Sharps and Inoculation Management

Transcription

1 SH CP 14 (Infection Prevention and Control Policy: Appendix 10) This Appendix must be read in conjunction with the Infection Prevention and Control Policy. Summary: Target Audience: Providing a clear, evidence based framework to ensure safe practice when sharps are used. All staff of all disciplines, Non-Executive Directors, Volunteers, Governors and Contractors Next Review Date: Feb 2021 Approved by: IP&C Group Date of meeting: 3 February 2017 Date issued: Author: Sponsor: Theresa Lewis Lead Nurse Infection Prevention and Control Sara Courtney Acting Chief Nurse Author: Theresa Lewis Lead Nurse IP&C 1

2 Version Control Change Record Date Author Version Page Reason for Change Mary Pilgrim 1 New Policy 09/11/12 Theresa Lewis 2 Throughout Following the acquisition of Ridgeway services Theresa Lewis 3 Throughout Following change of OH provider to ATOS Theresa Lewis 4 5 Following publication of EPIC 3 guidelines Theresa Lewis 4 9, 27 (Technical Amendment) A&E Letter added as an appendix Jacky Hunt 4 4 (Technical Amendment )Bite and scratches from service users to staff- more information added about care planning, and management support Theresa Lewis 5 Throughout Change of OH provider to People Asset Management Theresa Lewis 5 6 Technical amendment following NICE Alert; NICE_CG139_Feb2017 HCAI: prevention and control in primary and community care (March 2012) Reviewers/contributors Name Position Version Reviewed & Date Jacky Hunt IP&CN Sept 2013 Mary Pilgrim IP&CN Sept 2013 Angela Roberts IP&CN Sept 2013 Louise Piper Assistant IP&CN Sept 2013 Carol Hargreaves Occupational Health Advisor (ATOS) V De Wharbuton Occupational Health Advisor (ATOS) V IP&C Group V Divisional Directors & Professional Leads Group V Area Matrons (Physical Health) V Matrons (Mental Health & LD) V Paul Mabey Podiatry Lead V Caroline Atkinson Diabetes Specialist Nurse V Deborah Fishwick Diabetes Specialist Nurse V Chris Paterson Diabetes Specialist Nurse V Jacky Hunt IP&CN V5 Angela Roberts IP&CN V5 Louise Piper IP&CN V5 Laura Hodgkinson Clinical Director PAM V5 Ross Taylor Regional Business Manager PAM V5 Janet O Neil Head of Pam Academy V5 IPC Group members V5 Author: Theresa Lewis Lead Nurse IP&C 2

3 CONTENTS 1. Introduction 4 2. Definitions 4 Page 3. Process for Safe Management of Sharps Essential Practice during use and disposal of sharps Essentials of disposal Waste generated away from Health Care premises Community clinic Process following Sharps/Contamination Injury Actions to be taken by Employee Actions to be taken by Manager Actions to be taken by OHD Sharpsline Actions to be taken by OHD (PAM) Training References 14 Appendices 10.1 Sharps poster - immediate action following sharps incident, bite, scratch or splash Guide to Sharps box colour code Risk Assessment Source Patient Assessment and Consent Form Management of High Risk Sharps/Contamination Injuries Letter for A&E Department following a Needle Stick Injury 21 Author: Theresa Lewis Lead Nurse IP&C 3

