Blood Borne Viruses and Sharps Injuries: In Care Homes Camilla Piper Health Protection Nurse South East London Health Protection Unit Thanks to Mike King, Ann Baxter, Mandy Beaumont and Dr Nimal Premaratne (Consultant in Communicable Disease Control)

Aims & Objectives To inform delegates: The different types of Blood Borne Viruses (BBV) How to reduce the risks of cross-infection from these viruses First aid measures following needlestick / contamination injury

BBV and Sharps Injuries Outline of the Session What are Blood Borne Viruses? How are they spread? What are the risks? How can the risks be reduced? Robust infection prevention & control strategies Safe sharps management Staff immunisation What are Sharps/Contamination injuries? How to manage contamination incidents

Blood Borne Viruses (BBV) These include Hepatitis B Hepatitis C HIV / AIDS (transmitted via contamination by blood or certain body fluids - e.g. blood, vaginal fluids, semen)

Body fluids that may contain HIV, Hepatitis B or Hepatitis C: Blood Blood stained body fluids Semen Vaginal secretions Tissues CSF, amniotic, pericardial, pleural fluids Body fluids that are less likely to contain pathogenic (disease causing) organisms: Tears Nasal secretions Sweat Saliva (more likely if blood present)

Blood Borne Viruses: Hepatitis B SPREAD By blood from someone who is infected with the virus getting into someone else's body: * needlestick injuries * through damaged or cut skin including bites * by sharing needles and syringes * from mother to baby around the time of birth * through unprotected sexual intercourse * through sharing razors and toothbrushes * by tattooing, body piercing or acupuncture if instruments are not properly cleaned and sterilised

Blood Borne Viruses: Hepatitis C SPREAD By blood from someone who is infected with the virus getting into someone else's body: * needlestick injuries * IV drug use e.g sharing needles/syringes Less common routes of infection: * through damaged or cut skin including bites * blood transfusions before screening (1989) * sexual intercourse (less common) * mother to baby around the time of birth * sharing razors and toothbrushes * tattooing, body piercing or acupuncture if instruments not properly sterilised

Blood Borne Viruses: HIV/AIDS SPREAD By blood from someone who is infected with the virus getting into someone else's body: * needlestick injuries * through damaged or cut skin including bites * by sharing needles and syringes * from mother to baby around the time of birth * through unprotected sexual intercourse * through sharing razors and toothbrushes * by tattooing, body piercing or acupuncture if instruments are not properly cleaned and sterilised

How are BBV’s spread by blood/body fluids? Needlestick injury (nb diabetic lancets) Through damaged or cut skin

Spread of Infection BBVs (cont) Blood borne viruses CANNOT be caught from: coughing, sneezing shared use of facilities such as toilets, water fountains or telephones sharing glasses, plates and cutlery shaking hands swimming in a pool if blood or body fluids fall onto intact skin N.B For infection to be spread Infected blood (body fluid) needs to enter body

Sharps / Contamination injuries. BBVs infection: Sharps / Contamination injuries. BBVs infection: * Inoculation of blood’ by contaminated needle/sharp piercing skin * Contamination of broken skin with blood * Splashes blood into mucous membranes e.g eyes mouth * Contamination where clothes soaked by blood * Bites (which break the skin) ‘ blood & certain other body fluids

BBV’s - risk of transmission Hepatitis B positive source - 1 in 3 Hepatitis C positive source - 1 in 30 HIV - 1 in 300 (Estimated risk from person infected) (UKED 1998) Occupational risk (HCW) of acquiring BBV post exposure: HIV 0.37% HBV 20-40% (Alder 1997)

What are the risks of infection? * Risks vary for each person * Assess on individual basis. * Individual risks depend on immunity vaccination history type of contact exposure to and type of disease.

Minimising The Risks

Prevention of spread Hep B Hep C HIV / AIDS Vaccination is available Universal or standard precautions Hep C No vaccination is available HIV / AIDS

Prevention & control of BBV infections Risk assessment (e.g glucose testing machines) Standard Precautions Education (BBV & sharps, safe lifestyle) Sharps Management including blood lancets Vaccination and immunisation (at risk groups: special learning needs,foster homes) HCWs in contact blood / body fluids Policy Development (handwashing, sharps (handling/disposal), dealing with blood/body fluid spillages, needlestick injury (first aid), using protective clothing (PPE), waste disposal, linen/laundry, cleaning)

Blood Borne Viruses: Protection Prevention of infection / spread Robust Infection Control Standards e.g protective clothing, covering cuts, waste disposal, cleaning, dealing with spills Immunisation (Hepatitis B) Sharps management

Standard Infection Control Precautions Blood and body fluids Remember: Diseases cannot be caught if blood or body fluids fall onto intact skin. Cover cuts and grazes with waterproof dressings. Wear disposable gloves when handling any body fluids, including performing first aid eg for cuts Dispose of used gloves, soiled tissues, dressings as clinical waste.

Hepatitis B Immunisation For those at risk Occupational Risk groups Healthcare workers Staff / residents learning needs residential homes. Police, prison staff Commercial sex workers Foster carers Others at risk IV Drug users Looked after children Travellers to endemic areas Partners acute cases PEP etc. Vacccination programme Three doses Test for seroconversion 1-4 months after course completed

Management of Sharps Training Sharps policy eg use and handling Disposal directly into sharps bin Management of sharps bins Do not overfill Keep in safe place Seal and label with source Collect at clinical waste Immunisation

Do not bend or recap needles Resheathing is a hazardous cess. The health care worker moves the used needle towards the resheathing cap … Source: BMA booklet 1990 - Code of Practice for the Safe Use and Disposal of Sharps Do not bend or recap needles What not to do! ...and misses, jabbing the hand holding the cap. Resheathing should be avoided always

Sharps / contamination injuries Needlesticks, blood into open cuts, bites or scratches (which draw blood) FIRST AID: encourage bleeding of any puncture wound wash thoroughly with soap& water cover with waterproof dressing SPLASHES TO MOUTH OR EYES Rinse thoroughly with plenty of running water INFORM YOUR MANAGER IMMEDIATELY Assess Risk COMPLETE THE ACCIDENT / INCIDENT FORM (+ name of source if known) GO TO A&E (Occupational Health Dept if applicable) if significant injury NB PEP (Post Exposure Prophylaxis) may be required

Hepatitis A NOT a Blood Borne Viruses (BBV) HAV is transmitted by the faeco-oral route. Person to-person spread is the most usual method of transmission, although contaminated food or drink may sometimes be involved.

Final thoughts! Risk assess! Audit! Decide the next steps staff immunised? training in safe handling? (including use of diabetic lancing devices) compliance with infection control? Ensure there are agreed guidelines or a policy for staff

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