cross infection control and dealing with hypodermic needles · hypodermic needles and carry out...

~-~o- DARLINGTON II i BOROUGH COUNCIL

Corporate Health and Safety Arrangements Cross Infection Control and Dealing with Hypodermic Needles

Corporate Health and Safety Arrangements

Cross Infection Control and

Dealing with Hypodermic Needles

Contents

1.0 Purpose........................................................................................................................................2 2.0 Distribution..................................................................................................................................2 3.0 Responsibilities............................................................................................................................ 2

3.1 Managers and Supervisors......................................................................................................2 3.2 Employees ............................................................................................................................... 2 3.3 Occupational Health................................................................................................................ 2

4.0 Introduction.................................................................................................................................2 5.0 Risk of Infection........................................................................................................................... 3 6.0 Risk Assessment .......................................................................................................................... 4 7.0 General Control Measures & Safe Systems of Work – Cross Infection .......................................4 8.0 General Control Measures & Safe Systems of Work – Hypodermic Needles.............................. 5

8.1 What to do if your skin is damaged by a hypodermic needle................................................. 5 8.2 Injuries occurring where hypodermic needles are from a sterile source ............................... 6

9.0 Personal Protective Equipment (PPE).......................................................................................... 6 10.0 Inoculations .................................................................................................................................7 11.0 Information, Instruction, Training, Supervision and Monitoring................................................. 7 Appendix 1 – Hand Washing Guidance ....................................................................................................8 Appendix 2 - Additional advice for employees providing a care role. ...................................................... 9 Appendix 3 - Safe Working Procedure for Dealing with Hypodermic Needles.......................................10 Appendix 4 – Dealing with Hypodermic Needles and Sharps Toolbox Talk ...........................................11

Document Name Cross Infection Control and Dealing with Hypodermic Needles

Document Number CSA031/ 2

Authorised By Health, Safety and Wellbeing Team

Date of Current Issue July 2015

Previous Versions May 2014 (See note1)

1 NB: Previous versions. Arrangements CSA005 – General Cross Infection control (2011) and CSA032 – Cross Infection Control

Care Services (2011) amalgamated into CSA031 – Cross Infection Control and Dealing with Hypodermic Needles (2013). CSA005 and CSA032 taken out of circulation.

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1.0 Purpose

To provide managers, supervisors and employees with guidance on methods of minimising the risk of cross infection occurring and spreading and to provide information on managing the risks associated with dealing with and disposing of hypodermic needles.

2.0 Distribution

To be brought to the attention of all employees whose work may involve a risk of cross infection, those who come into contact with or are required dispose of hypodermic needles and to their managers and supervisors.

3.0 Responsibilities

3.1 Managers and Supervisors

Managers and Supervisors are responsible for;

Ensuring that task based risk assessments identifying cross infection and required control measures are implemented, communicated to all relevant employees and the implementation monitored.

Ensure that relevant information, safe systems of work and instructions are communicated to all employees and the implementation monitored.

Ensure that all relevant employees have received suitable and sufficient training and/ or tool box talks.

Ensure that this arrangement and all contents are complied with.

3.2 Employees

Employees are responsible for;

Ensuring compliance with safe systems of work and control measures identified in risk assessments.

Attending relevant training and toolbox talks.

3.3 Occupational Health

Occupational Health are responsible for providing guidance on possible ill-health affects, vaccinations, health surveillance and support to employees who may have been injured by hypodermic needles.

4.0 Introduction

The work activities undertaken by some employees can involve contact with potentially infectious materials such as, soil; household waste; human bodily fluids; hypodermic needles and/or syringes; animal carcasses and excrement etc. There is a possibility of such material being contaminated with a range of biological agents, which could give rise to a risk of infections in employees, unless suitable precautions are taken. Some of the diseases which can arise from such an infection can be very serious or even life threatening. However, the risk of infection is minimised if employees follow information, instruction and training provided to them.