4 For urgent management of sharp/bite/ break to skin injury go straight to Appendix 10.1 and Section 4 (page 9) 1. Introduction: The Trust has a duty of care to: Ensure that risks from sharps injuries are minimized in Southern Health NHS Foundation Trust; this will decrease the risk of occupationally acquired blood-borne infections such as hepatitis B virus (HBV), human immunodeficiency virus (HIV) or hepatitis C (HCV). Implement The European Union (EU) Council Directive May 2010, which is to achieve the safest possible working environment by preventing injuries to workers and to set up an integrated approach establishing policies in risk assessment, risk prevention, training, information, awareness and monitoring. Provide a clear, evidence based framework to ensure safe practice when sharps are used. (The Health Act 2008). Provide post-exposure treatment for hepatitis B with specific immunoglobulin and vaccination for non-immune staff exposed to hepatitis B infection Ensure HIV post exposure prophylaxis is available for those who have been exposed to HIV, or where there is a high risk of the source patient being HIV positive see Appendix 10.3 for further information on risk assessment Hepatitis C has no vaccine or post-exposure treatment but post-exposure screening for HCV antibody is carried out where indicated by risk assessment 2. Definitions: 2.1 Sharp is any object, which can puncture the skin and may be contaminated by blood or body fluids, e.g. hypodermic needles, suture needles, and scalpel blades, pieces of bone, teeth splinters and glass ampoules. Bites, scratches inflicted from one person to another may also pose a contamination of blood and body fluids risk to be dealt with in the same manner as a sharps injury if skin is broken. (Please see Appendix 10.1 for immediate actions following a sharps/inoculation injury) If your staff care for a service user who is known to bite/scratch, please add the following paragraph below to their care plan: If staff skin has been broken by biting or scratching, staff must carry out basic first aid (allow to bleed, wash it, cover it) then promptly report the incident to their manager, to People Assess Management (PAM) by phoning any time day or night and on Ulysses Safeguard. Managers have a responsibility to ensure their staff area aware of this guidance and ensure they can be released to follow it. Author: Theresa Lewis Lead Nurse IP&C 4

5 2.2 Sharp container/box must be UN 3291 approved, it is a yellow container which is available with different colour lids, depending on the type of sharp being disposed (see table, Appendix 10.2). At no time are sharps containers to be placed in clinical waste bags. 2.3 Sharp container identity tag. To enable traceability of healthcare waste sharps, medicines/waste. Each container is to be allocated a unique reference number by being sealed or having attached to it a uniquely identifiable identity tag/tape at the point of origin premise, or on a larger premise the department/ward to allow tracking. These are available from your cleaning contractor. 2.4 Sharps Incident/injury is when intact skin is breached by a sharp object (needle, instrument or bone). (For immediate action see Appendix 10.1).This also includes human bites and scratches that can break the skin. These injuries pose a significant risk to the physical and mental health of a staff member, cost the healthcare organisation time and resources and have the potential to result in costly litigation. 2.5 Splashes of blood and body fluids to the mucous membranes, (eyes, nose or mouth) or over skin that is not intact, (abrasions, cuts eczema etc.) also pose a risk of contamination and will be dealt with in the same way as sharps injuries. 2.6 Exposure to blood and body fluids constitutes a risk of contracting occupationally acquired infection and therefore prevention is mandatory for all healthcare personnel. An exposure is when blood or bodily fluid from a person is ingested, inoculated or is in contact with mucous membrane, eyes or broken skin of another person. This may be due to a sharps injury, or a splash, a bite or a scratch. 2.7 PEP (Post Exposure Prophylaxis). Medication given after occupational exposure to reduce the risk of acquiring a blood borne virus 2.8 Needle Protection Devices The main aim of such devices is to minimize the risk of injury to healthcare workers (HCWs) during needle use and after disposal to the facilities staff who are responsible for the collection of disposal units. 3. Process for Safe Management of Sharps: 3.1 The safe use and disposal of sharps is essential to protect healthcare workers from exposure to communicable infections during the course of their work. Measures therefore must be in place to protect all Trust staff from blood borne viruses such as Hepatitis B and C and HIV. 3.2 This document provides guidance on the management of sharps/contamination injuries for all SHFT employees, managers, and for clinical staff employed by, or on behalf of PAM who provide Occupational Health Services to SHFT 3.3 The assessment and management of risks associated with the use of sharps in healthcare settings play a key role in establishing which safe systems should be in place to minimise any identified risks. e.g. positioning the sharps box as close as possible to the site of the intended procedure. 3.4 End-users should be involved in evaluating safer sharps devices to determine their effectiveness, acceptability to practitioners, impact on patient care and cost benefit prior to widespread introduction (epic ). Author: Theresa Lewis Lead Nurse IP&C 5

