Blood-Borne Viruses Guidance
Blood-borne viruses (BBVs) may cause severe disease in some people and few or
no symptoms in others. The virus can spread to another person, whether or not the
infected person has symptoms. The main blood-borne viruses of concern are:


Hepatitis B and Hepatitis C which cause Hepatitis, a disease of the liver
Human Immunodeficiency Virus (HIV), which causes acquired Immune
Deficiency Syndrome (AIDS)
These viruses are carried in the blood of infected people (who may not know they
are infected). They can also be found in other body fluids, for example, semen,
vaginal secretions and breast milk. Body fluids such as urine, faeces, saliva and
vomit may contain the virus but are unlikely to carry an infection risk unless they are
contaminated with blood. However, care should still be taken, as the blood may not
be visible.
It is important to remember that the precautions referred to in this document need to
be applied in proportion to the risk experienced by staff. As with all health and safety
requirements, staff / employees includes those such as agency and voluntary
workers.
Acquired Immune Deficiency Syndrome (AIDS) is a term that is used to describe the
late stage of HIV. This is when the immune system has stopped working and the
person develops a life-threatening condition, such as pneumonia (infection of the
lungs). The term AIDS was first used by doctors when the exact nature of HIV was
not fully understood. However, the term is no longer widely used because it is too
general to describe the many different conditions that can affect somebody with HIV.
Specialists now prefer to use the terms of advanced or late-stage HIV infection.
HIV is not passed on easily from one person to another, especially compared to
other viruses. That’s because HIV is present in body fluids. So for HIV to be passed
on, the body fluids of someone who is already infected have to get into an uninfected
person’s body and then into their bloodstream.
The body fluids that contain enough HIV to infect someone are:
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Seminal fluid
Vaginal fluids, including menstrual fluids
Breast milk
Blood
The mucous found in the rectum
Pre-cum (the fluid that the penis produces for lubrication before ejaculation)
Other body fluids, like saliva, sweat or urine, do not contain enough of the virus to
infect another person.
1
So the main ways that HIV can be transmitted are:
 Through sexual intercourse and other sexual activities
 From mother to baby
 From blood to blood
The most common way to become infected with HIV is through sexual contact. HIV
is not passed on through normal social contact, including:

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Through unbroken, healthy skin
Kissing
Sharing cups, plates, cutlery or linen, such as towels
Using the same toilets and swimming pools.
Caring for someone living with HIV or AIDS does not put you at risk, and neither
does mouth-to-mouth resuscitation. You cannot breathe it in or get infected by
mosquitoes or other animals.
There is, therefore, a virtually insignificant risk of contract HIV at work, even in what
may be through of as higher risk areas.
Scope
Most staff and service users will only be exposed to common airborne infections
such as colds and influenza. However, some staff may be at risk of exposure to
BBVs, such as:
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Health care workers and those delivering personal care
Staff of special schools / residential accommodation for those with challenging
behaviours e.g. human biting resulting in breaking the skin and drawing blood.
Staff exposed to violence resulting in skin breakage
Staff at risk from sharps injury (skin puncture), by coming into contact with things
such as used hypodermic needles, broken contaminated glass or contaminated
machinery / motor vehicles.
Staff regularly exposed to bodily fluids as part of their normal duties, including
handling of clinical waste, contaminated laundry, waste/refuse of unknown origin,
sewage e.g. refuse workers, house clearance workers.
First Aiders / Appointed Persons.
Staff who work with people who have severe learning disabilities or known drug
offenders.
2
NB: Of course some first aiders and carers will feel vulnerable to the potential
risk of exposure to BBVs. However if universal precautions are taken, which
should always be the case, the risk is significantly reduced to an acceptable
level. Examples of universal precautions include:
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Good hand washing and care of the hands.
Ensuring cuts and breaks in the skin on the first aiders hands and arms are
covered with a waterproof dressing.
Using protective clothing i.e., disposable gloves. Minor wounds should be
cleaned and dried using clean water and disposable paper towels or tissues. A
first aid plaster or dressing (individually wrapped) can be applied if
desired. Larger wounds should be washed with water; a suitable dressing or
pressure pad can be applied if needed. Disposable gloves should be worn
where possible, but in an emergency first aid care should not be withheld
because gloves are not available.
This list corresponds with the groups included in Health and Safety Executive
guidance and the Immunisation Against Infectious Disease 2006 document from the
Department of Health. However, this list is not intended to be comprehensive. In
order to determine staff at risk of exposure to Hepatitis B specifically, a risk
assessment should be completed.
KCC is committed to the health, safety and welfare of its employees and recognises
the duty of care owed to others not in its employment. In turn it also recognises the
duty of care owed by others to our employees and volunteers while working on our
premises.
The why, what and how
Urine, faeces, saliva, sputum, tears and vomit carry a minimal risk of BBV infection,
unless they are contaminated with blood. Care should always be taken however, as
the presence of blood is not always obvious. BBVs can also remain infectious in
dried blood and liquid for several weeks.
BBVs cannot be spread in swimming pools, sharing toilets, crockery, or by daily
workplace activities, such as shaking hands or working with others. Accidents with
blood-contaminated needles in healthcare workers are probably the most common
method of occupational transmission of BBV.
Contraction of BBV can be prevented by safe working practices. For most people,
simple measures such as being careful when cleaning up spilt blood and keeping
wounds covered are all that are required. However, any incident in which blood from
one person may have penetrated the skin of another person (e.g. by biting or from a
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contaminated needle), or as a result of contamination of the mucous membranes
(eyes, nose and mouth), should be reported to the officer in charge or the
headteacher.
Hepatitis B, Hepatitis C and HIV can be spread through:

