontaminate their hands with an approved hand disinfectant after visiting any service user in their own home.1 advice and support is available to managers and staff around issues concerning communicable diseases.g.3 The Occupational Health Adviser will ensure that: 2. Clostridium Difficile. 2. MRSA.4.4.

LS23 7LN) or on the D of H’s website using the following internet address: http://www.gov. General information Staff who do not provide personal care to Service Users e. as they may need to refrain from work until they have recovered. which gives similar guidance in respect of specific diseases which may be encountered in the natural environment.gov.g.10 report to their manager if they are suffering from any communicable disease e.pdf Those who work in the countryside can obtain a copy of the County Council document Health Information for Countryside Workers on the intranet. Health and Safety Team paths@eastsusssex. must ensure.uk Autumn 2009 Page 4 of 12 .4. Visiting Officers and Social Workers.Occupational Health Policy on Communicable Diseases 2.g.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/docu ments/digitalasset/dh_4136384. Wetherby. food poisoning. such as Leptospirosis. that effective hand washing protocols are followed. PO Box 410. to minimise the risk of cross infection. 3. Reference Appendix A Reference should also be made to the “Guidelines on the Control of Infection in Residential and Nursing Homes” (obtainable from the Department of Health.dh.

the approved hand rub solution (2mls) must come into contact with all surfaces of the hands. If the approved hand disinfectant causes a rash. lather well. before using an approved hand disinfectant. Hand washing facilities should include liquid soap dispensers (bar soap is prohibited for use by care staff). hands should be free of dirt and organic material. When decontaminating hands. • • Health and Safety Team paths@eastsusssex. However. eg home care.Occupational Health Policy on Communicable Diseases APPENDIX A: Basic Standard Precautions Good personal hygiene precautions are crucial to preventing the spread of all infections. rubbing vigorously. and After cleaning of any kind. paying particular attention to the tips of the fingers. Effective hand washing is the single most important intervention in the control of cross-infection. and staff must always wash their hands: • • • • • • • Before and at the end of each working period Before and after direct physical contact with service users After using the toilet Before and after removing protective clothing such as disposable aprons and gloves Before eating. rinse hands under running water and dry thoroughly with paper towels. The hands must be rubbed together vigorously. etc the Occupational Health Adviser must be contacted as soon as practicable. cracking of the skin. the thumbs and the areas between the fingers. • • Effective use of hand disinfectant: • Where the specific hand washing facilities above are not always available or suitable. drinking or handling food When they are obviously soiled.uk Autumn 2009 Page 5 of 12 . an approved hand disinfectant must be provided and used. and in between the fingers. disposable paper towels in all care. easy access to hot and cold running water and an adjacent (ideally foot-operated) waste bin. Effective hand washing should be performed as follows: • • wet the hands up to the wrist before applying liquid hand cleanser. until the solution has evaporated and the hands are dry. smooth the liquid hand cleanser evenly over the hands. including the thumbs.gov.

non latex gloves e. other body fluids (e.gov. Therefore. razors. vinyl or nitrile.uk Autumn 2009 Page 6 of 12 . Disposable Gloves: To ensure latex allergies are minimised. scissors. must be available for use at all times. or anything that may have come in contact with blood.Occupational Health Policy on Communicable Diseases APPENDIX A (continued) Protective Clothing: • Disposable aprons and gloves must be worn whenever there is a risk of splashing or contamination with blood. • Health and Safety Team paths@eastsusssex. latex gloves should only be used in exceptional circumstances and only following a risk assessment. Please note that hands must be washed after carefully removing gloves. • Changed between service users. They should be: • Single use. clinical waste etc. Blood and body fluid spills must be dealt with immediately in accordance with the “Don’t spread infection” leaflet obtainable electronically (link below). saliva) or chemicals. vomit. handling laundry. on the same person. Personal grooming items. nail files. urine. Additional Information: • • • Staff must cover cuts or breaks in skin on exposed parts of the body with a waterproof plaster or dressing whilst at work. and when cleaning. faeces. eg. clippers. Additional information can be found in the “Don’t Spread Infection” Guidance which is located on the intranet. • Changed between tasks. and not re-used.g.g. etc. must never be shared with others.