6 3.5 Essential Practice during use and disposal of sharps; Risk assessment should be undertaken prior to each procedure with the aim of reducing or eliminating risk Appropriate personal protective equipment must be worn. Where possible gloves should be worn especially if there are cuts or broken areas of skin. Gloves will not prevent an injury but they significantly reduce the risk of transmission of blood borne viruses Sharps must not be passed directly from hand to hand and handling should be kept to a minimum Use sharps safety devices where available and ensure all users are trained in their correct use Needles must not be recapped, bent broken or disassembled after use (only exception is certain dental syringes). It is acceptable to bend needles when are part of an approved sharps safety device (NICE CG139 updated 2017) In dentistry, if recapping or disassembly is unavoidable, a risk assessment must be undertaken and appropriate safety devices should be used. (NICE 2012) Used sharps must be discarded into a sharps container (conforming to UN3291 and BS 7320 standards) at the point of use by the user (DH Saving Lives 2007) Sharps containers must not be filled above the fill line The safety aperture in the sharps bin must be closed between uses All sharps bins should be positioned out of the reach of children at a height that enables safe disposal by all members of staff Sharps bins should not be positioned on the floor They should be secured to avoid spillage of sharps eg by using a bracket Disposable needles and syringes must be disposed of as a single unit Sharps bins should be made available at all locations where sharps are used. Sharps bins should be correctly assembled in accordance with the manufacturer s instructions and be the appropriate size for the sharps being discarded. Prior to first use the label must be completed with hospital, ward, dept or clinic or health centre, assembled by and date assembled. Sharps bins should be stored out of public areas. Portable sharps bins should be stored ready for use, with the appropriate integrated sharps tray, in a cupboard out of public areas. Sharps trays should be cleaned with a Clinell sanitising wipe after each use. In the home environment sharps containers should ideally be placed out of reach if children are present or visiting. Remember! USE BRACKETS TO SECURELY FIT TO WALL OR TROLLEY LOCK WHEN CONTENTS REACH FILL LINE CLOSE TEMPORARY CLOSURE WHEN NOT IN USE COMPLETE LABEL WITH RELEVANT DETAILS WHEN BRINGING INTO SNAP LID USE Author: & Theresa FINAL Lewis Lead Nurse IP&C ON 6 CLOSURE

7 3.6 Essentials of disposal The sharps bin must not be used for any other purpose than the disposal of sharps The sharps bin must be locked when ready for final disposal in accordance with the manufacturer s instructions. To avoid the risk associated with overfilling, sharps containers must be removed from the clinical area when at the fill line and/or have been in use for a total of three months maximum. Safe Management of Healthcare Waste, previously (HTM 07.01). Used containers should be securely closed and labelled with the date and point of origin prior to sending for disposal with either a traceable tag or tape attached. They must be stored in a locked, segregated cupboard or clinical waste bin If a sharps bin is deemed faulty, does not lock or appears damaged, then it should be carefully placed inside a larger sharps bin for disposal. Sharps must never be placed into waste bags. Sharps bins must never be moved or transported with their safety aperture open. 3.7 Waste generated away from Health Care premises. Local Authorities have the primary responsibility for disposing of any waste generated in the patient s own home (generated by the patient). Disposal of clinical waste generated when SHFT staff visit the patient at home will normally be the Trust s responsibility (refer to Trust s Handling and Disposal of Waste Policy) 3.8 Mobile staff During transit:- The aperture of the box to be fully locked (if full) If the sharps bin is not full, the aperture should be placed in the temporary closure position to avoid spillage of contents during transit If the aperture is in the temporary position in transit, it should also go inside a rigid wipeable lidded container in the boot of the staff members car. An alternative is the community nursing box which holds a small sharps box and can hold other clinical items in adjustable sections (see details below). Community Nursing box (red) available from Daniels Healthcare, NHS order code: FSL 262. For more information go to Author: Theresa Lewis Lead Nurse IP&C 7

