communicable disease policy

8/6/2019 Communicable Disease Policy

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Health and Safety Team [email protected] Autumn 2009 Page 1 of 12

Occupational Health Policy on CommunicableDiseases

1 Introduction............................................................................................................

2 Responsibilities ................................................................................................... 2

3. 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 cross-infection.

A risk assessment approach will be taken to manage the hazards associated withexposure to foreseeable communicable diseases, to determine the appropriatecontrol measures required which will include educating, informing, instructing, andwhere necessary, training staff in the appropriate safe working practices.

Key points

This Policy has been introduced to ensure that the required standards aremet to protect staff who may be at risk from communicable diseases atwork.

Managers and staff must ensure that the appropriate personal hygieneprecautions are observed, particularly in the provision of direct personalcare.

Responsibilities fall on Chief Officers, Managers and employees

Detailed information and guidance on specific communicable diseases isgiven in Appendix B

Copies of all the Health and Safety Policies can be found on the Intranet:


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Occupational Health Policy on Communicable Diseases


1. Introduction

This Policy describes the arrangements to ensure that those employees who, byvirtue of their job and working environment, eg in Adults and Childrens Services, maybe exposed to a small risk of contracting certain infectious and communicable

diseases, have their health safeguarded.

The County Council cannot assume responsibility for action on diseases to which thecommunity at large is at risk and which are not work-related.

2 Responsibilities

2.1 Chief Officers must ensure that:

2.1.1 this Policy is implemented in their departments, and arrange for the

production, issue and application of specific departmental procedures, code ofpractice, leaflets, etc appropriate to implement this Policy;

2.2 LMG and other Line Managers must ensure that:

2.2.1 their staff, including agency staff, volunteers, etc and theinfectious/communicable diseases to which they may be exposed specifically asa result of their work, are identified in order to:-

confirm who may be harmed and how;

determine the level of risk;

implement the appropriate control measures, including safe methods ofwork, and informing and instructing all their staff (potentially) affected,and

emphasise that on a generic risk assessment approach, effective handwashing/disinfecting is the most effective control measure to protect(care) staff against foreseeable communicable diseases.

2.2.2 any employee who refuses immunisation recommended by the CountyCouncil, to be appropriately advised and encouraged, or otherwise theirrefusal recorded on their personal file.

2.2.3 safe and appropriate waste disposal procedures must be implemented

2.2.4 appropriate and effective cleaning procedures must be implemented,including procedures for dealing with laundry

2.2.5 records are kept of those service users known to have MRSA, or anyother communicable diseases. Specific risk assessments must be carried outsensitively, and the necessary control measures, recorded in their individualcare plans.

2.2.6 the Occupational Health Adviser and the Personnel and Training (PAT)

Safety Advisers are notified of any needlestick injury, and note that additionallysome diseases that could result from these injuries may be reportable underThe Reporting of Injuries, Diseases and Dangerous Occurrences Regulations


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1995 (RIDDOR).

2.2.7 a PAT Safety Adviser is informed of any infection, contracted by a staffmember, which could be attributable to their work.

2.2.8 an outbreak of infection is managed effectively and advice is sought

on specific safe working practices and/or potential diseases from theOccupational Health Unit, District/Borough Council Environmental HealthOfficers and/or the Consultant in Communicable Diseases Control, SussexLocal Health Protection Unit (01273 403597).

2.3 The Occupational Health Adviser will ensure that:

2.3.1 advice and support is available to managers and staff around issuesconcerning communicable diseases.

2.4 Employees must:

2.4.1 report all sharps incidents to their manager and attend their nearestAccident and Emergency Department for appropriate treatment and advice assoon as possible, taking the completed Sharps Injury Questionnaire (page 11)with them.

2.4.2 attend their GP surgery or Hospital Minor injuries Unit (or out of hourstheir nearest Accident and Emergency Department) for appropriate treatmentand advice, whenever they suspect they may have contracted an infectiousdisease at work, eg from biting, spitting or scratching by a third party.

