COMMUNITY CARE TRUST (SOUTH DEVON) LTD
HEPATITIS B
POLICY NO. CCT023
INTRODUCTION
a)
Hepatitis B is predominantly a blood borne disease but can also be acquired
by sexual intercourse or by transmission from mother to baby. Most people
acquiring the disease as adults become free of any marker of infection within
a few months but a small proportion may go on to be long term carriers.
b)
Babies acquiring the disease at birth are more likely to become carriers and
their carriage may be life long.
c)
A proportion of those who have suffered from Hepatitis B, whether acquired at
birth or later, may continue to carry the virus in a highly infectious form which
is characterised by the marker ‘e’ antigen. The blood of such individuals is
highly infectious if it gains access to the blood or tissues of someone else.
DEFINITION OF A HEALTHCARE WORKER
For the purposes of this policy, a healthcare worker is defined as any person whose
activities involve contact with clients or with blood or other body fluids from clients in
a healthcare setting.
DEFINITION OF EXPOSURE PRONE PROCEDURE
An exposure prone procedure is one where there is a risk that injury to the healthcare
worker may result in the exposure of the client’s open tissues to the blood of the
healthcare worker. Such a procedure is one where the healthcare worker’s gloved
hands may be in contact with sharp instruments, needle tips and sharp tissues
(spicules of bone or teeth) inside a client’s open body cavity, wound or confined
anatomical space, where the hands or finger tips may not be completely visible at all
times. Such procedures must never be performed by a healthcare worker who is
Hepatitis B ‘e’ antigen positive.
DEFINITION OF INOCULATION RISK
Where there is a risk to a healthcare worker of contaminating themselves with blood
or other body fluids by injection or absorption. Clients who are infected with Hepatitis
B pose an inoculation risk.
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DEFINITION OF BODY FLUID
Blood and blood products
Saliva
Vomit
Urine
Semen
Cervical secretions
Any other fluid containing visible blood
Unfixed tissues and organs which may contain body fluids
PREVENTION OF INFECTION
a)
Occupational risk of transmission of Hepatitis B virus to healthcare workers
arises from the possibility of their being accidentally inoculated with blood or
some other body fluids from an infected client. Blood is the primary source
but all body fluids must be handled with the same precautions. The
categories of clients who must be considered to be an actual or potential
inoculation risk are as follows:
 Clients who are HBsAg positive, or have been so in the past and have not
had a clearance test.
 Clients who are HIV antibody positive.
 Sexual partners of inoculation risk clients.
 Drug misusers who have used injections at any time.
b)
The primary measures for prevention of occupational exposure to the
Hepatitis B virus are:
 Protection of existing wounds, skin lesions, conjunctival and mucosal
surfaces and prevention of puncture wounds, cuts and abrasions in the
presence of body fluids.
 Avoiding contamination of the operator or their clothing with body fluids.
 Regular hand washing and showering where necessary.
 Control of work surface contamination with body fluids by containment and
disinfection.
 Avoidance of sharps usage where possible, but when their use is essential
the exercising of particular care in handling and disposal.
 Correct disposal of contaminated waste.
c)
PENETRATING WOUNDS/NEEDLESTICK INJURIES TO STAFF
These must be dealt with immediately by washing the wound liberally with
soap and water and encouraging bleeding.
Any puncture wound or
contamination of broken skin or mucous membrane with body fluid must be
reported promptly using the accident and untoward incidents procedure.
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d)
PROCEDURAL REQUIREMENTS AND RESPONSIBILITIES OF STAFF TO
PROTECT CLIENTS FROM HEPATITIS B INFECTION
Healthcare workers’ responsibilities
Healthcare workers must pay meticulous attention at all times to the well
established and accepted safe working practices already laid down in
procedures when coming into contact with client’s blood, fluid or tissues.
These include the wearing of waterproof dressings or gloves over cuts or
sores on their hands and the routine use of gloves and other protective
clothing for exposure prone invasive procedures.
Providing such precautions are scrupulously followed, the great majority of
clinical procedures pose no risk of Hepatitis B transmission. However, during
exposure prone invasive procedures, unavoidable injury to the operator can
occur, with subsequent entry of his blood into the client’s tissues and the
consequent risk of infection.
It is therefore Trust policy, in line with current guidelines, for all healthcare
workers to be immunised against Hepatitis B and subsequently tested for
immunity if they do not respond to this course of immunisation and
subsequent boosters, to see whether they are carriers of the disease.
Any healthcare worker who normally performs exposure prone invasive
procedures found to be Hepatitis B ‘e’ positive must cease to perform any
exposure prone invasive procedures. Any other healthcare worker who may
be Hepatitis B ‘e’ positive will be assessed with regard to any possible risk to
clients and if necessary redeployed.
Where there is any doubt about the advisability of allowing a healthcare
worker to continue with their particular occupation, expert advice may be
sought via the Occupational Health Medical Officer from among others, the
Infection Control Doctor, the Regional Consultant in Occupational Health or
the UK Advisory Panel for Hepatitis B Infected Healthcare Workers.
Any healthcare worker who is unwilling to take part in the immunisation
programme for employees with a subsequent testing procedure to detect
conversion or the carriage of markers of infectivity will be deemed to be a
Hepatitis B ‘e’ carrier and therefore highly infectious.
This will apply to those staff already in post and will be applied as a condition
of employment to all future healthcare workers to be appointed. It will also
apply to staff employed on locum or short term contracts who must either
supply acceptable written proof of Hepatitis B immunity or lack of infectivity
before employment, or agree to be tested before the employment
commences.
GENERAL REMARKS
Any healthcare worker found during the course of the immunisation procedure to be
a carrier of Hepatitis B will be offered the opportunity to consult a Consultant GastroEnterologist or physician with an interest in liver disease with regard to the possibility
of further treatment and follow up.
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Any healthcare worker who during the course of the immunisation programme is
found to be a Hepatitis B carrier must be investigated in an attempt to assess the
source of the original infection. Hepatitis B is now recognised as an occupational
disease in healthcare workers.
Healthcare workers infected with Hepatitis B require and will receive the same care,
consideration and confidentiality as all other clients.
NON-DISCLOSURE BY AN EMPLOYEE ON DIAGNOSIS OR SUSPICION OF
HEPATITIS B INFECTION
Should a healthcare worker knowingly fail to disclose Hepatitis B infection and
continue to perform exposure prone procedures they will face immediate suspension
from duty and disciplinary action which may result in termination of contract.
Date of last review:
Version number:
Date of next review:
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April 2014
Signature ……………………………….
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