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

code of practice. 2. including safe methods of work.4 appropriate and effective cleaning procedures must be implemented. Introduction This Policy describes the arrangements to ensure that those employees who. • implement the appropriate control measures.6 the Occupational Health Adviser and the Personnel and Training (PAT) Safety Advisers are notified of any needlestick injury. and note that additionally some diseases that could result from these injuries may be reportable under The Reporting of Injuries.1 this Policy is implemented in their departments.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. and the necessary control measures. Specific risk assessments must be carried out sensitively. effective hand washing/disinfecting is the most effective control measure to protect (care) staff against foreseeable communicable diseases. 2.1 their staff. 2. etc and the infectious/communicable diseases to which they may be exposed specifically as a result of their work.gov.2. by virtue of their job and working environment. have their health safeguarded. etc appropriate to implement this Policy. and arrange for the production.3 safe and appropriate waste disposal procedures must be implemented 2. or otherwise their refusal recorded on their personal file. recorded in their individual care plans.2.2 LMG and other Line Managers must ensure that: 2.Occupational Health Policy on Communicable Diseases 1. volunteers. • determine the level of risk.2. leaflets. including procedures for dealing with laundry 2. eg in Adults and Children’s Services. issue and application of specific departmental procedures. are identified in order to:• confirm who may be harmed and how.1 Responsibilities Chief Officers must ensure that: 2. and informing and instructing all their staff (potentially) affected. and • emphasise that on a generic risk assessment approach. including agency staff. to be appropriately advised and encouraged. or any other communicable diseases. 2 2.2.1.2. 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.2 any employee who refuses immunisation recommended by the County Council.2. 2.uk Autumn 2009 Page 2 of 12 . Diseases and Dangerous Occurrences Regulations Health and Safety Team paths@eastsusssex.

2. 2. 2.4.6 adhere to the basic standard personal hygiene precautions detailed in Appendix A.7 a PAT Safety Adviser is informed of any infection. 2. Norovirus and sharps.9 refer to Appendix B containing information specific to Tuberculosis. Health and Safety Team paths@eastsusssex. spitting or scratching by a third party.Occupational Health Policy on Communicable Diseases 1995 (RIDDOR). MRSA.2. in a proprietary sharps container.5 use any personal protective clothing provided.3.gov. Clostridium Difficile. which should then be dealt with as clinical waste. 2.8 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. contracted by a staff member.4. 2. eg from biting.4.1 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. 2.4. Sussex Local Health Protection Unit (01273 403597). Hepatitis B. taking the completed Sharps Injury Questionnaire (page 11) with them.uk Autumn 2009 Page 3 of 12 .4 safely dispose of discovered/discarded sharps.4. whenever they suspect they may have contracted an infectious disease at work.3 ensure that incident reports are completed in relation to the above incident types.g. eg needles and syringes. 2. 2.4. 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.4. which could be attributable to their work.4 Employees must: 2. human and animal body fluids as well as sharps.7 thoroughly decontaminate their hands with an approved hand disinfectant after visiting any service user in their own home. contaminated waste. 2.4.3 The Occupational Health Adviser will ensure that: 2. 2. 2.1 advice and support is available to managers and staff around issues concerning communicable diseases.8 adopt the agreed safe methods of work for dealing with biological agents e.

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

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

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

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

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

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

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

Assessed by: Date: Health and Safety Team paths@eastsusssex.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 .gov.

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

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