2.4.3 ensure that incident reports are completed in relation to the aboveincident types.

2.4.4 safely dispose of discovered/discarded sharps, eg needles andsyringes, in a proprietary sharps container, which should then be dealt with asclinical waste;

2.4.5 use any personal protective clothing provided;

2.4.6 adhere to the basic standard personal hygiene precautions detailed inAppendix A.

2.4.7 thoroughly decontaminate their hands with an approved handdisinfectant after visiting any service user in their own home;

2.4.8 adopt the agreed safe methods of work for dealing with biologicalagents e.g. contaminated waste, human and animal body fluids as well assharps;

2.4.9 refer to Appendix B containing information specific to Tuberculosis,Hepatitis B, MRSA, Clostridium Difficile, Norovirus and sharps;


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2.4.10 report to their manager if they are suffering from any communicable diseasee.g. food poisoning, as they may need to refrain from work until they haverecovered.

3. General information

Staff who do not provide personal care to Service Users e.g. Visiting Officers andSocial Workers, must ensure, that effective hand washing protocols are followed, tominimise the risk of cross infection. Reference Appendix A

Reference should also be made to the Guidelines on the Control of Infection inResidential and Nursing Homes (obtainable from the Department of Health, PO Box410, Wetherby, LS23 7LN) or on the D of Hs website using the following internetaddress:http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4136384.pdf

Those who work in the countryside can obtain a copy of the County Councildocument Health Information for Countryside Workers on the intranet,which givessimilar guidance in respect of specific diseases which may be encountered in thenatural environment, such as Leptospirosis.


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APPENDIX A: Basic Standard Precautions

Good personal hygiene precautions are crucial to preventing the spread of allinfections.

Effective hand washing is the single most important intervention inthe control of cross-infection, and staff must always wash theirhands:

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, drinking or handling food

When they are obviously soiled, and

After cleaning of any kind.

Hand washing facilities should include liquid soap dispensers (bar soap is prohibitedfor use by care staff), disposable paper towels in all care, easy access to hot andcold running water and an adjacent (ideally foot-operated) waste bin.

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, including the thumbs,and in between the fingers.

lather well, rubbing vigorously.

rinse hands under running water and dry thoroughly with paper towels.

Effective use of hand disinfectant: Where the specific hand washing facilities above are not always available or

suitable, eg home care, an approved hand disinfectant must be provided andused. However, before using an approved hand disinfectant, hands should befree of dirt and organic material.

When decontaminating hands, the approved hand rub solution (2mls) mustcome into contact with all surfaces of the hands. The hands must be rubbedtogether vigorously, paying particular attention to the tips of the fingers, thethumbs and the areas between the fingers, until the solution has evaporatedand the hands are dry.

If the approved hand disinfectant causes a rash, cracking of the skin, etc theOccupational Health Adviser must be contacted as soon as practicable.


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APPENDIX A (continued)

Protective Clothing: Disposable aprons and gloves must be worn whenever there is a risk of

splashing or contamination with blood, other body fluids (e.g. faeces, urine,vomit, saliva) or chemicals; and when cleaning, handling laundry, clinicalwaste etc.They should be:

Single use.

Changed between service users.

Changed between tasks, and not re-used, on the same person.

Disposable Gloves:To ensure latex allergies are minimised, latex gloves should only be used in

exceptional circumstances and only following a risk assessment. Therefore, non

latex gloves e.g. vinyl or nitrile, must be available for use at all times.

Please note that hands must be washed after carefully removing gloves.

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.

Blood and body fluid spills must be dealt with immediately in accordance withthe Dont spread infection leaflet obtainable electronically (link below).

Personal grooming items, eg. razors, scissors, nail files, clippers, etc. oranything that may have come in contact with blood, must never be shared withothers.

Additional information can be found in the Dont Spread InfectionGuidance which is located on the intranet.