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Unprotected sexual contact with an infected person.
The injection of infected blood into an uninfected person’s bloodstream (e.g. drug
users sharing needles, needlestick injuries, contaminated needles used for
tattooing and ear piercing).
Contamination of open wounds and biting.
A mother to her unborn child.
An accident form HS157 must be completed to record the incident and first aid action
taken as described in part 5 of this document.
Hepatitis
There are several types of Hepatitis, but Hepatitis B and C are blood-borne viruses.
Not all those with acute Hepatitis will have symptoms. Depending on the type, a
certain number will go on to develop chronic infection but even then some may
experience only mild symptoms or no symptoms at all. After the virus enters the
body, the incubation period is one to six months. Many people have their virus in
their bodies for a long time (sometimes for life) and never have any symptoms.
These people are carriers and may be unaware that they carry the virus. Most
carriers are infectious, whereas some get rid of the virus after several years. About
25% of carriers develop serious liver disease.
Hepatitis B, sometimes called Hep B or HBV, is a liver disease. The virus circulates
in the blood stream and causes inflammation of the liver, possibly leading to jaundice
in rare cases. A sudden inflammation of the liver is known as acute Hepatitis. Where
inflammation of the liver lasts longer than six months the condition is known as
chronic Hepatitis. Cirrhosis of the liver can also occur if the liver is damaged longterm, which in turn can develop into liver cancer in some people.
There is a vaccine that can protect people from Hepatitis B. It is suitable for
protecting the small number of people at greatest risk of contracting the disease.
Hepatitis C, sometimes called Hep C or HCV, is also a liver disease. The effects
vary from one individual to another. While many people will remain symptom free,
some will develop cirrhosis and a few will develop liver cancer. Hepatitis C is spread
in the same way as Hepatitis B. Unlike Hepatitis B, there is no available vaccine for
Hepatitis C, so universal infection control measures should be followed at all times.
Hepatitis C can now be treated and around 55% of those individuals are cured.
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Acquired Immune Deficiency Syndrome (AIDS)
A great deal of information has been issued by central government on the subject of
AIDS. The disease is principally transmitted either sexually or by the injection of
contaminated blood. In the normal working environment, the risk of AIDS being
transmitted is very small. Even for staff caring for children or adults who carry the
antibodies of these diseases, who could therefore be infectious, the risks are
extremely small provided simple routine hygiene precautions are taken.
AIDS is caused by the virus HIV which attacks the body’s immune system. This can
leave the body open to a wide variety of infections and can lead to death. However,
many people who carry the virus (and are therefore HIV Positive) remain entirely
healthy.
Information and Training
Heads of establishments and other managers are responsible for seeing that full
information about the nature of these diseases and the measures necessary to
control them are made available to all staff, and that staff receive appropriate training
via a competent person. Heads of establishments and other managers are
responsible for seeing that good hygiene practices are regularly followed in all KCC
premises, and that staff are allowed adequate time for carrying out the
recommended procedures.
Employees need to know:
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If they could be exposed to blood-borne viruses and how;
The risks posed by this exposure;
The main findings of the risk assessment;
The precautions they should take to protect themselves and other employees,
contract staff, volunteers or visitors; and
What procedures to follow in the event of an emergency.
Risk assessment for Blood-Borne Viruses
Managers should firstly consider if their team are exposed to blood-borne viruses
through their work activities, remembering to consider volunteer activities. A list of
occupational staff groups at possible risk of contraction has been produced for that
purpose (Appendix 2). The list is designed to identify KCC staff members who are at
greater risk than others within the organisation. If your team is not covered by this list
and you believe them to be at risk, please contact either Staff Care Services
(Occupational Health) or the Health and Safety Advice Line for further information
and guidance. No KCC employee would be classed as being at ‘high risk’ on a
national scale, as those most at risk are emergency staff, hospital staff, dentists and
similar occupations.
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For teams identified on the list, a risk assessment should be completed. A generic
risk assessment form has been created to identify further procedures (Appendix 3).
When completing the risk assessment, the following factors should be considered:
Where the infection is likely to be present e.g., needles, waste?
Ways in which employees/volunteers may be exposed e.g., first aid, handling
contaminated items?
What information is given to employees/volunteers about BBVs?
Estimate the level of exposure considering:
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How often staff / volunteers are likely to come into contact with blood?
How many different peoples’ blood are they likely to come into contact with?
How good are existing measures e.g., universal hygiene precautions?
Guidance on completing a risk assessment is available from SafetyNet or contact the
Health and Safety Advice Line. It is recommended that staff members who are
identified as being in the moderate / high risk categories on the risk assessment be
vaccinated against Hepatitis B.
First Aid Treatment
For all BBV contamination accidents / injuries, including:
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Where a needle or other sharp object punctures the skin.
Where BBV contamination of an open wound, eyes, mouth or other mucous
membrane has occurred.
Where a human bite or scratch puncturing the skin has occurred.
The injured person MUST:
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Wash splashes off the skin with soap and running water.
If the skin is broken, gently encourage the wound to bleed. Do NOT suck the
wound – rinse thoroughly under running water.
Wash out splashes in the eyes with plenty of tap water – do not swallow the
water.
Cover the wound with a waterproof dressing.
Seek medical attention as soon as possible e.g. from an A&E department or
their own doctor ideally within 1 hour and not more than 48 hours.
Inform the manager / team leader / head teacher.
Complete an accident/incident form (HS157).
Inform the Occupational Health Unit and the Health and Safety Advice Line.
6
The Manager MUST:

