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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.
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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
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have their health safeguarded. recorded in their individual care plans.1. volunteers. and informing and instructing all their staff (potentially) affected. Diseases and Dangerous Occurrences Regulations Health and Safety Team paths@eastsusssex. may be exposed to a small risk of contracting certain infectious and communicable diseases.2. code of practice.uk Autumn 2009 Page 2 of 12 . are identified in order to:• confirm who may be harmed and how. issue and application of specific departmental procedures. and note that additionally some diseases that could result from these injuries may be reportable under The Reporting of Injuries. Introduction This Policy describes the arrangements to ensure that those employees who.4 appropriate and effective cleaning procedures must be implemented.2.5 records are kept of those service users known to have MRSA.2 any employee who refuses immunisation recommended by the County Council. etc appropriate to implement this Policy. etc and the infectious/communicable diseases to which they may be exposed specifically as a result of their work.3 safe and appropriate waste disposal procedures must be implemented 2.2 LMG and other Line Managers must ensure that: 2. and arrange for the production. including agency staff. eg in Adults and Children’s Services.1 Responsibilities Chief Officers must ensure that: 2. 2. • determine the level of risk. 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.gov.2.Occupational Health Policy on Communicable Diseases 1. and the necessary control measures. including procedures for dealing with laundry 2.2. by virtue of their job and working environment. 2. and • emphasise that on a generic risk assessment approach. including safe methods of work. Specific risk assessments must be carried out sensitively. to be appropriately advised and encouraged. 2. or any other communicable diseases.2.1 this Policy is implemented in their departments. • implement the appropriate control measures. effective hand washing/disinfecting is the most effective control measure to protect (care) staff against foreseeable communicable diseases.2. leaflets. 2 2. 2.6 the Occupational Health Adviser and the Personnel and Training (PAT) Safety Advisers are notified of any needlestick injury.1 their staff.
Norovirus and sharps. District/Borough Council Environmental Health Officers and/or the Consultant in Communicable Diseases Control.g.4.4 safely dispose of discovered/discarded sharps. Sussex Local Health Protection Unit (01273 403597). eg from biting. human and animal body fluids as well as sharps.uk Autumn 2009 Page 3 of 12 .4.8 adopt the agreed safe methods of work for dealing with biological agents e.6 adhere to the basic standard personal hygiene precautions detailed in Appendix A.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.1 advice and support is available to managers and staff around issues concerning communicable diseases.gov.7 a PAT Safety Adviser is informed of any infection.3. which could be attributable to their work.3 The Occupational Health Adviser will ensure that: 2. 2. Clostridium Difficile. contaminated waste. 2.4. MRSA. taking the completed Sharps Injury Questionnaire (page 11) with them.Occupational Health Policy on Communicable Diseases 1995 (RIDDOR).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. 2. Hepatitis B.9 refer to Appendix B containing information specific to Tuberculosis.2.4. 2. 2. spitting or scratching by a third party. eg needles and syringes. 184.108.40.206.1 report all sharps incidents to their manager and attend their nearest Accident and Emergency Department for appropriate treatment and advice as soon as possible. contracted by a staff member. Health and Safety Team paths@eastsusssex. whenever they suspect they may have contracted an infectious disease at work.4. 2.3 ensure that incident reports are completed in relation to the above incident types. 2.4. 2.4. 2.7 thoroughly decontaminate their hands with an approved hand disinfectant after visiting any service user in their own home. in a proprietary sharps container.4 Employees must: 2. which should then be dealt with as clinical waste. 2. 2.
as they may need to refrain from work until they have recovered.gov.dh.4. PO Box 410.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/docu ments/digitalasset/dh_4136384. food poisoning.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.10 report to their manager if they are suffering from any communicable disease e. General information Staff who do not provide personal care to Service Users e. Health and Safety Team firstname.lastname@example.org Autumn 2009 Page 4 of 12 . 3. that effective hand washing protocols are followed.g. 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. such as Leptospirosis. which gives similar guidance in respect of specific diseases which may be encountered in the natural environment. to minimise the risk of cross infection. must ensure. LS23 7LN) or on the D of H’s website using the following internet address: http://www.g. Visiting Officers and Social Workers.Occupational Health Policy on Communicable Diseases 2.