8 Summary of the safe use and disposal of sharps PROCESS: Safe use and disposal of sharps ACTION RATIONALE EVIDENCE Assessment of procedure involving sharp Use sharp safe equipment when available (EU Directive 2010) and ensure all users are trained to use them Do not re-sheath sharps after use Take sharps bin to patient where clinically appropriate Management of sharps injury. See Appendix 10.1 Use of personal protective equipment Sharps injuries/ near misses to be recorded on Adverse incident reporting form Reduction of risk of sharps injury Reduction of risk of sharps injury Reduces risk of accidental injury Minimal handling of dirty sharp Reduction of risk of occupationally acquired infection Reduction of risk of occupationally acquired infection To provide an accurate record of risk within the Trust Only use a medical sharp when their use is essential, paying particular care in handling and safe disposal, if possible use safer device Use of safe working practice for staff as per the Health & Safety at Work Act 1974 Section 7 Safer practice guidelines, reduced risk of accidental sharps injury Reduction of risks to other persons, ensure sharp is disposed of as soon it has been used Prompt first aid and reporting of injury and risk assessment by trained professional reduces the risk of an occupationally acquired infection Appendix 10.1 Management of Sharps Injury Use of personal protective equipment reduces the exposure to bodily fluids and reduces risk from an occupational exposure Refer to Appendix 5 Standard Precautions of Infection Prevention and Control Policy Provides a record of sharps injury hot spots identifying areas, which require further assessment of procedures and support. The manager of the individual sustaining the sharps injury is responsible for the investigation of the incident and the provision of a report to the Divisional Governance Team 4. Process following Sharps / Contamination Injury see also Appendix Action to be taken by Employee: If an employee sustains a sharps / contamination injury they should: Apply First Aid measures as follows Percutaneous Injury (i.e. Needle Stick): Wash the affected area with copious amounts of running cold water, but do not scrub. Allow wound to bleed, but do not suck or lick the area. Author: Theresa Lewis Lead Nurse IP&C 8

9 Apply a dry waterproof dressing. Exposed Mucous Membranes (i.e. eyes): Irrigate with copious amounts of water. If contact lenses are worn, irrigate before and after removing the lens in the event of an exposure. Report the injury to your Line Manager. Employee to note the date/time/body fluid type and source of exposure Contact the Occupational Health 24 hour Sharpsline on To enable a risk assessment, information will be required regarding the source patient and the injury type. The employee and manager must undertake an initial risk assessment see Appendix A full risk assessment of the injury/incident will be carried out by Occupational Health Sharpsline in conjunction with details provided by you and your manager (Appendix 10.3). Occupational Health will advise the employee about attendance at their nearest A&E if the injury is considered HIGH RISK for potential blood borne virus transmission. If the risk assessment carries a high risk of BBV (HIV) transmission, the employee should be referred to the nearest GUM service for the appropriate post exposure treatment, the immediate post exposure treatment will be offered and commenced in A&E. If attendance at A&E is advised please take a copy of the A&E letter which can be found in Appendix This letter is also available for download from the staff intranet ( Source patient: Wherever there is a possible risk of infection following a contamination injury a blood sample should be collected from the source patient for testing with their consent. Source blood will be tested for HIV, Hepatitis B and Hepatitis C and will help determine if further treatment is required Complete an Incident Report form on the Ulysses incident reporting system. Following a sharps or contamination injury, a member from the occupational health dept will contact the employee within the next working day. The employee will provide OH with an update on any interventions received in A&E and follow up appointments (if required) can be agreed 4.2 Action to be taken by the Manager In the event of a member of staff receiving an injury from a contaminated sharp the manager should: Ensure that all First Aid has been carried out (See 4.1) Liaise with Occupational Health staff carrying out the risk assessment and provide input into the risk assessment if appropriate. Occupational Health would only normally expect the employee to ring up. Undertake an assessment of the risk of carriage of BBV (with medical staff if required). Appendix 10.3 can be used to undertake this risk assessment. The purpose of this assessment is to identify whether the injury is considered HIGH RISK for potential blood borne virus transmission. Source patient: Wherever there is a possible risk of infection following a Author: Theresa Lewis Lead Nurse IP&C 9