If possible, obtain a blood sample with full consent from the source, where
known, of the needlestick.
If the service user is known to be Hepatitis B or HIV positive or the injured person
(recipient) is a known non-responder to Hepatitis B vaccine (not immune), the
recipient must attend the local A&E department or GUM clinic for post exposure
prophylaxis treatment – ideally within 1 hour and not more than 48 hours.
Special consideration for first aiders
If you are a first aider in the workplace, the risk of being infected with a BBV while
carrying out your duties is small. There has been no recorded case of HIV or
Hepatitis B being passed on during mouth-to-mouth resuscitation. The following
precautions can be taken to reduce the risk of infection:
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Cover any cuts or grazes on your skin with a waterproof dressing;
Wear suitable disposable gloves when dealing with blood or any other body
fluids;
Use suitable eye protection and a disposable plastic apron where splashing is
possible;
Use devices such as face shields when you give mouth-to-mouth resuscitation,
but only if you have been trained to use them;
Wash your hands after each procedures.
As a first aider it is important to remember that you should not withhold treatment for
fear of being infected with a BBV.
Associated procedures and documentation
The documentation below refers to related guidance and legislation.
Related Guidance
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HSE INDG342 – Blood-borne viruses in the Workplace
(http://www.hse.gov.uk/pubns/indg342.pdf)
SafetyNet guidance:
Safe Disposal of Discarded Needles and Syringes
Universal Precautions for the Control of Infection
Guidance on MRSA
First Aid
Use of gloves (SC)
Infection Control - Prevention of Healthcare-associated Infection in Primary and
Community Care (NICE)
Infection Control Guidance for Care Homes (Department of Health)
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Guidance on Communicable Disease and Infection Control in Schools and
Nurseries (Kent Health Protection Unit)
Guidelines for Infection Prevention and Control in the Community (Kent Health
Protection Unit)
Legislation
 The Health and Safety at Work Act 1974
 The Management of Health and Safety at Work Regulations 1999
 The Personal Protective Equipment Regulations 1992
 The Control of Substances Hazardous to Health Regulations 2002
 Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
(RIDDOR) 2013
 The Health & Safety (First-Aid) Regulations 1981
Frequently asked questions
How can I prevent exposure to blood-borne viruses?
Exposure to blood-borne viruses can be prevented by adhering to infection control
procedures as outlined in the Universal Precautions for the Control of Infection
guidance. Managers must remember that vaccination is not the ultimate protection
and the emphasis must be on behaviour.
A safe and effective vaccine for the prevention of Hepatitis B infection is available,
that said, immunisation should not be relied upon as a primary control to prevent
exposure.
There are currently no vaccines available against Hepatitis C or HIV, although there
are measures that can be taken following exposure, which may prevent the
development of infection. Studies have indicated, however, that antiviral therapy
does not prevent acquisition of infection following Hepatitis C exposure, although
there is evidence that therapy given shortly after acquisition is more successful, in
terms of a sustained viral response, than therapy given later. Such treatment should
be seen as distinct from post-exposure ‘prophylaxis’.
The procedures for management of incidents involving exposure to a blood-borne
virus can be found at Appendix 5.
What is the procedure for vaccination against Hepatitis B?
Hepatitis B immunisation is recommended for all employees whose work tasks
involve exposure to blood, blood-stained body fluids or tissues and there is a risk of
