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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 .

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blood borne viruses and sharps injuries in care homes
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
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
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
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
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
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
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
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
How are BBV’s spread by blood/body fluids?
  • Needlestick injury (nb diabetic lancets)
  • Through damaged or cut skin
spread of infection bbvs cont
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
slide11

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
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
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.
prevention of spread
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
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)
slide17

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
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
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
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
slide21
Resheathing is a hazardous cess. The health care worker moves the used needle towards the resheathing cap …
  • Source: BMA booklet 1990 -
  • Code of Practice for the Safe Use and Disposal of Sharps

Do not bend or recap needles

  • ...and misses, jabbing the hand holding the cap. Resheathing should be avoidedalways
sharps contamination injuries needlesticks blood into open cuts bites or scratches which draw blood
Sharps / contamination injuriesNeedlesticks, 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
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
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
thank you
THANK YOU
  • SOUTH EAST LONDON HEALTH PROTECTION UNIT
  • 1 Lower Marsh
  • London SE1 7NT
  • 020 7716 7030