10 contamination injury a blood sample should be collected from the source patient for testing. Blood will need to be tested for HIV and Hep C and also Hep B. Informed consent (Appendix 10.4) should be obtained from the patient (if they have capacity to grant consent), as well as consent that the results can be released to occupational health, this will ensure that the injured member of staff is only treated with PEP when it is necessary to do so. If results from source patient testing are clinically significant the manager or doctor in charge of patient care, must contact occupational health with the results to ensure that any further treatment can be managed appropriately If an employee has been prescribed emergency PEP treatment then the manager must make sure that the employee attends the GUM clinic for follow up before their emergency supply of treatment has run out. This will make sure that the employee receives continuity of treatment and appropriate advice, support and management of therapy. If the employee has been referred to Occupational Health for follow up appointments, the manager must make sure they attend Conduct a thorough investigation as to the cause of the incident/injury, and forward a copy of the report to Safety & Risk and Human Resources, along with the completed Incident Form via the Ulysses reporting system Adopt immediate preventative strategies as necessary, e.g. safe disposal of sharps, use a safety engineered device if available and not currently used, sharps containers and safe closure of these containers. Please ensure that a list of all actions undertaken is included within the report. Unknown source An injury sustained from an unknown source will usually be classed as low risk unless there are exceptional environmental circumstances, e.g. the injury was sustained in a GUM clinic where HIV testing was being undertaken. In all cases where the source is unknown, the injured member of staff should be reassured, have a blood sample drawn for storage as usual, have their immunisation status checked and updated. They should then be offered the opportunity to have follow up testing at appropriate intervals, i.e. 6, 12 and 24 weeks after the injury as a reassurance measure. Appointments for follow up testing will be arranged and undertaken by PAM OH team Employers have a responsibility to ensure that all employees are trained in the sharps / contamination injury procedures, and the safe disposal of sharps and sharps containers. 4.3 Action to be taken by Occupational Health Sharpsline N.B. If the incident involves blood contact on intact skin there should be no requirement for the employee involved to contact the Sharps Line. If they do, they should be reminded of the need to report the incident in accordance with their Incident reporting procedures. The case should then be closed. Following receipt of a call to the Sharps Line: The Sharps line Occupational Health will undertake a full risk assessment of the injury regarding the incident from the employee involved and record it on the online OHIO management system. The risk assessment is designed to capture Author: Theresa Lewis Lead Nurse IP&C 10

11 the risk of exposure to BBV and determine the appropriate Occupational Health management of the incident. For all injuries considered HIGH risk, the staff member will be directed to their nearest A&E dept for initial treatment. Once the initial information is obtained, the Sharps Line will refer to the local PAM clinic for a review telephone appointment within the next working day (if required) where a review of employees immunity status will be carried out and updated if required. It is of course recognised that this may prove to be a highly distressing period for the individual involved, of which Southern Health NHS Foundation Trust managers can assist in offering a range of support options. The Sharps Line OH should record the call on OHIO detailing any advice given. 4.4 Action to be taken by Occupational Health In the event of a Southern Health NHS Foundation Trust employee receiving a contaminated sharps injury Occupational Health should: Following an injury/incident being reported to the sharpsline, occupational health will contact the staff member within the next working day. Review all relevant information about details of exposure, including information available on the source material, injury type and source patient. Ask employee to provide an update on any interventions received in A&E including check if base line bloods were taken Confirm the employees Hepatitis B immunity status. The risk of transmission of Hepatitis B, Hepatitis C and HIV will be assessed initially using the risk assessment in Appendix If the incident carries a low risk or no risk of BBV transmission, the employee should be reassured. Occupational Health will follow the process in Appendix 10.5 Management of High Risk Sharps / Contamination Injuries, to manage the sharps exposure If the incident carries a high risk of transmission of a HIV, the staff member will have been advised to attend A&E and PEP treatment will have been commenced. If the incident carries a high risk of Hepatitis B, treatment will vary dependent on the employees immunity see Appendix Arrange a follow up appointment in local OH clinic (if required) Sign post to EAP for counselling Source patient: If there is a risk of transmission of Blood Borne Viruses, consent should have been sought by the medical staff treating them to obtain a blood sample for testing for BBV. (Appendix 10.4). Where the patient is under the care of their GP or GUM clinic then consent may need to be obtained to approach their GP / GUM clinic in an attempt to identify their status in relation to BBV. Consent should be obtained from the patient that the results can be released to occupational health this will ensure that members of staff will be followed up Author: Theresa Lewis Lead Nurse IP&C 11

