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 • emphasise that on a generic risk assessment approach.2 any employee who refuses immunisation recommended by the County Council.2. 2.gov. etc and the infectious/communicable diseases to which they may be exposed specifically as a result of their work. eg in Adults and Children’s Services. Diseases and Dangerous Occurrences Regulations Health and Safety Team paths@eastsusssex.6 the Occupational Health Adviser and the Personnel and Training (PAT) Safety Advisers are notified of any needlestick injury. or otherwise their refusal recorded on their personal file. have their health safeguarded. and arrange for the production.1. 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. etc appropriate to implement this Policy. and the necessary control measures. to be appropriately advised and encouraged. 2. 2.1 their staff.3 safe and appropriate waste disposal procedures must be implemented 2. may be exposed to a small risk of contracting certain infectious and communicable diseases. 2.2.2.2.2. by virtue of their job and working environment. effective hand washing/disinfecting is the most effective control measure to protect (care) staff against foreseeable communicable diseases.2.2 LMG and other Line Managers must ensure that: 2. 2 2. • determine the level of risk. including procedures for dealing with laundry 2. Specific risk assessments must be carried out sensitively. and note that additionally some diseases that could result from these injuries may be reportable under The Reporting of Injuries.5 records are kept of those service users known to have MRSA.1 Responsibilities Chief Officers must ensure that: 2. including safe methods of work.4 appropriate and effective cleaning procedures must be implemented. issue and application of specific departmental procedures. are identified in order to:• confirm who may be harmed and how. leaflets. volunteers. • implement the appropriate control measures. including agency staff.Occupational Health Policy on Communicable Diseases 1.uk Autumn 2009 Page 2 of 12 .1 this Policy is implemented in their departments. and informing and instructing all their staff (potentially) affected. code of practice. recorded in their individual care plans. or any other communicable diseases. Introduction This Policy describes the arrangements to ensure that those employees who.

3 ensure that incident reports are completed in relation to the above incident types. human and animal body fluids as well as sharps. which should then be dealt with as clinical waste. spitting or scratching by a third party. eg needles and syringes.4.1 advice and support is available to managers and staff around issues concerning communicable diseases. in a proprietary sharps container.5 use any personal protective clothing provided.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.4.2. 2.gov. 2. 2.3 The Occupational Health Adviser will ensure that: 2. 2. MRSA.4. 2.7 thoroughly decontaminate their hands with an approved hand disinfectant after visiting any service user in their own home.8 adopt the agreed safe methods of work for dealing with biological agents e. Hepatitis B.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. eg from biting. 2.4. 2. contracted by a staff member.9 refer to Appendix B containing information specific to Tuberculosis. 2.4 safely dispose of discovered/discarded sharps.4 Employees must: 2.7 a PAT Safety Adviser is informed of any infection. 2. Norovirus and sharps. whenever they suspect they may have contracted an infectious disease at work.3.6 adhere to the basic standard personal hygiene precautions detailed in Appendix A. 2.4.g.4. taking the completed Sharps Injury Questionnaire (page 11) with them.Occupational Health Policy on Communicable Diseases 1995 (RIDDOR). Health and Safety Team paths@eastsusssex. District/Borough Council Environmental Health Officers and/or the Consultant in Communicable Diseases Control. Sussex Local Health Protection Unit (01273 403597).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. contaminated waste. which could be attributable to their work.uk Autumn 2009 Page 3 of 12 .2. Clostridium Difficile. 2.4. 2.

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

However. eg home care. 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. lather well. When decontaminating hands. easy access to hot and cold running water and an adjacent (ideally foot-operated) waste bin. and in between the fingers. • • Health and Safety Team paths@eastsusssex. disposable paper towels in all care. The hands must be rubbed together vigorously. paying particular attention to the tips of the fingers. If the approved hand disinfectant causes a rash. an approved hand disinfectant must be provided and used. and After cleaning of any kind. including the thumbs.uk Autumn 2009 Page 5 of 12 . before using an approved hand disinfectant.gov. • • 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. smooth the liquid hand cleanser evenly over the hands. rinse hands under running water and dry thoroughly with paper towels. Effective hand washing is the single most important intervention in the control of cross-infection. rubbing vigorously. the approved hand rub solution (2mls) must come into contact with all surfaces of the hands. the thumbs and the areas between the fingers. hands should be free of dirt and organic material. etc the Occupational Health Adviser must be contacted as soon as practicable. cracking of the skin. Hand washing facilities should include liquid soap dispensers (bar soap is prohibited for use by care staff).Occupational Health Policy on Communicable Diseases APPENDIX A: Basic Standard Precautions Good personal hygiene precautions are crucial to preventing the spread of all infections. 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.

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

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

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

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

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

uk Autumn 2009 Page 11 of 12 .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.

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

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