PROTECTION FROM OCCUPATIONAL ACQUIRED/TRANSMITTED COMMUNICABLE DISEASES Policy

Transcription

1 PROTECTION FROM OCCUPATIONAL ACQUIRED/TRANSMITTED COMMUNICABLE DISEASES Policy 1

2 Policy title Protection from Occupational Acquired /Transmitted Communicable Diseases Policy COR 60 reference Policy category Occupational Health Relevant to All Staff Date published January 2016 Implementation January 2016 date Date last December 2015 reviewed Next review January 2019 date Policy lead Head of Occupational Health Contact details Accountable director Approved by (Group): Approved by (Committee): Document history Membership of the policy development/ review team Director of Nursing and People Infection Control Committee December 2015 Quality Committee 19 January 2016 Date Version Summary of amendments May Revised within the Infection Control Manual Jan Stand-alone policy and updating procedures Consultant Occupational Physician, Head of Occupational Health and Infection and Control Lead Consultation Occupational Health Staff and HR DO NOT AMEND THIS DOCUMENT Further copies of this document can be found on the Foundation Trust intranet. 2

3 CONTENTS 1 KEY POINTS PURPOSE SCOPE... 4 BLOOD BORNE VIRUSES... 5 AIR BORN TRANSMISSION (DROPLET INFECTIONS)... 5 ORAL / FAECAL TRANSMISSION RESPONSIBILITIES DEFINITIONS USED PROCEDURE: MONITORING COMPLIANCE AND EFFECTIVENESS CONSULTATION REFERENCES APPENDIX 1 GROUPS OTHER THAN SUBSTANTIVE EMPLOYEES APPENDIX 2 WORKPLACE RISK ASSESSMENT SUMMARY APPENDIX 3 - OVERVIEW OF THE IMMUNISATION AND IMMUNITY SCREENING REGIMES APPENDIX 4 OVERVIEW OF THE ADDITIONAL IMMUNISATION AND IMMUNITY SCREENING REGIMES FOR EPP WORKERS APPENDIX 5 OUTBREAK MANAGEMENT RECORD FORM APPENDIX 6 - OVERVIEW OF PROTECTION PROCESSES APPENDIX 7 EQUALITY AND HUMAN RIGHTS IMPACT ASSESSMENT FORM

4 1 Key Points The protection of HCWs, patients and others at work, relies on the co-ordination and co-operation of various staff and specialist advisory services within the Trust. The decision to immunise HCWs (and others) should be based on risk assessment of the type of work / activity being undertaken and also taking into consideration the following: The biological hazards to which they may be exposed and the likelihood and consequences of infection. The risks and consequences of transmission of infection to patients should a non-immune HCWs contract or be diagnosed with a serious communicable disease. 2 Purpose The purpose of this document is: To describe the circumstances in which health care workers (HCWs), patients or others, may be exposed to occupationally acquired communicable diseases. To describe the measures to protect health care workers from occupationally acquired infections including: risk assessment processes the provision of advice, information, training and guidance the provision of immunisation programmes and immunity screening programmes the provision of advice regarding exclusion from work To describe the measures for protecting patients from communicable disease, which may be transmitted by infected HCW s who have either acute or chronic infections. 3 Scope This document applies to all HCWs within the Trust including voluntary workers. Agreed services will be available to others entering the Trust in accordance with the level of risk associated with their activity. For a list of the current schemes and programmes see Appendix 1. The communicable disease covered in this policy include 4

5 Blood borne viruses Hepatitis B Hepatitis C HIV Air born transmission (droplet infections) Tuberculosis Rubella (German measles) Varicella Zoster Virus (Chicken pox) & Shingles Measles Influenza Oral / faecal transmission Hepatitis A And other diseases that may require outbreak management advice, such as, Norovirus 4 Responsibilities Individual / group Trust Employees Responsibility To co-operate with the employer and follow all advice, information and guidance related to their protection and that of patients and others and not wilfully place themselves or patients or others at risk whilst at work. To attend New Entrant Screening in the OHS Attend all mandatory training. To use personal protective equipment and safer devices provided as appropriate. To report incidents involving exposure to blood or body fluids immediately and in accordance with Trust guidance Report immediately any concerns regarding self, patients or others in respect of communicable disease exposure e.g. signs and symptoms of ill health, equipment failure, poor hygiene standards etc. 5