12 appropriately. If objective evidence is provided and the source is clear of BBV, treatment can be discontinued, otherwise it should continue as per the initial risk assessment. However if the employee continues to be worried blood tests can be continued as per process It is inappropriate for consent to be obtained from the patient by the recipient of the injury, where the injured party is clinically responsible for the care of the source patient then a senior colleague or member of another clinical team should approach the patient for consent. If necessary, due to the geographical spread of the organisation, consent may be obtained via the telephone. Author: Theresa Lewis Lead Nurse IP&C 12

13 Process Flowchart Employee Manager Occupational Health / Sharps line Apply immediate first aid and report Injury to your Manager. Note date/time/nature of injury and source of exposure Contact the Occupational Health 24 hour Sharpsline on for risk assessment with the relevant details of the incident Provide support and reassurance to the staff member as required. Undertake risk assessment of source to assess for high risk see Appendix10.3 Commence initial investigation into the circumstances of incident. OH will complete a full risk assessment and give advice as to risk level. A referral to A& E may be recommended if source is known or suspected to be high risk Record information on OHIO If advised by occupational health, attend A&E for blood sampling and possible treatment If advised by occupational health adviser, attend PAM OH clinic for bloods and / or immunisation boosters Ensure staff member completes Incident Report on Ulysses Complete manager s section and attach copy of investigation report If HIV PEP prescribed ensure staff member attends GUM clinic within 72 hours Follow up Source Patient testing. If results clinically significant inform OH Contact staff member within next working day of incident. Update on any A&E interventions including to ask if base line bloods were taken Arrange follow up appointment at local PAM OH clinic Sign post to EAP for counselling For exposure to known Hep B risk asses if Hep B booster / or full vaccination course is required Report incident in Ulysses Ensure staff member attends OH clinic appointments if required for any further follow up Follow up at 6, 12 and 24 weeks If taking PEP will liaise with GUM Follow up source patient testing if required Author: Theresa Lewis Lead Nurse IP&C 13

14 5. Training: Refer to TNA in IP&C Policy. 6. References Council of the European Union: Council Directive 2010/32/EU: IMPLEMENTING THE Framework Agreement on the prevention from sharps injuries in the hospital and healthcare sector. Official Journal of the European Union. Department of Health: (October 2007), Saving Lives: reducing infection, delivering clean and safe care. HII no 1and HII no3. Department of Health (September 2008) HIV post-exposure prophylaxis Guidance from the UK Chief Medical Officers Expert Advisory Group on AIDS Department of Health (2015) The Health and Social Care Act 2008, Code of Practice for the Prevention and Control of Infections and related guidance. London. Health Protection Agency, (December 2012). Eye of the Needle, United Kingdom surveillance of significant occupational exposure to bloodborne viruses in healthcare workers. HPA London Loveday H et al (2014) epic 3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England National Institute for Health and Clinical Excellence (2012) Infection Prevention and control of healthcare-associated infections in primary and secondary care. NICE 2012 updated Feb 2017 Royal College of Nursing (November 2009) Safe management of health care waste Safe Management of healthcare waste, previously HTM Author: Theresa Lewis Lead Nurse IP&C 14

15 Appendix 10.1: Sharps Poster - Immediate Action Following Sharps Incident, Bite, Scratch or Splash Immediate actions following a Needle Stick Injury (NSI), bite, scratch or splash ALLOW IT TO BLEED, but do not massage the site. If puncture wound do NOT suck WASH IT with soap under hot running water If body fluid splash into eyes, irrigate with cold water, if contact lenses are worn, irrigate eyes, remove lenses and irrigate eyes again If body fluid splash into mouth DO NOT swallow rinse out mouth several times with cold water COVER IT With a waterproof dressing Immediately assess the risk of transmission of blood borne viruses e.g. hepatitis B, hepatitis C or HIV REPORT IT Complete safeguarding report (Refer to the Policy for the Management of Incidents for guidance on incident reporting) Injury from used needle, instrument, bite, scratch or bone seek immediate advice from Occupational Health on 24 hour helpline (PAM) Author: Theresa Lewis Lead Nurse IP&C 15

