HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Welcome to an on-line health and safety training package intended for staff and students working within UofE buildings on the Little France campus. Information contained within these pages is for use by University of Edinburgh staff and students only.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL This on-line training package, which is a very basic introduction to the subject, is intended principally for laboratory-based workers, and it is not a substitute for more detailed training, which may be organised by senior laboratory managers as required. Last updated: November 2013

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Please take time to view the following material, and direct any urgent questions to your H&S Advisor, Senior Laboratory Manager, or the Little France Buildings H&S Manager (the contact details for whom are shown on the penultimate page of this presentation). Thank you

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Infection Control? Human blood and other biological fluids and tissues are handled routinely within these buildings. It is possible, therefore, for a laboratory worker to be occupationally exposed to pathogens. Proper procedures (which is where infection control comes in) help prevent infections of laboratory workers.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Modes of Transmission Direct Contact with biological material containing pathogens. Indirect Contact (with a contaminated instrument or surface). Ingestion (or contact with the eyes, nose or mouth ) perhaps where there have been splashes. Inhalation (where microorganisms have been released as aerosols).

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Chain of Infection Pathogen Susceptible Host Source Entry Mode

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Chain of Infection Breaking the cycle at any one or more places will have the effect of reducing the potential for a laboratory-based worker to be infected in the workplace.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Standard Precautions Create and implement Local Rules for the safe management of pathogenic materials, to take account of the potential for these to be spread by blood, but also: by other body fluids, secretions and excretions, whether or not they appear to contain blood; and the implications of a worker’s non-intact (broken) skin, and possible contamination of their mucous membranes.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Routine Precautions Hand-washing. Use of lab coats, gloves, eye protection etc as dictated by prior risk assessment. Appropriate laboratory equipment. Environmental surfaces. Accident prevention.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL In other words … Good Microbiological Practice (GMP), which should be second nature to all competent scientists working within biomedicine.

HEALTH & SAFETY @ LITTLE FRANCE Management Roles in Infection Control Provision of information, training, instruction and supervision for those who may potentially be exposed to risk of infection; Exposure prevention (including immunisation where relevant) and post-exposure management;

Management Roles in Infection Control (continued) HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Management Roles in Infection Control (continued) Management of medical conditions and work-related illnesses and restrictions; and Accident reporting and investigation, and accident and health records.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Bloodborne Pathogens Blood-borne viruses, such as hepatitis B virus (HBV) and human immunodeficiency virus (HIV): Are transmissible in laboratories; May result in very serious chronic infections; and Some may be carried by people who are currently unaware that they are infected.

HEALTH & SAFETY @ LITTLE FRANCE Concentration of HBV in Body Fluids INFECTION CONTROL Concentration of HBV in Body Fluids High Moderate Low/Not Detectable Blood Semen Urine Serum Vaginal fluid Faeces Wound exudates Saliva Sweat Tears Breast milk

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Hepatitis B Immunisation Vaccinate all lab workers who are considered to be at risk of exposure to blood (based on need identified by Risk Assessment). Provide access to Occupational Health professionals. Test for antibodies one to two months after 3rd dose of vaccine.

HEALTH & SAFETY @ LITTLE FRANCE Exposure Prevention Strategies INFECTION CONTROL Exposure Prevention Strategies Local rules Engineering controls Procedural controls Management controls

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Local Rules Generic site-wide rules Local laboratory rules Containment lab rules

HEALTH & SAFETY @ LITTLE FRANCE Containment Laboratories INFECTION CONTROL Containment Laboratories

HEALTH & SAFETY @ LITTLE FRANCE Containment Laboratories INFECTION CONTROL Rules for Containment Laboratories No unauthorized visitors. No children in labs. Induction safety training required before commencing work, and possibly also specific biosafety-related training.

HEALTH & SAFETY @ LITTLE FRANCE Containment Laboratories INFECTION CONTROL Rules for Containment Laboratories Lab coats are mandatory … At all times. Must be worn … Properly fastened up. Must be removed before leaving the laboratory. Contaminated lab coats should be sent for cleaning.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL They don’t work draped around one’s shoulders like Batman’s cape, and they work even less well hung over the back of a chair. And this rule is not somehow suspended at weekends and holidays … It applies all the time, on each and on every occasion when working in the lab.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Correct technique for removing gloves Source: West Virginia University

HEALTH & SAFETY @ LITTLE FRANCE Containment Laboratories INFECTION CONTROL Rules for Containment Laboratories After removing lab coats, but before leaving the lab, workers must wash their hands. Hand washing is necessary whether or not the worker has been wearing lab gloves.

HEALTH & SAFETY @ LITTLE FRANCE Containment Laboratories INFECTION CONTROL Rules for Containment Laboratories Food and drink must not be stored or consumed in containment labs. This prohibition most certainly does include bottled water!

HEALTH & SAFETY @ LITTLE FRANCE Containment Laboratories INFECTION CONTROL Rules for Containment Laboratories Mouth pipetting is strictly prohibited. Manually operated pipette filling devices must be used instead.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Engineering Controls Isolate or remove the hazard e.g.: Use sharps containers. Select laboratory equipment with injury prevention features.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Procedural Controls Change the manner of performing tasks. For example: Using instruments (and not fingers – gloved or otherwise) to handle biological material. Outlaw the re-sheathing of hypodermic needles.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Management Controls Policies, procedures, and enforcement measures. These take priority over engineered and procedural controls.

HEALTH & SAFETY @ LITTLE FRANCE Post-Exposure Management Plan INFECTION CONTROL Post-Exposure Management Plan Set out clear policies and procedures, for accidental exposures, and provide rapid access to: Clinical care; Post-exposure prophylaxis (PEP); and Testing of exposed workers.

HEALTH & SAFETY @ LITTLE FRANCE Post-Exposure Management INFECTION CONTROL Post-Exposure Management Apply wound management Report accidents and exposures Assess the risk of infection: Type and severity of exposure Status of infectious material Susceptibility of exposed person

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Accident Reporting Report all accidents and near- miss occurrences using the on- line form at: http://www.safety.ed.ac.uk/ in order to ensure that the circumstances are investigated; and, wherever biological materials are involved, that you also inform UofE’s Occupational Heath Unit.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Occupational Health Unit UofE’s Occupational Heath Unit can be contacted on a confidential basis for further information and advice by telephoning 650 8190 or by emailing Occupational.Health@ed.ac.uk

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Finally … Even where the sole consideration is perception of risk, an individual’s perception is their reality, and people should not be put in the position of feeling concerned because of what they perceive as a possible risk to them.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL For that reason, regardless of what others on this campus may or may not be permitted to do within their own premises, we DO NOT permit the wearing of personal protective equipment (including lab coats and gloves, theatre scrubs etc) in any public areas of our buildings.

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL Lindsay Murray Health & Safety Manager, The University of Edinburgh, College of Medicine & Veterinary Medicine (Chancellor’s Building, Medical School and Queen’s Medical Research Institute), Little France Room SU215, Chancellor’s Building Ext: 26390 lgm@staffmail.ed.ac.uk

HEALTH & SAFETY @ LITTLE FRANCE INFECTION CONTROL You have now completed this on-line training package summarising several important aspects of infection control. Please also attend any practical training that may be organised by your senior laboratory manager. Thank you