injury e.g. puncturing / breaking of the skin, splashing into the eyes or mouth.
Immunisation can also be recommended based on a risk assessment.
Where universal hygiene precautions are deemed to be insufficient to bring the risk
of BBV contamination down to an acceptable level, Hepatitis B immunisation is
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advised. This provides effective protection but should not be regarded as a substitute
to safe working practices.
Should vaccination be recommended by the risk assessment, the line manager
should approach a healthcare provider (see Appendix 1). The vaccinations are given
at 0, 1 and 6 months with a blood test at 8 months, following the first injection. It is
very important to attend for this blood test as this is the only means of determining
your level of immunity (protection) and whether or not the vaccine has worked.
A booster injection is given 5 years after the initial injection if your level of immunity
is adequate (the timing and need for a Hepatitis B booster injection is subject to
change and advice must always be sought via your care provider).
The cost of the vaccination can be claimed back from KCC and it is the responsibility
of managers to make provision for the cost of immunisation in their budgets. It may
also be possible to negotiate a slightly reduced price for each individual as part of a
‘bulk purchase’. Following guidance issued by the General Practitioners Committee
(GPC) to its members not to vaccinate their patients for occupational purposes as it
is the employer’s responsibility; most GPs will not issue vaccinations. However,
many GPs still do so.
It should also be noted that some people do not respond to the vaccine. First aid
measures described above must be followed and the injured person must seek
further advice and prophylaxis treatment via the local A&E department.
The Hepatitis B Immunisation Programme and schedule can be found at Appendix 4.
What is the procedure for post-exposure injections against Hepatitis B?
Any staff that have been exposed to any blood-borne virus should be given a postexposure prophylaxis (PEP) treatment / advice within 48 hours, and preferably within
one hour of exposure.
Staff who may have been exposed to a blood-borne virus must contact their local
hospital immediately and report the type of injury and donor status of infection (if
known).
What is the procedure for Hepatitis B booster injections?
Current medical advice on the necessity of booster injections varies, with some
studies showing that they are not necessary to ensure long-term protection against
Hepatitis B.
A booster injection is usually given 5 years after the initial vaccination. The need for
a booster injection depends on your level of immunity following Hepatitis B
vaccination. Your level of immunity is measured by a blood test after you have
completed the course of vaccination, and is usually at 8 months following your first
injection.
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Individuals should seek current guidance from their care provider and with reference
to Department of Health, Hepatitis B, Chapter 18, “The Green Book”.
How do you test for blood-borne virus?
BBVs are detected by a blood test. The test looks for antibodies to the virus which
are produced by the body’s immune system in response to the virus.
The most common test for HIV is a blood test, although newer tests can detect HIV
antibodies in mouth fluid. If staff are concerned they may have contracted a bloodborne virus as a result of occupational exposure they must consult either
occupational health or their local A&E (in the interim). Another place staff can access
testing is their local Genito Urinary Medicine (GUM) clinic.
What general precautionary measures should I take for personal hygiene?
To avoid contraction of BBVs, personal hygiene measures should be followed at all
times.