6 Managers / Supervisors Undertake risk assessment in accordance with Trust policy re Control of Substances Hazardous to Health (COSHH). To ensure the Occupational Health Service (OHS) and Human Resources service are informed of any schemes that introduce others into clinical areas and / or contact with patients. To ensure all new staff attend New Entrant Screening in the OHS Provide Health Care Worker (HCW) and others with relevant information and instructions and training in safe work practice for specific work activities which may place them at risk. To ensure all Personal Protective Equipment (PPE) and safer devices are available for use. Seek support from the specialist advisors i.e. Infection Prevention and Control, Health and Safety and Occupational Health as required Ensure that HCWs or others having sharps injury or exposure to blood or body fluids are supported in accordance with the Management of Sharps Injuries and Exposures to Blood and Body fluids Procedure Policy (see OHS Trust intranet page for full details) Liaise and co-operate with the specialist support services in respect of matters related to the risk of transmission of communicable diseases e.g. Outbreak management Occupational Health Provide an immunisation and immunity screening service in accordance with Department of Health, NICE guidance and The Green Book recommendations Provide appropriate Occupational Health Service (OHS) activities for the management and follow up of individuals potentially exposed to communicable diseases in accordance with the relevant Department of Health and NICE guidance e.g. follow up post sharps injuries and exposures to blood and body fluids. OHS will also provide support in the management of outbreaks. Provide appropriate medical advice and possible referral of HCWs and others suffering from a communicable disease. Promote the services that are available to HCWs and others. Health and Safety Provide advice, support and information with the risk assessment process for the COSHH Regulations. Promote and monitor the reporting of individual exposures to 6

7 blood and body fluids via Datix. Trust Infection Prevention and Control Staff Trust Infection Control Prevention Committee Chief Executive Provide advice, support and information regarding all matters related to the reduction of risk of occupationally acquired or transmitted Communicable Disease and in the management of outbreaks. To review and approve policies and procedures. To receive monitoring information and provide advice and guidance to reduce the risk of occupationally acquired or transmitted Communicable Disease The Chief Executive has overall and final responsibility for Infection Prevention and Control. 5 Definitions Used Others Individuals who enter clinical areas to support patients, observe clinical staff or who undertake work experience activity but who are not issued with a contract of employment. Exposure-prone procedures Exposure prone procedures (EPPs) as defined by the Department of Health (DoH) are those where there is a risk that injury to the worker may result in exposure of the patient's open tissues to the blood of the worker. These procedures include those where the worker's gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient's open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times. Inoculation injury and sharps incidents A sharps incident is defined as an inoculation with an instrument such as a needle or scalpel blade, which has been contaminated by blood or other body fluid or blood or body fluid splashed into the eye, mouth or onto the skin surface which has an open cut or abrasion Body fluids that should be handled with the same precaution as blood Cerebrospinal fluid, peritoneal fluid, pleural fluid, synovial fluid, amniotic fluid, semen, vaginal secretions, breast milk. Any other body fluid containing visible blood, including saliva in association with dentistry Unfixed tissues and organs 7