16 Appendix 10.2: Guide to Sharps Box Colour Code (Safe Management of Healthcare Waste RCN 2007) Yellow sharps with yellow lid Sharps contaminated with residual of medicinal product Examples: Partially discharged sharps and sharps used in the administration of vaccines Used medicines vials & ampoules Yellow bin with orange lid Sharps NOT contaminated with medicine Examples: Sharps used for blood tests Single use sharp instruments including podiatry NB: All of these sharps can be placed in yellow lidded sharps bin Yellow sharps with purple lid Sharps contaminated with cytotoxic or cytostatic medicinal products. Examples: Sharps used to administer cytotoxic products Blue bin with blue lid All waste medicines and their primary packaging Examples: Unused medicines Denatured Controlled Drugs Red lidded container for anatomical waste Xray filters Xray developers Recognisable body parts Placenta White rigid receptacle Leak proof rigid container with Hg (mercury) suppressant Amalgam waste or materials contaminated with amalgam NB For disposal of batteries a small bucket or large container can be obtained from Veolia on Author: Theresa Lewis Lead Nurse IP&C 16

17 Appendix 10.3: Risk Assessment A sharps / contamination injury can be assessed as high or low risk. The assessment must consider the type of injury sustained, the nature of the material to which the individual is exposed and the risk of carriage of a BBV in the source patient. BOX A The Injury High Risk: 1. Percutaneous Exposure 2. Exposure on broken skin 3. Mucous membrane exposure (e.g. eye) Low Risk: Exposure on intact skin BOX B The Material 1) High risk body fluids: Blood or blood-stained low risk fluid Amniotic fluid Breast milk CSF Pericardial fluid Peritoneal fluid Pleural fluid Saliva (associated with dentistry) Semen Synovial fluid Unfixed tissues or organs Vaginal secretions 2) Low risk (unless blood stained):urine Vomit Saliva Faeces Author: Theresa Lewis Lead Nurse IP&C 17

18 BOX C The Source Patient A) Known to be HIV positive or High risk behaviours associated with BBV transmission: Men who have had sex with men IV drug users (past or current) Recipients of blood products outside the UK Travellers from high risk areas (Africa, Carribean, Far East) who have had sex with men or women living there or received hospital treatment there Persons who have sex with a person in the above groups. B) Known to be Hepatitis B or C positive or Presence of current jaundice / liver disease possibly of viral origin or High risk behaviours associated with BBV transmission (as A) C) Not known to be HIV or Hepatitis B or C positive and no risk factors D) Source not known Risk Assessment For a sharps / contamination injury to be classified as high risk the following criteria apply: The incident must be a High Risk Injury 1,2 or 3 (see The Injury BOX A) AND There must be contact with a High Risk body fluids (see The Material BOX B) AND The Source Patient must be either A and/or B (see The Source Patient BOX C) If any one item from these 3 risk factors is missing the injury is low risk Author: Theresa Lewis Lead Nurse IP&C 18

