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:
* 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
Vaccination is available
Universal or standard precautions
Hep C
No vaccination is available
Universal or standard precautions
HIV / AIDS
No vaccination is available
Universal or standard precautions
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 …
...and misses, jabbing the
hand holding the cap.
Resheathing should be
avoided always
Source: BMA
booklet 1990 Code of
Practice for the
Safe Use and
Disposal of
Sharps
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
a) staff immunised?
b) training in safe handling?
(including use of diabetic lancing devices)
c) compliance with infection control?
Ensure there are agreed guidelines or
a policy for staff
THANK YOU
SOUTH EAST LONDON HEALTH
PROTECTION UNIT
1 Lower Marsh
London SE1 7NT
020 7716 7030