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Appendix B: Specific Infections

Tuberculosis:

The possibility of contracting TB is low unless staff are providing direct prolongedpersonal care in the same room to the at risk groups in a social care setting, ieolder people, and asylum seekers and their children. Where staff have previouslybeen immunised against TB this should give long term protection. However, if staffhave any doubts, or believe they may not have been previously immunised, theyshould consult their GP who may refer them to a Chest Clinic for a skin test toconfirm whether they have any immunity, and whether BCG immunisation isappropriate.

Hepatitis B:

Current medical advice is that Hepatitis B is generally not a significant occupationalrisk, and widespread immunisation is not necessary. However, decisions onimmunisation for staff who work with particular at risk groups, eg service users withsevere learning difficulties, and who may have direct exposure to contaminatedsharps, infected blood or other bodily fluids contaminated with infected blood, shouldbe made on the basis of a local risk assessment. The HSE publication INDG342Blood-borne Viruses in the Workplace gives more guidance on Hepatitis B andassociated risk assessments.

If, in exceptional circumstances and as a result of a specific risk assessment, HepatitisB immunisation is considered appropriate, the relevant staff should approach their GPfor advice in the first instance. If the GP is unable to assist with such a service, eitherdirectly or through a third party, they should contact Occupational Health for advice onalternative arrangements .

Any employee who refuses immunisation recommended by the County Council, to beappropriately advised and encouraged, or otherwise their refusal recorded on theirpersonal file.

If, following an incident involving a person known, or suspected, of being a Hepatitis Bcarrier; staff suffer from a needlestick injury, bite, spitting, etc they must report to theirGP or to an Accident and Emergency Unit as soon as possible.

Clostridium Difficile (C.Difficile)

C. Difficile is a bacterium that lives in the large bowel. It most commonly affects elderlypeople with other underlying diseases. It is the major cause of antibiotic associateddiarrhoea.

The spread of infection is a greater risk in hospitals and care homes where there aremany people in close contact with each other and touching equipment or surfaces thatare contaminated with the bacteria. The elderly and the ill are particularly vulnerable inparticular if they are taking broad spectrum antibiotics for one or more conditions.


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APPENDIX B (continued)

The bacterium is spread by touch therefore if you work or visit in a care home orhospital 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 theenvironment:

wearing disposable gloves and aprons when giving care to patients who have CDifficile or when cleaning equipment that could be contaminated, e.g.commodes.

Norovirus (Winter Vomiting Disease)

Outbreaks often occur in establishments such as hospitals and care homes wherethere are many people in close contact with each other. It is easily spread amongpeople who are already ill.

The virus is spread by the faecal/oral route (unwashed hand to mouth), by touchingcontaminated surfaces/objects or person to person contact (unwashed hand to mouth).

The most effective way to control the spread of norovirus is by:

washing your hands frequently and thoroughlyparticularly after using the toilet,and before preparing food:

disinfecting any surfaces or objects that could be contaminated with a norovirususing a bleach based household cleaner and following the product instructions:

flushing away faeces and vomit in the toilet, keeping the toilet area clean andhygienic:

washing contaminated clothing and linen in hot soapy water to help ensure thevirus is killed.

Infected people should not prepare food until 48 hours after symptoms haveceased.

Methicillin Resistant Staphylococcus Aureus (MRSA)Staphylococcus Aureus (SA) is a common bacterium. In recent years some strainshave become resistant to many of the antibiotics used in the treatment of infections,and these are called Methicillin Resistant Staphylococcus Aureus (MRSA).

There is a difference between numerous people in the general population who areasymptomatically colonised with MRSA (eg carry it on their skin or in their nose)harmlessly without any associated problems; and those who have a specific MRSAinfection. Such infection can slow down recovery, or result in serious disease such asblood poisoning or bronchopneumonia.

Some service users who have been discharged from hospital may have developedMRSA.


