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

1 this Policy is implemented in their departments. 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. to be appropriately advised and encouraged. code of practice. recorded in their individual care plans. Specific risk assessments must be carried out sensitively. including agency staff. leaflets. eg in Adults and Children’s Services. etc and the infectious/communicable diseases to which they may be exposed specifically as a result of their work.Occupational Health Policy on Communicable Diseases 1.2 LMG and other Line Managers must ensure that: 2.2 any employee who refuses immunisation recommended by the County Council.5 records are kept of those service users known to have MRSA. including safe methods of work.6 the Occupational Health Adviser and the Personnel and Training (PAT) Safety Advisers are notified of any needlestick injury.3 safe and appropriate waste disposal procedures must be implemented 2. and note that additionally some diseases that could result from these injuries may be reportable under The Reporting of Injuries. issue and application of specific departmental procedures.1 Responsibilities Chief Officers must ensure that: 2. volunteers.2. and • emphasise that on a generic risk assessment approach.2. and the necessary control measures. by virtue of their job and working environment. 2. 2 2. and arrange for the production.1. including procedures for dealing with laundry 2. and informing and instructing all their staff (potentially) affected. have their health safeguarded. • determine the level of risk. effective hand washing/disinfecting is the most effective control measure to protect (care) staff against foreseeable communicable diseases.2.2. Diseases and Dangerous Occurrences Regulations Health and Safety Team paths@eastsusssex. • implement the appropriate control measures. may be exposed to a small risk of contracting certain infectious and communicable diseases. etc appropriate to implement this Policy.gov. Introduction This Policy describes the arrangements to ensure that those employees who.4 appropriate and effective cleaning procedures must be implemented.2. are identified in order to:• confirm who may be harmed and how.2. or otherwise their refusal recorded on their personal file.uk Autumn 2009 Page 2 of 12 . 2. 2.1 their staff. 2. or any other communicable diseases.

Occupational Health Policy on Communicable Diseases 1995 (RIDDOR). contaminated waste.4. 2.2 attend their GP surgery or Hospital Minor injuries Unit (or out of hours their nearest Accident and Emergency Department) for appropriate treatment and advice.6 adhere to the basic standard personal hygiene precautions detailed in Appendix A. contracted by a staff member.4. 2.4.2. which should then be dealt with as clinical waste.4.4. 2.5 use any personal protective clothing provided. 2.1 advice and support is available to managers and staff around issues concerning communicable diseases.4. Clostridium Difficile. human and animal body fluids as well as sharps. 2. Health and Safety Team paths@eastsusssex.gov. spitting or scratching by a third party. Hepatitis B.3. which could be attributable to their work.4 Employees must: 2. 2. 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.3 ensure that incident reports are completed in relation to the above incident types.4. eg from biting. 2.g.4 safely dispose of discovered/discarded sharps.3 The Occupational Health Adviser will ensure that: 2. whenever they suspect they may have contracted an infectious disease at work.4. 2. 2. 2.8 adopt the agreed safe methods of work for dealing with biological agents e.4.9 refer to Appendix B containing information specific to Tuberculosis. Sussex Local Health Protection Unit (01273 403597). taking the completed Sharps Injury Questionnaire (page 11) with them.2.uk Autumn 2009 Page 3 of 12 . Norovirus and sharps. eg needles and syringes.7 a PAT Safety Adviser is informed of any infection.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. District/Borough Council Environmental Health Officers and/or the Consultant in Communicable Diseases Control.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. MRSA. 2.

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

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

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

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

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

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

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

gov.uk Autumn 2009 Page 11 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.

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

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