The HSE publication INDG342 “Blood-borne Viruses in the Workplace” gives more guidance on Hepatitis B and associated risk assessments. Where staff have previously been immunised against TB this should give long term protection. to be appropriately advised and encouraged.Difficile) C.uk Autumn 2009 Page 7 of 12 . Hepatitis B: Current medical advice is that Hepatitis B is generally not a significant occupational risk. they should contact Occupational Health for advice on alternative arrangements . either directly or through a third party. should be made on the basis of a local risk assessment. of being a Hepatitis B carrier. The spread of infection is a greater risk in hospitals and care homes where there are many people in close contact with each other and touching equipment or surfaces that are contaminated with the bacteria. infected blood or other bodily fluids contaminated with infected blood. and widespread immunisation is not necessary. However. following an incident involving a person known. in exceptional circumstances and as a result of a specific risk assessment. the relevant staff should approach their GP for advice in the first instance. Difficile is a bacterium that lives in the large bowel.Occupational Health Policy on Communicable Diseases Appendix B: Specific Infections Tuberculosis: The possibility of contracting TB is low unless staff are providing direct prolonged personal care in the same room to the “at risk groups” in a social care setting. if staff have any doubts. It most commonly affects elderly people with other underlying diseases. or believe they may not have been previously immunised.gov. or suspected. and asylum seekers and their children. If. If the GP is unable to assist with such a service. they should consult their GP who may refer them to a Chest Clinic for a skin test to confirm whether they have any immunity. bite. It is the major cause of antibiotic associated diarrhoea. staff suffer from a needlestick injury. Clostridium Difficile (C. Any employee who refuses immunisation recommended by the County Council. eg service users with severe learning difficulties. Hepatitis B immunisation is considered appropriate. and whether BCG immunisation is appropriate. The elderly and the ill are particularly vulnerable in particular if they are taking broad spectrum antibiotics for one or more conditions. Health and Safety Team paths@eastsusssex. spitting. However. and who may have direct exposure to contaminated sharps. If. decisions on immunisation for staff who work with particular at risk groups. etc they must report to their GP or to an Accident and Emergency Unit as soon as possible. ie older people. or otherwise their refusal recorded on their personal file.

Infected people should not prepare food until 48 hours after symptoms have ceased. The most effective way to control the spread of norovirus is by: • • • • washing your hands frequently and thoroughly particularly after using the toilet. e. Health and Safety Team paths@eastsusssex. Norovirus (Winter Vomiting Disease) Outbreaks often occur in establishments such as hospitals and care homes where there are many people in close contact with each other. Some service users who have been discharged from hospital may have developed MRSA.uk Autumn 2009 Page 8 of 12 . Methicillin Resistant Staphylococcus Aureus (MRSA) Staphylococcus Aureus (SA) is a common bacterium. In recent years some strains have become resistant to many of the antibiotics used in the treatment of infections. or result in serious disease such as blood poisoning or bronchopneumonia. The virus is spread by the faecal/oral route (unwashed hand to mouth). by touching contaminated surfaces/objects or person to person contact (unwashed hand to mouth).Occupational Health Policy on Communicable Diseases APPENDIX B (continued) The bacterium is spread by touch therefore if you work or visit in a care home or hospital it is very important that you take care to minimise the risk and spread of possible infection by: • washing your hands after any contact with a patient/service user: • maintaining good hygiene practices through thorough cleaning of the environment: • wearing disposable gloves and aprons when giving care to patients who have C Difficile or when cleaning equipment that could be contaminated. commodes. and these are called Methicillin Resistant Staphylococcus Aureus (MRSA).g. There is a difference between numerous people in the general population who are asymptomatically colonised with MRSA (eg carry it on their skin or in their nose) harmlessly without any associated problems. It is easily spread among people who are already ill.gov. and before preparing food: disinfecting any surfaces or objects that could be contaminated with a norovirus using a bleach based household cleaner and following the product instructions: flushing away faeces and vomit in the toilet. keeping the toilet area clean and hygienic: washing contaminated clothing and linen in hot soapy water to help ensure the virus is killed. Such infection can slow down recovery. and those who have a specific MRSA infection.