hands should be free of dirt and organic material. and in between the fingers.Occupational Health Policy on Communicable Diseases APPENDIX A: Basic Standard Precautions Good personal hygiene precautions are crucial to preventing the spread of all infections. smooth the liquid hand cleanser evenly over the hands. Hand washing facilities should include liquid soap dispensers (bar soap is prohibited for use by care staff). and After cleaning of any kind. However. • • Health and Safety Team paths@eastsusssex. 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.gov. Effective hand washing is the single most important intervention in the control of cross-infection. until the solution has evaporated and the hands are dry. drinking or handling food When they are obviously soiled. rinse hands under running water and dry thoroughly with paper towels. an approved hand disinfectant must be provided and used. When decontaminating hands. etc the Occupational Health Adviser must be contacted as soon as practicable. If the approved hand disinfectant causes a rash. Effective hand washing should be performed as follows: • • wet the hands up to the wrist before applying liquid hand cleanser. The hands must be rubbed together vigorously. eg home care. including the thumbs. before using an approved hand disinfectant. the approved hand rub solution (2mls) must come into contact with all surfaces of the hands. 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.uk Autumn 2009 Page 5 of 12 . disposable paper towels in all care. easy access to hot and cold running water and an adjacent (ideally foot-operated) waste bin. lather well. cracking of the skin. rubbing vigorously. paying particular attention to the tips of the fingers.
nail files. and not re-used.gov. faeces. latex gloves should only be used in exceptional circumstances and only following a risk assessment. razors. Personal grooming items. clinical waste etc. handling laundry. 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. Therefore. • Changed between tasks. vomit. vinyl or nitrile. and when cleaning. must never be shared with others. • Health and Safety Team paths@eastsusssex. Disposable Gloves: To ensure latex allergies are minimised. 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. They should be: • Single use. saliva) or chemicals. etc. or anything that may have come in contact with blood. non latex gloves e. on the same person.uk Autumn 2009 Page 6 of 12 .g. urine. Additional information can be found in the “Don’t Spread Infection” Guidance which is located on the intranet. clippers. • Changed between service users.g. scissors. Please note that hands must be washed after carefully removing gloves. other body fluids (e. eg. must be available for use at all times.
bite. in exceptional circumstances and as a result of a specific risk assessment. decisions on immunisation for staff who work with particular at risk groups. should be made on the basis of a local risk assessment. spitting. 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. or suspected. and who may have direct exposure to contaminated sharps. Any employee who refuses immunisation recommended by the County Council. etc they must report to their GP or to an Accident and Emergency Unit as soon as possible. It is the major cause of antibiotic associated diarrhoea. to be appropriately advised and encouraged. Clostridium Difficile (C. However. ie older people. they should contact Occupational Health for advice on alternative arrangements . Hepatitis B immunisation is considered appropriate. If. either directly or through a third party.Difficile) C. 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. It most commonly affects elderly people with other underlying diseases. Hepatitis B: Current medical advice is that Hepatitis B is generally not a significant occupational risk.gov. eg service users with severe learning difficulties. The elderly and the ill are particularly vulnerable in particular if they are taking broad spectrum antibiotics for one or more conditions.uk Autumn 2009 Page 7 of 12 . If. of being a Hepatitis B carrier. following an incident involving a person known. If the GP is unable to assist with such a service. the relevant staff should approach their GP for advice in the first instance. infected blood or other bodily fluids contaminated with infected blood. or otherwise their refusal recorded on their personal file. Difficile is a bacterium that lives in the large bowel. Where staff have previously been immunised against TB this should give long term protection. or believe they may not have been previously immunised. staff suffer from a needlestick injury. if staff have any doubts. and widespread immunisation is not necessary. However. they should consult their GP who may refer them to a Chest Clinic for a skin test to confirm whether they have any immunity. Health and Safety Team paths@eastsusssex. and whether BCG immunisation is appropriate. and asylum seekers and their children.