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MRSA is passed on by human contact, commonly by the hands, and it is thereforeessential that staff who provide personal care to service users and come into direct

APPENDIX B (continued)

physical contact with them, practice the highest standards of hygiene precautions toprevent contracting MRSA or spreading it (or any other organism) to other people(Appendix A).

Staff with skin problems on their hands, e.g. eczema, dermatitis and psoriasis,must seek occupational health advice before providing, or continuing toprovide, personal care for service users with MRSA.

Where service users are known to have MRSA, a specific risk assessment must besensitively carried out using the generic risk assessment (Appendix C) given belowwhich must be tailored by establishment managers, etc to reflect the specific service

provision.

For more information on MRSA please log onto the NHS Direct or theDepartment of Health website..

Sharps Incidents

In the event of any sharps incident involving the risk of blood-borne infections, egneedlestick injuries, contamination of cuts and abrasions with blood-borne fluids,

human scratches, 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 wound should then be covered with an appropriate dressing.

employees should report to an Accident and Emergency Unit as soon aspossible, taking the Introductory Letter (attached) with them.

the incident should be reported on a Health and Safety Incident Report formand the incident investigated.

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.


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APPENDIX C: Generic Risk Assessment For MRSA

HAZARD

MRSA bacteria

WHO MIGHT BE AFFECTED?

Service users, care staff and other staff who may visit or come into direct physicalcontact with service users in residential, day or home care services.

HOW MIGHT THEY BE AFFECTED?

Describe work activity involved and potential source(s) of infection, eg by directphysical contact with the broken skin, open wounds etc, of infected service users; bytransfer between service users.

REQUIRED (CURRENT) CONTROL MEASURES

Policy on Communicable Diseases at Work communicated toall relevant staff.Basic Standard Hygiene Precautions to be applied when working with all serviceusers, including effective hand washing, the use of protective clothing and sharpsand body fluid management.Hand Care cuts or breaks in the skin must be covered with an impermeabledressing. Staff with skin conditions affecting their hands should avoid physicalcontact with service users (and seek advice from the Occupational Health Unit).Hand Disinfectant All staff who visit service users in the community mustthoroughly decontaminate their hands with an approved hand disinfectant aftervisiting every service user in their own home.

Cleaning Appropriate and effective cleaning procedures must be implementedincluding procedures for dealing with laundry.Waste Safe and appropriate waste disposal procedures must be implemented.Information/Instruction all relevant staff must be provided with suitableinformation on the prevention and control of MRSA in the workplace.Record Keeping identify and record those service users known to have MRSA andstipulate the necessary control measures in their care plans.

RISK LEVEL RISK = LOW (ie Likely Frequency - 2 Likely Severity 4 = RiskRating 8)

This calculation had been undertaken using the format contained in ESCCsRisk Assessment Policy,


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Further Recommendations

Maintain (current) control measures above and inform and supervise staff involved.

Assessed by: Date:


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APPENDIX D: Sharps Injury Questionnaire

To: A&E Department

The person presenting this completed form is an East Sussex County Councilemployee who has been exposed to a sharps injury and/or possible contaminatedbody fluids at work. In addition to any treatment given, would you please advise whatfuture action, if any, may be appropriate.

From: East Sussex County Council - Occupational Health Service1. About the person affected:

NAME JOB TITLE

Have you been immunised against Hepatitis B? Yes/No Date (if known):

2. About the incident:

DATE and TIME:a) Were you injured by something sharp? YES NO

If No, go to Part (b). If Yes, was it:

a recently used hypodermic needle? YES NOa discarded hypodermic needle? YES NOsome other sharp object, eg a diabetic pen? YES NOa bite? YES NO

b) Was your skin broken or damaged before the incident? YES NOIf Yes, did damaged skin come into contact with another persons

blood or blood stained body fluidYES NO

c) Was there contact from body fluid with your eye or mouth? YES NOAny other relevant details:

3. About others:

Was another person involved?YES/NO

If Yes, their Name:

Contact address or number, if available:

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