More in-depth guidance on this area is available in the SafetyNet document
Universal Precautions for the Control of Infection.
Where can we get further guidance on blood-borne viruses?
Other external documents on specific areas of risk can also be found in ‘Associated
procedures and documentation’ section of this document, and online.
The British Liver Trust website (www.britishlivertrust.org.uk) contains lots of useful
information on diseases related to liver disease.
What general precautionary measures should I take for personal hygiene?
To avoid contraction of BBVs, personal hygiene measures should be followed at all
times.
More in-depth guidance on this area is available in the SafetyNet document
Universal Precautions for the Control of Infection.
Where can we get further guidance on blood-borne viruses?
Other external documents on specific areas of risk can also be found in ‘Associated
procedures and documentation’ section of this document, and online.
The British Liver Trust website (www.britishlivertrust.org.uk) contains lots of useful
information on diseases related to liver disease.
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Where can I obtain further advise?
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NHS Choices - http://www.nhs.uk/nhs-direct/Pages/NHS-Direct-legacyenquiries.aspx
Public Health England 03442 257968
KCC Staff Care Services (Occupational Health) – 03000 411411
Health and Safety Advice Line 03000 418456
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Appendix 1
Health care providers
Provider
Tel No.
Address
Dartford & Gravesham NHS
Trust
01322 428100
Darent Valley Hospital
Darenth Wood Road
Dartford
Kent DA2 8DA
Queen Mary’s Hospital
Sidcup
0208 302 2678
East Kent Hospitals NHS
Trust
01227 766877
Maidstone & Tunbridge
Wells NHS Trust
0845 155 1000
Medway NHS Trust
01634 830000
Queen Mary’s Hospital
Frognal Lane
Sidcup
Kent
DA14 6LT
East Kent Hospital Trust
Headquarters
Kent and Canterbury Hospital
Ethelbert Road
Canterbury
Kent
CT1 3NG
Trust Headquarters
Jenex House
Church Street
Maidstone
Kent
ME14 1DS
Medway Maritime Hospital
Windmill Road
Gillingham
Kent
ME7 5NY
Last Reviewed: April 2014
NB: Immunisation programmes must be provided by appropriately qualified providers
e.g. Occupational Health services or GPs. For further information on national
standards for immunisation, please click on the following link.
Note: Staff Care Services, KCC Occupational Health are now able to provide the
vaccination programme for Hepatitis B. There will be a charge for this service.
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Appendix 2
Occupational staff groups at possible risk of contracting a Blood-borne virus
(BVV)
NB: Staff groups include volunteers
Directorate
Occupational group
SC
Older People/Learning
Disability/Assessment &
Enablement Services
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BBV hazard
a) Contact with body fluids e.g. urine, faeces
Carers
Agency staff
Drivers/escorts
Care Centre Staff
Community Support
Workers including
Occupational therapist
Technicians
Personal Assistants
Therapy Staff
b) Handling sharps e.g. needles
c) Human biting & scratching resulting in
breaking of the skin
d) Handling contaminated laundry
e) Disposal of Clinical Waste
f) Contamination of open wounds whilst
handling:
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Blood-stained body fluids
Cleaning of vehicles
Children’s Social Services
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a) Human biting & scratching resulting in
breaking of the skin
Children’s services
provider unit staff
Pupil referral unit staff
Caretakers
b) Contamination of open wounds whilst
handling:
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Blood-stained body fluids
Disposal of clinical waste
Handling sharps e.g. needles
Disposal of contaminated waste
Attend local A&E clinic as soon as possible
(ideally within 1 hour and no later than 48
hours):