Some service users who have been discharged from hospital may have developed MRSA. or result in serious disease such as blood poisoning or bronchopneumonia. Such infection can slow down recovery. and those who have a specific MRSA infection. It is easily spread among people who are already ill. Health and Safety Team paths@eastsusssex. Infected people should not prepare food until 48 hours after symptoms have ceased.g. keeping the toilet area clean and hygienic: washing contaminated clothing and linen in hot soapy water to help ensure the virus is killed.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. 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. e. 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. and these are called Methicillin Resistant Staphylococcus Aureus (MRSA). The virus is spread by the faecal/oral route (unwashed hand to mouth). In recent years some strains have become resistant to many of the antibiotics used in the treatment of infections. The most effective way to control the spread of norovirus is by: • • • • washing your hands frequently and thoroughly particularly after using the toilet.gov.uk Autumn 2009 Page 8 of 12 . 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. 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.
eg needlestick injuries. 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. Where service users are known to have MRSA. Staff with skin problems on their hands. the wound should then be covered with an appropriate dressing. contamination of cuts and abrasions with blood-borne fluids. personal care for service users with MRSA.uk Autumn 2009 Page 9 of 12 . which should then be dealt with as clinical waste. commonly by the hands. Health and Safety Team paths@eastsusssex. must seek occupational health advice before providing. Sharps Incidents In the event of any “sharps” incident involving the risk of blood-borne infections. e.gov. employees should report to an Accident and Emergency Unit as soon as possible. etc to reflect the specific service provision. taking the Introductory Letter (attached) with them. 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. or continuing to provide. For more information on MRSA please log onto the ‘NHS Direct’ or the ‘Department of Health’ website. .g. 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. should be dealt with as follows: • • • • • the wound should be encouraged to bleed freely. it should be washed with liquid soap and running water. the incident should be reported on a Health and Safety Incident Report form and the incident investigated. practice the highest standards of hygiene precautions to prevent contracting MRSA or spreading it (or any other organism) to other people (Appendix A). dermatitis and psoriasis.
Occupational Health Policy on Communicable Diseases APPENDIX C: Generic Risk Assessment For MRSA HAZARD MRSA bacteria WHO MIGHT BE AFFECTED? 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.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 . Staff with skin conditions affecting their hands should avoid physical contact with service users (and seek advice from the Occupational Health Unit). Hand Care – cuts or breaks in the skin must be covered with an impermeable dressing. open wounds etc. REQUIRED (CURRENT) CONTROL MEASURES Policy on Communicable Diseases at Work – communicated to all relevant staff. eg by direct physical contact with the broken skin. Health and Safety Team paths@eastsusssex. care staff and other staff who may visit or come into direct physical contact with service users in residential. Basic Standard Hygiene Precautions – to be applied when working with all service users.gov. Record Keeping – identify and record those service users known to have MRSA and stipulate the necessary control measures in their care plans. Cleaning – Appropriate and effective cleaning procedures must be implemented including procedures for dealing with laundry. the use of protective clothing and sharps and body fluid management. Waste – Safe and appropriate waste disposal procedures must be implemented. Information/Instruction – all relevant staff must be provided with suitable information on the prevention and control of MRSA in the workplace. RISK LEVEL RISK = LOW (ie Likely Frequency . day or home care services. of infected service users. by transfer between service users. including effective hand washing. HOW MIGHT THEY BE AFFECTED? Describe work activity involved and potential source(s) of infection.
Occupational Health Policy on Communicable Diseases Further Recommendations Maintain (current) control measures above and inform and supervise staff involved.uk Autumn 2009 Page 11 of 12 . Assessed by: Date: Health and Safety Team email@example.com.
gov.uk Autumn 2009 Page 12 of 12 . may be appropriate. NAME About the person affected: JOB TITLE Date (if known): Have you been immunised against Hepatitis B? Yes/No 2. go to Part (b). if available: Health and Safety Team paths@eastsusssex. About others: YES/NO Was another person involved? If Yes. If Yes. 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. 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.Occupational Health Service 1. In addition to any treatment given. From: East Sussex County Council . About the incident: DATE and TIME: a) Were you injured by something sharp? If No. their Name: Contact address or number. if any. would you please advise what future action.
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