19 Appendix 10.4: SOURCE PATIENT ASSESSMENT AND CONSENT FORM For completion by: Patients / Carer Source of Injury (please circle) Known Unknown If source patient known please complete Patient Name Hospital Number NHS Number Date of Birth Consultant Country of Origin Following an injury where a member of staff may be exposed to blood or body fluids it is the Department of Health and Trust Policy to assess the likelihood of transmission of blood borne viruses by obtaining the source patient s consent to having HIV, Hepatitis B and Hepatitis C testing following a discussion of the implications. Some of the questions are of a personal nature and may not apply to you, but it is very helpful if you would answer all the questions. 1 Are you or your partner known or suspected of having, or believe you may be at risk of any of the following : Hepatitis B Hepatitis C HIV 2 Have you or your partner ever injected or been injected with drugs not prescribed by a doctor? 3 If you are a man have you ever had sex with another man, even safer sex using a condom? 4. If you are a woman has your partner ever had sex with another man, even safer sex using a condom? 4 Have you or your partner had sex and/or had a medical procedure carried out in parts of the world where HIV /Aids is common? Yes No I understand that a member of staff may have been accidentally exposed to my blood or body fluid and I consent for a sample of my blood to be tested for HIV, Hepatitis B and Hepatitis C antibodies. I understand the implications for testing. a) I understand that the results will be released to my treating doctor and also to the Trust Occupational Health Provider solely for the purpose of ensuring that the member of staff receives the appropriate treatment b) I consent to testing but I do / do not want to be informed of the result Signed.Print Name Date.. Author: Theresa Lewis Lead Nurse IP&C 19

20 Appendix 10.5: Management of High Risk Sharps / Contamination Injuries The appropriate tests to take after a needle-stick injury should be based on the assessed risk (of contracting a blood borne virus) to the recipient, from the source, and the recipient s vaccination status. The table below shows the tests that may be appropriate at a given time point but some of these tests may not be required if the risks were assessed as low. If the exposed person is very anxious, follow-up testing for HIV, HCV and HBV (if not immune) may help to alleviate their anxiety. Hepatitis C PCR testing is not appropriate in these circumstances. (Reference HSE Sharps injuries Please note that at the time of injury HBV immunisation status will have been assessed and an immunisation course and/or booster may have been scheduled. This should run alongside the above regime but the appointments may not always been combined as the timings above must be adhered to. Testing outside this schedule will result in inaccurate results. If blood taken from the source is found to be negative to all BBV, the testing process can STOP at this point. High Risk Low Risk HIV HBV HBV Other TIME HCV HCV ASAP HBsAb* HBsAb Save serum Offer Counselling NEGATIVE POSITIVE 6 WEEKS Hep C PCR 12 Hep C Abs WEEKS + HEP C 24 WEEKS PCR Hep C Abs Hep C Abs HIV Combi HBSag** HBSag HBSag Offer counselling. * (HBsAb) is the antibody that best correlates with immunity to hepatitis B virus (HBV) ** HBsAg is the surface antigen of the hepatitis B virus (HBV). It indicates current hepatitis B infection. *** HCV genetic material (RNA) testing uses polymerase chain reaction (PCR) to identify an active hepatitis C infection. If there is a positive result to any BBV, at any stage, the case should be escalated immediately as per PAM escalation policy. Author: Theresa Lewis Lead Nurse IP&C 20

21 Appendix 10.6: Letter for A&E Department following a Needle Stick Injury To: A&E Department Re: Name.., D.O.B is employed in Southern Health Foundation Trust (SHFT). During an incident at work, the staff member has been exposed to a potential risk from blood borne viruses. SHFT procedure recommends that: The staff member completes first aid measures following the injury The staff member reports the incident to SHFT s Occupational Health service OHD (PAM) undertakes an initial risk assessment but all details of the source may not yet be confirmed. OHD (PAM) liaises with the staff member s line manager to bring this to conclusion. Current Department of Health Guidance * recognises the increased risk of possible transmission of blood borne viruses to NHS staff, although risks are usually low. Please could you 1) Determine the requirement for and initiate any post exposure prophylaxis based on the nature of the injury and the available information regarding the source. 2) Draw a sample of blood from the staff member to be stored for medico-legal purposes. The staff member does not need to be tested for blood borne viruses following an injury. Follow up bloods after completion of any treatment will be carried out by Occupational Health Thank you for your help in this matter, please do not hesitate to contact the Occupational Health Sharps line on should you require further information. Yours sincerely PAM *HIV post-exposure prophylaxis: guidance from the UK Chief Medical Officers Expert Advisory Group on AIDS (EAGA) May Updated guidance on occupational HIV post-exposure prophylaxis (PEP) from the UK Chief Medical Officers' Expert Advisory Group on AIDS (EAGA) Author: Theresa Lewis Lead Nurse IP&C 21