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5.0 Risk of Infection

A communicable disease (infectious condition) is one that can be passed on and may cause illness. This covers a wide range of medical conditions that can be spread in a number of ways i.e. through the air by droplets, via ingestion etc. Where employees work in certain environments there can be an increased risk of infection from exposure unless appropriate precautions are taken. There are four main sources of infection within the workplace:

Blood and body fluids (e.g. saliva) and sources of blood/body fluids such as human bodies, animal carcases and raw meat;

Human or animal waste products such as faeces, urine and vomit;

Respiratory discharges such as coughs and sneezes;

Skin – direct contact.

Employees are at greater risk when dealing with blood, bodily fluids or items containing bodily fluids. Direct contact between such materials and broken skin, the eyes, or for certain materials, the ingestion or inhalation of material thrown up by water jetting or in other water droplets, may lead to infection by certain blood borne pathogens, viruses etc. Employees handling or working in close proximity to animal carcasses, or excrement also run the risk of flea or other insect bites. Employees who come into contact with soil in such a way that the soil contaminates skin, which may then become the site of a wound, may be at risk of tetanus infection. Employees who are exposed to rats or rat urine are at risk from leptospirosis. The bacteria can get into the body through cuts and scratches and through the lining of the mouth, throat and eyes after contact with infected urine or contaminated water, such as in sewers, ditches, pond and slow-flowing rivers. Employees who clean or service areas accessible to the general public, where the careless or malicious disposal of hypodermic needles and/or needles and syringes may have taken place, run the risk of accidental needle stick injuries.

Route of entry - Infection can occur via:

Putting contaminated hands and fingers into the mouth, nose or eyes;

Breathing in infectious droplets from the air e.g. coughs and sneezes;

Splashes of blood and other body fluids into the eyes, nose or mouth;

Broken skin if it comes into direct contact with micro-organism;

A skin penetrating injury via sharp objects, through a bite by an infected animal or insect or a contaminated needle.

The following list gives some examples of such employee groups where they may come into contact with blood, faeces or other bodily fluids and/ or contaminated water during the course of their work; (This is not an exhaustive list)

Building Services,

Housing Services

Environmental Services

Building Cleaning

Care Services

Educational Services

Any operative whose work is likely to come into contact with untreated sewage,

Any other operatives or supervisors who carry out work of a similar nature to any of the above groups.

Any other supervisors or inspectors who oversee or check on site the work done by any of the above groups.

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6.0 Risk Assessment

There will always be a degree of risk of contracting an infectious disease and employees are reminded that the most effective precautions against transmission are hand hygiene. However, in order to assist in preventing the spread of infection, task based risk assessments shall be completed for activities undertaken and where there is a risk of cross infection the hierarchy of controls will be followed;

1. Elimination – can the task be eliminated or carried out without there being a risk of cross infection?

2. Substitution – can substitutions be made? 3. Engineering Controls – can a mechanical aid be used i.e. using long handled shears to prune

rather than short secateurs, using a mop to clear blood rather than a cloth, using a litter picker to pick up hypodermic needles rather than gloved hands etc.;

4. Signage, warnings and/or administrative controls – warn other people of dangers; 5. Personal protective equipment – Personal Protective Equipment (PPE) is a last resort however

managers must ensure that where PPE is required as a control measure that the type of PPE and the standard is identified in the task based risk assessments.

When completing task based risk assessments consideration shall be given to the following;

Planning: e.g. procedures, safe systems of work, corporate guidance, permit to work etc. Training: e.g. Induction, use of work equipment, manual handling, and toolbox talks etc. Physical control measures: e.g. engineering controls, barriers, guards, personal protective equipment etc. Supervision: e.g. implementing procedures, enforcing standards, enforcing PPE requirements etc.

Reference shall be made to the Corporate Health and Safety Risk Assessment Procedure.

7.0 General Control Measures & Safe Systems of Work – Cross Infection

Good personal hygiene is an extremely important measure against the spread of infection and the following general points shall be followed.

