1. 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)

2. 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

3. 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

4. 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)

5. 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)

6. 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

7. 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

8. 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

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

10. 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

11. 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

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

13. 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.

14. Minimising The Risks

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

16. 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)

17. 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

18. 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.

19. 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

20. 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

21. 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
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

22. 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

23. 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.

24. 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

25. SOUTH EAST LONDON HEALTH PROTECTION UNIT
THANK YOU
SOUTH EAST LONDON HEALTH PROTECTION UNIT
1 Lower Marsh
London SE1 7NT