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
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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

and arrange for the production. including agency staff. 2. • implement the appropriate control measures. 2. and informing and instructing all their staff (potentially) affected. Introduction This Policy describes the arrangements to ensure that those employees who. may be exposed to a small risk of contracting certain infectious and communicable diseases. issue and application of specific departmental procedures. Specific risk assessments must be carried out sensitively.2.2. and note that additionally some diseases that could result from these injuries may be reportable under The Reporting of Injuries. Diseases and Dangerous Occurrences Regulations Health and Safety Team paths@eastsusssex.2.5 records are kept of those service users known to have MRSA.2. etc and the infectious/communicable diseases to which they may be exposed specifically as a result of their work. have their health safeguarded.2 LMG and other Line Managers must ensure that: 2.2.2 any employee who refuses immunisation recommended by the County Council. or otherwise their refusal recorded on their personal file. 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. etc appropriate to implement this Policy.1 Responsibilities Chief Officers must ensure that: 2. effective hand washing/disinfecting is the most effective control measure to protect (care) staff against foreseeable communicable diseases.6 the Occupational Health Adviser and the Personnel and Training (PAT) Safety Advisers are notified of any needlestick injury. eg in Adults and Children’s Services. or any other communicable diseases. leaflets.Occupational Health Policy on Communicable Diseases 1. code of practice.2. 2. to be appropriately advised and encouraged. and the necessary control measures.1 this Policy is implemented in their departments. 2. recorded in their individual care plans. are identified in order to:• confirm who may be harmed and how.1 their staff.3 safe and appropriate waste disposal procedures must be implemented 2.uk Autumn 2009 Page 2 of 12 . including safe methods of work. volunteers. by virtue of their job and working environment. and • emphasise that on a generic risk assessment approach. 2 2. • determine the level of risk.4 appropriate and effective cleaning procedures must be implemented.gov. including procedures for dealing with laundry 2.

3. which could be attributable to their work. eg from biting. Sussex Local Health Protection Unit (01273 403597).4.8 adopt the agreed safe methods of work for dealing with biological agents e.4 Employees must: 2.gov.7 a PAT Safety Adviser is informed of any infection. contaminated waste. 2. 2. contracted by a staff member.4. 2.4. whenever they suspect they may have contracted an infectious disease at work.5 use any personal protective clothing provided.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.4.3 The Occupational Health Adviser will ensure that: 2. 2. 2. Hepatitis B.Occupational Health Policy on Communicable Diseases 1995 (RIDDOR).uk Autumn 2009 Page 3 of 12 . 2. spitting or scratching by a third party. human and animal body fluids as well as sharps. 2.3 ensure that incident reports are completed in relation to the above incident types. MRSA. Norovirus and sharps.1 advice and support is available to managers and staff around issues concerning communicable diseases.6 adhere to the basic standard personal hygiene precautions detailed in Appendix A. District/Borough Council Environmental Health Officers and/or the Consultant in Communicable Diseases Control. taking the completed Sharps Injury Questionnaire (page 11) with them.4. Clostridium Difficile. which should then be dealt with as clinical waste. in a proprietary sharps container.4.4.8 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.9 refer to Appendix B containing information specific to Tuberculosis. Health and Safety Team paths@eastsusssex. 2.2.4. 2. 2.7 thoroughly decontaminate their hands with an approved hand disinfectant after visiting any service user in their own home.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.4 safely dispose of discovered/discarded sharps.4.g.2. 2. 2. eg needles and syringes.

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

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

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

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

Such infection can slow down recovery.g.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. Some service users who have been discharged from hospital may have developed MRSA.uk Autumn 2009 Page 8 of 12 . and those who have a specific MRSA infection. keeping the toilet area clean and hygienic: washing contaminated clothing and linen in hot soapy water to help ensure the virus is killed. 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. e. Methicillin Resistant Staphylococcus Aureus (MRSA) Staphylococcus Aureus (SA) is a common bacterium. by touching contaminated surfaces/objects or person to person contact (unwashed hand to mouth). 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. Infected people should not prepare food until 48 hours after symptoms have ceased. or result in serious disease such as blood poisoning or bronchopneumonia.gov. commodes. In recent years some strains have become resistant to many of the antibiotics used in the treatment of infections. Health and Safety Team paths@eastsusssex. 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. The most effective way to control the spread of norovirus is by: • • • • washing your hands frequently and thoroughly particularly after using the toilet. The virus is spread by the faecal/oral route (unwashed hand to mouth). It is easily spread among people who are already ill. and these are called Methicillin Resistant Staphylococcus Aureus (MRSA).

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

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

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.gov.uk Autumn 2009 Page 11 of 12 .

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. If Yes.gov.uk Autumn 2009 Page 12 of 12 . their Name: Contact address or number. may be appropriate. In addition to any treatment given. go to Part (b). if any. 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 Service 1. eg a diabetic pen? a bite? b) Was your skin broken or damaged before the incident? If Yes. if available: Health and Safety Team paths@eastsusssex. About the incident: DATE and TIME: a) Were you injured by something sharp? If No. would you please advise what future action. was it: a recently used hypodermic needle? a discarded hypodermic needle? some other sharp object. From: East Sussex County Council . About others: YES/NO Was another person involved? If Yes. NAME About the person affected: JOB TITLE Date (if known): Have you been immunised against Hepatitis B? Yes/No 2.