8 6 Procedure: Individual/ group Managers / Supervisors Action 1. Conduct COSHH Risk Assessment process. For details please refer to COSHH risk assessment procedures on Trust intranet 2. When recruiting new staff complete the Occupational Health Workplace Risk Assessment form (WRA) based on the service risk assessment. This is forwarded to recruitment for the details to be placed on the Health Questionnaire issued to the candidate. For further details please refer to recruitment processes on Trust intranet For copy of WRA - see Appendix 2 3. Ensure all new staff have attended for new entrant screening at the OHS and refer staff who have not done so. 4. Ensure all HCWs receive corporate and local induction training and ongoing mandatory training related to Infection Control including but not exclusively: Safe handling and disposal of Sharps Management of Sharp Injuries and Exposure to Blood and Body Fluids. Use of safer devices and PPE All clinical procedures related to Infection Prevention and Control associated with the service area. Ensure all accidents and incidents which place HCWs or others at risk of acquiring a communicable disease are reported and investigated in accordance with Trust policy and any areas of concern are fed back to the relevant Infection Prevention Control Sub group. 8

9 Individual/ group Occupational Health Service Action As part of the recruitment process and on receipt of a completed Health Questionnaire the OHS will: Assess the individual and deliver immunity screening programmes and immunisations and offer all necessary follow up / recall in accordance with OHS Standard Operating Procedures. For detail of Immunisation programmes and Immunity screening regimes see Occupational Health Service Guidance for staff Immunisation and Immunity Screening on Trust intranet Overview of the Immunisation and Immunity Screening regimes see Appendix 3 Identify those HCWs undertaking Exposure Prone Procedures and undertake additional immunity screens as clinically indicated. For details on additional checks required for Health care worker undertaking Exposure Prone Procedures see Occupational Health Service Guidance for assessing and supporting staff whose work involves Exposure Prone Procedures (EPP) on Trust intranet. For Overview of Immunisation and Immunity Screening regimes for EPP workers see Appendix 4 Support HCWs identified as being infected with a communicable disease (either acute or chronic) For detail of the clinical management of HCWs infected with a communicable disease see Policy for the Management of Infections in Health Care Workers on Trust intranet Identify those staff / HCWs preparing or handling foods and ensure they not infected with any diseases that could contaminate food supplied to patients (or staff) Promote safe working practices and provide information and guidance through the provision of an employee booklet, and sharps injury management advice cards see Trust intranet During employment the OHS will: Provide appropriate follow up where sharps injuries and blood body fluids exposures are reported in accordance with the policy on the Management of Sharps Injuries and Blood and Body Fluids Exposures, see Trust intranet 9

10 Individual/ group Action Provide advice on when HCWs should be excluded from work or certain work areas and provide appropriate follow up for outbreaks in liaison with infection prevention and control staff and in accordance with the infection control standards. For detail of OHS Outbreak record form to be completed by TRUST and returned to OHS see Appendix 5 Ensure all relevant documentation regarding HCWs immunisations and immunity screening is created, maintained, stored and destroyed in accordance with all TRUST data protection and information governance and Department of Health record keeping standards, both in hard copy and electronic format on the COHORT database. Provide reports to the TRUST IPC Committee on activity undertaken and any significant risks identified and provide an annual overview. Infection Prevention and Control Infection Prevention and Control (IPC) staff will provide advice, instruction and training via: Corporate induction. Provision specific training sessions. Ad hoc requests In liaison with the OHS provide advice on: Appropriate follow up for outbreaks and sharps injury and blood body fluids exposures. When HCWs should be excluded from work or certain work areas, when infected with a communicable disease. For further details please refer to Corporate and Mandatory training programmes on Trust intranet IPC will issue a report to the Trust IPC Committee on activity undertaken and any significant risks identified. 10

11 Individual/ group Health and Safety Action Health and Safety staff will provide advice, instruction and training via: Corporate induction. Provision specific training sessions. Ad hoc requests For further details please refer to Corporate and Mandatory training programmes on Trust intranet Support managers in conducting risk assessment procedures in accordance with the COSHH regulations Monitor all accidents and incidents reported via Datix Health and Safety will issue a report to the TRUST IPC Committee on activity undertaken and any significant risks identified. For overview flow chart see Appendix 5 11