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Seek specialist advice / treatment from
microbiologist / virologist
Ensure blood sample collected for storage
Directorate
Occupational group
BBV hazard
GT

a) Handling sharps e.g. needles

Fixed site needle
exchanges
Community teams
Kent Scientific Services

a) Contamination of open wounds whilst
handling:
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Laboratory staff
Blood-stained body fluids
Disposal of clinical waste
Handling sharps e.g. needles
Disposal of contaminated waste
Community Safety
a) Contact with sharps

b) Human biting & scratching resulting in
breaking of the skin
Community wardens
c) Contamination of the eyes or mouth of
body fluid e.g. sputum, vomit
d) Contamination of open wounds whilst
handling:

Blood-stained body fluids
Waste Management

a) Contact with sharps
Waste site staff
b) Human biting & scratching resulting in
breaking of the skin
c) Contamination of the eyes or mouth of
body fluid e.g. sputum, vomit
d) Contamination of open wounds whilst
handling:

Blood-stained body fluids
Country Parks
a) Contact with sharps

b) Human biting & scratching resulting in
Country park rangers
14
breaking of the skin
c) Contamination of the eyes or mouth of
body fluid e.g. sputum, vomit
d) Contamination of open wounds whilst
handling:
All
 Blood-stained body fluids
a) Puncturing of the skin whilst handling:
First Aiders
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(Please see Page 3 re:
universal precautions)
Blood-stained body fluids
Sharps
b) Other first aid responsibilities
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Appendix 4
Hepatitis B Immunisation Programme
Introduction
Under Control of Substances Hazardous to Health (COSHH) Regulations 2002
requirements:
If a risk assessment shows that there is a risk of exposure to biological agents, and
effective vaccines exist, then provision should be made to determine whether an
employee is already immunised, and vaccination should be offered to those not
already immunised.
As with all control measures, vaccination needs to be checked and reviewed and
boosters provided where deemed necessary. It is recommended that immunity of
employees is assessed before or after vaccination to provide an indication as to the
necessity and effectiveness of the vaccination and inform the risk assessment as to
whether additional control measures are required for that individual or work activity.
Final decisions on immunisation should be made on the basis of a local risk
assessment. In settings where the client’s behaviour is likely to lead to significant
exposures on a regular basis (e.g. biting), the Department of Health “The Green
Book” indicates that it would be prudent to offer immunisation to staff even in the
absence of documented Hepatitis B transmission.
Employees are at liberty to refuse vaccination, but any refusal should be considered
as part of the risk assessment - since additional controls may be necessary - and
considered with regards to the type of work assigned to the individual.
Immunisation programmes must be provided by appropriately qualified providers e.g.
occupational health services or GPs.
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Immunisation Schedule
Generally the schedule for Hepatitis B, consists of three doses, with or without a
fourth dose.
Time
Description
Rationale
Written consent sought.
Medical history and
Primary vaccine1
Month 1
Primary vaccine 2
Month 2
Primary vaccine 3
Month 6
Determines individual
response to vaccine and
measures antibody titre
level i.e. immune / nonimmune
Post vaccine blood test
Post vaccine (reinforcing)
booster dose
Non-responders - (non
immune) - will be followed
up on an individual basis
and further vaccination or
blood tests may be
offered.
Month 8
In accordance with “The
Green Book” and if no post
exposure vaccine given
prior to this date.
Year 5
Managers may only be informed if an employee is immune or non-immune. No
individual blood tests results or reasons for further blood tests will be provided to
protect and maintain the medical confidentiality of the individual.
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Appendix 5
Flow Chart - Guidance on management of incidents involving potential
exposure to a blood-borne viruses
Incident / accident potentially involving BBV:

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Skin puncture from sharp
Human bite or scratch braking the skin
Blood/body fluid splash or contamination of
open wound, eyes or mouth.
First Aid treatment:


Encourage wound to gently bleed under running
water / wash wounds copiously with running
water
Do not scrub or suck site
Contact OH provider:

Determine current immune status of the
recipient (injured person):
Immune or Non - immune
Attend local A&E clinic as soon as possible
(ideally within 1 hour and no later than 48
hours):


Seek specialist advice / treatment from
microbiologist / virologist
Ensure blood sample collected for storage
Individual prophylaxis treatment and follow up
care is determined by specialist:

Inform OH provider18/ GP of outcome.
Complete
Accident/Incident
Form (HS157)
RIDDOR
reporting if
appropriate