human scratches. etc to reflect the specific service provision. personal care for service users with MRSA. commonly by the hands. . employees should report to an Accident and Emergency Unit as soon as possible. or continuing to provide. the wound should then be covered with an appropriate dressing. should be dealt with as follows: • • • • • the wound should be encouraged to bleed freely. eg needlestick injuries.gov. e. a specific risk assessment must be sensitively carried out using the generic risk assessment (Appendix C) given below which must be tailored by establishment managers.uk Autumn 2009 Page 9 of 12 . must seek occupational health advice before providing. Sharps Incidents In the event of any “sharps” incident involving the risk of blood-borne infections. which should then be dealt with as clinical waste. practice the highest standards of hygiene precautions to prevent contracting MRSA or spreading it (or any other organism) to other people (Appendix A).g. eczema. the incident should be reported on a Health and Safety Incident Report form and the incident investigated. All discovered (discarded) needles and syringes must be safely disposed of in a proprietary sharps container.Occupational Health Policy on Communicable Diseases MRSA is passed on by human contact. Health and Safety Team paths@eastsusssex. and it is therefore essential that staff who provide personal care to service users and come into direct APPENDIX B (continued) physical contact with them. Where service users are known to have MRSA. Staff with skin problems on their hands. contamination of cuts and abrasions with blood-borne fluids. dermatitis and psoriasis. For more information on MRSA please log onto the ‘NHS Direct’ or the ‘Department of Health’ website. it should be washed with liquid soap and running water. taking the Introductory Letter (attached) with them.

uk Autumn 2009 Page 10 of 12 . of infected service users. Hand Disinfectant – All staff who visit service users in the community must thoroughly decontaminate their hands with an approved hand disinfectant after visiting every service user in their own home. HOW MIGHT THEY BE AFFECTED? Describe work activity involved and potential source(s) of infection. REQUIRED (CURRENT) CONTROL MEASURES Policy on Communicable Diseases at Work – communicated to all relevant staff. Health and Safety Team paths@eastsusssex. day or home care services. Basic Standard Hygiene Precautions – to be applied when working with all service users. eg by direct physical contact with the broken skin.2 × Likely Severity – 4 = Risk Rating – 8) • This calculation had been undertaken using the format contained in ESCC’s Risk Assessment Policy. by transfer between service users. Information/Instruction – all relevant staff must be provided with suitable information on the prevention and control of MRSA in the workplace. Hand Care – cuts or breaks in the skin must be covered with an impermeable dressing. Record Keeping – identify and record those service users known to have MRSA and stipulate the necessary control measures in their care plans. RISK LEVEL RISK = LOW (ie Likely Frequency .Occupational Health Policy on Communicable Diseases APPENDIX C: Generic Risk Assessment For MRSA HAZARD MRSA bacteria WHO MIGHT BE AFFECTED? Service users.gov. open wounds etc. Staff with skin conditions affecting their hands should avoid physical contact with service users (and seek advice from the Occupational Health Unit). the use of protective clothing and sharps and body fluid management. Cleaning – Appropriate and effective cleaning procedures must be implemented including procedures for dealing with laundry. care staff and other staff who may visit or come into direct physical contact with service users in residential. including effective hand washing. Waste – Safe and appropriate waste disposal procedures must be implemented.

Occupational Health Policy on Communicable Diseases Further Recommendations Maintain (current) control measures above and inform and supervise staff involved. Assessed by: Date: Health and Safety Team paths@eastsusssex.uk Autumn 2009 Page 11 of 12 .gov.

if any. may be appropriate. would you please advise what future action.Occupational Health Service 1. if available: Health and Safety Team paths@eastsusssex. In addition to any treatment given. About others: YES/NO Was another person involved? If Yes.uk Autumn 2009 Page 12 of 12 . their Name: Contact address or number.gov. From: East Sussex County Council . did damaged skin come into contact with another person’s blood or blood stained body fluid c) Was there contact from body fluid with your eye or mouth? Any other relevant details: YES YES YES YES YES YES YES YES NO NO NO NO NO NO NO NO 3.Occupational Health Policy on Communicable Diseases APPENDIX D: Sharps Injury Questionnaire To: A&E Department The person presenting this completed form is an East Sussex County Council employee who has been exposed to a sharps injury and/or possible contaminated body fluids at work. was it: a recently used hypodermic needle? a discarded hypodermic needle? some other sharp object. About the incident: DATE and TIME: a) Were you injured by something sharp? If No. NAME About the person affected: JOB TITLE Date (if known): Have you been immunised against Hepatitis B? Yes/No 2. eg a diabetic pen? a bite? b) Was your skin broken or damaged before the incident? If Yes. go to Part (b). If Yes.