12 Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendat ions and Lead(s) Change in practice and lessons to be shared 7 Monitoring Compliance and Effectiveness OHS Activity H&S Activity Infection Control Activity OH Service Manager H&S Manager Infection Control Champions OHS - ICC Report H&S - ICC Report ICC Reports Quarterly plus annual overview Quarterly plus annual overview Quarterly plus annual overview Infection Control Committee Required actions will be identified and completed in a specified timeframe Required changes to practice will be identified and action taken within a specific time frame. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders. For further detail regarding protection of staff and patients from occupationally acquired infections please refer to reference list below. 8 Consultation Infection Control, Health & Safety and Occupational Health Clinical teams and have all been consulted in the development of this policy. 12

13 9 References 1. The Green Book Green Book 2. Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers. DH_ Tuberculosis in the UK- time to regain control. Ibrahim Abubakar et al, BMJ 2011; 343:d NICE guidance clinical diagnosis and management of tuberculosis and measures for its prevention and control CG Varicella zoster virus Occupational aspects of management 6. UK Health Departments. Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV:New healthcare workers, DH_ HSC 2000/020 Hepatitis B infected health workers andcirculars/healthservicecirculars/dh_ Hepatitis B infected healthcare workers and antiviral therapy Department of Health DH_ Hepatitis C Infected Healthcare Workers HSC 2002/010 et/dh_ pdf 10. Hepatitis C Infected Healthcare Workers et/dh_ pdf 13

14 11. Management of HIV infected Healthcare Workers The Report of the Tripartitie Working Groups April HIV Infected Health Care Workers:Guidance on Management and Patient Notification Ref DOH 2010 Annex A 13. Health Protection Agency, The Management of HIV infected Healthcare Workers who perform exposure prone procedures: updated guidance, January

15 Appendix 1 Groups Other than substantive employees Peer Support Workers (mental health and physical health work issues) User Involvement Individuals Pre medical school trainees Volunteers Work Experience schemes 15

16 Appendix 2 Workplace Risk Assessment Summary Tool accessible on the Intranet 16

17 Appendix 3 - Overview of the Immunisation and Immunity Screening Regimes Communicable Disease Clinical staff involving EPP Clinical and other staff in prolonged contact with patients or regular exposure to blood or body fluids. Clinical and other staff in social contact with patients or exposure to equipment contaminated with blood or body fluids. Staff with no contact with patients or potential exposure to blood or body fluids Blood Borne Viruses Hepatitis B Immunity Screening (Serology- Hep B surface antibodies or Hep B core antibodies) Mandatory Recommended Recommended Not required. Confirmation of non infectivity (Serology Hep B surface antigen) Mandatory Recommended if individual considered to have been exposed to risk with consent Recommended if individual considered to have been exposed to risk with consent Recommended if individual considered to have been exposed to risk with consent Immunisation if not previously immunised / immune Strongly recommended Recommended Recommended Not required. 17

18 Communicable Disease Clinical staff involving EPP Clinical and other staff in prolonged contact with patients or regular exposure to blood or body fluids. Clinical and other staff in social contact with patients or exposure to equipment contaminated with blood or body fluids. Staff with no contact with patients or potential exposure to blood or body fluids Hepatitis C Confirmation of non Infectivity (Serology- Hepatitis C antibodies and if positive Hepatitis viral load) Mandatory Offered to all and recommended if individual considered to have been exposed to risk with consent Offered to all and recommended if individual considered to have been exposed to risk with consent Recommended if individual considered to have been exposed to risk with consent Immunisation if not previously immunised / immune N/a N/a N/a N/a HIV Confirmation of non infectivity ( Serology -HIV antibodies) Mandatory Offered to all and recommended if individual considered to have been exposed to risk with consent Offered to all and recommended if individual considered to have been exposed to risk with consent Recommended if individual considered to have been exposed to risk with consent Immunisation if not previously immunised / immune N/a N/a N/a N/a 18

19 Communicable Disease Clinical staff involving EPP Clinical and other staff in prolonged contact with patients or regular exposure to blood or body fluids. Clinical and other staff in social contact with patients or exposure to equipment contaminated with blood or body fluids. Staff with no contact with patients or potential exposure to blood or body fluids Air Borne Viruses (Droplet infection) Tuberculosis Immunity Screening (BCG Scar and where necessary IGRA test) Recommended Recommended Recommended Recommended (Public health measure) Confirmation of non infectivity ( symptom questionnaire / past infection and Serology IGRA test for those from or visited country of high incidence for >1 month in past 5 years) Recommended Recommended Recommended Recommended Immunisation if not previously immunised and have negative IGRA test Recommended Recommended Recommended Recommended (Public health measure) 19

20 Communicable Disease Clinical staff involving EPP Clinical and other staff in prolonged contact with patients or regular exposure to blood or body fluids. Clinical and other staff in social contact with patients or exposure to equipment contaminated with blood or body fluids. Staff with no contact with patients or potential exposure to blood or body fluids Varicella Zoster Immunity Screening (Definite history or if no/uncertain history Serology- VZV antibodies) Recommended Recommended Recommended Recommended (Business continuity) Immunisation if not previously immunised / immune Recommended Recommended Recommended Recommended (Business continuity) Rubella (German Measles) Immunity Screening ( Serology- Rubella antibodies) Immunisation if not previously immunised / immune Recommended Recommended Recommended Recommended (Business continuity) Recommended Recommended Recommended Recommended (Business continuity) Measles 20

21 Communicable Disease Clinical staff involving EPP Clinical and other staff in prolonged contact with patients or regular exposure to blood or body fluids. Clinical and other staff in social contact with patients or exposure to equipment contaminated with blood or body fluids. Staff with no contact with patients or potential exposure to blood or body fluids Immunity Screening if no documentation of two MMR vaccines ( Serology- Measles antibodies) Immunisation if not previously immunised / immune Recommended Recommended Recommended Recommended (Business continuity) Recommended Recommended Recommended Recommended (Business continuity) Influenza Immunisation (annual) Recommended Recommended Recommended Recommended (Business Continuity) Faecal/oral Transmission Hepatitis A ** Laboratory workers, sewage workers and staff in large residential institutions for those with learning difficulties. Immunisation if not previously immunised / immune Recommended* * Recommended** Recommended** Not recommended 21

22 Communicable Disease Clinical staff involving EPP Clinical and other staff in prolonged contact with patients or regular exposure to blood or body fluids. Clinical and other staff in social contact with patients or exposure to equipment contaminated with blood or body fluids. Staff with no contact with patients or potential exposure to blood or body fluids NB All Immunisations recommended are done so provided no individual contraindications exist. 22

23 Appendix 4 Overview of the Additional Immunisation and Immunity Screening Regimes for EPP workers Communicable Disease Hepatitis B Clinical staff involving EPP Immunity Screening (Serology- Hepatitis B surface antibody or Hepatitis B core antibody) Confirmation of non infectivity (Serology- Hepatitis B surface antigen) Mandatory Mandatory Immunisation if not previously immunised / immune Strongly recommended * Hepatitis C Confirmation of non infectivity (Serology-If Hepatitis C antibody positive test for Hepatitis C DNA) Mandatory HIV Confirmation of non infectivity (Serology HIV antibody) Mandatory 23

24 Appendix 5 Outbreak Management record form EXPOSURE TO: {ONLY ENTER ON THIS LIST STAFF WHO HAS HAD HIGH CONTACT WITH THE PATIENT CONCERNED} NAME (Block Capitals) It is important to ensure FULL NAME and correct spelling DOB POST PERMANENT STAFF YES/NO AGENCY STAFF YES/NO HISTORY OF: YES/NO Immune by serology YES/NO Screening required, serology, vaccination 24

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26 Appendix 6 - Overview of Protection Processes 26

27 Appendix 7 Equality Impact Assessment Tool 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? 5. If so can the impact be avoided? 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? Yes/No No No No No No No No No No No N/A No N/A N/A N/A Comments The policy provides for information to be given in other languages where necessary. The policy provides for alternative media to be used to seek consent where necessary. 27