Infection control principles must be followed at all times;

All employees should receive infection control and personal hygiene instruction as part of their induction training;

Work clothes should be laundered after completion of each shift. If working in residential care settings work clothes should not be worn to travel to and from work;

Employees working in the community should change out of their uniforms before doing none work related activities e.g. shopping on the way home from work;

Clean work clothes should be worn each day;

Employees must report any illness to their line manager before starting work;

Employees must cover cuts and abrasions etc. with a waterproof dressing whilst at work;

Jewellery should not be worn whilst at work other than a wedding ring and wrist watches should be removed prior to undertaking personal care and hand hygiene;

If employees have dermatitis, eczema, ulcers or any other non-healing skin condition a GP must be consulted, and the employee’s line manager informed;

The line manager will consider if health surveillance is required and where necessary refer to Occupational Health.

Where a need for health surveillance is identified the Manager shall ensure known risks forms are completed and the procedure detailed in the Corporate Health Surveillance arrangement is implemented and monitored.

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Further guidance is available in the Corporate Health and Safety Arrangement, Health Surveillance.

8.0 General Control Measures & Safe Systems of Work – Hypodermic Needles

The main risk of coming into contact with hypodermic needles, outside of health care areas, involves street cleaning, refuse collection, amenity horticulture, and general cleaning and caretakers who may come across carelessly or maliciously discarded hypodermic needles. Discarded hypodermic needles are more commonly found in parks and playing fields and are also found in toilet cisterns, communal stairways, alleyways, council housing and cash point lobbies.

Managers must decide whether employees work activities might bring them into contact with hypodermic needles and carry out suitable and sufficient task based risk assessment’s.

Risk Assessments shall include risk control measures that reduce the risk of an injury and also devise procedures that inform employees what to do if an incident occurs involving a hypodermic needle. The risk assessment is to be conducted on the basis of information on where hypodermic needles and other sharps have been found, or are likely to be found, and whether there had been any incidents previously involving either employees or the public.

Specific risk assessments are required for employees that are required to clear areas where hypodermic needles have been found or are likely to found. Procedures for collecting or clearing discarded hypodermic needles or other sharps will include the use of needle pickers, sharps boxes and identify employee training requirements for using them.

Under no circumstances should employees be required to touch hypodermic needles, sheathed or unsheathed, with their bare hands or put their hands where they cannot see.

8.1 What to do if your skin is damaged by a hypodermic needle.

The Health Protection Agency regards needle stick injuries from an unknown source e.g. discarded hypodermic needles in the community as LOW RISK. Employees should not panic and be reassured that transmission of blood borne viruses following a needle stick injury is rare. Managers must ensure that employees are made aware that the risk of infection from injuries, are LOW and there is NO immediate need to attend Accident and Emergency.

First Aid Guidance for any injury involving a hypodermic needle from a non-sterile source

Stop work immediately

Apply pressure around the wound to encourage bleeding; pushing the blood back out of the wound (this will assist in preventing foreign material being carried around the blood stream.)

Clean the wound with soap and water where possible; if not available use antiseptic wipes from the first aid kit. Apply an adhesive dressing to keep the wound clean

After initial first aid treatment (self-administered or administered by a qualified first aider), notify your Supervisor/Manager (if you have not already done so). Give the exact address or location of where the incident occurred, giving details of where the needle was found and how many were present.

When you have notified you Supervisor/ Manager you should attend your GP where an assessment of the injury should be made. Your GP will require details such as where the

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needle was located, was it sheathed/ un-sheathed, was the needle from a known source or unknown source.

Most injuries are deemed as LOW risk therefore treatment may not be given for transmission of blood-borne viruses. Your GP will explain why the injury is deemed as LOW risk and why treatment is not required.

Should the injury occur out of your GP’s normal working hours employees should attend the local NHS walk in centre or the local Accident and Emergency Department where an assessment of the injury should be made.

Complete an accident report form and forward this to your supervisor/manager following the normal accident reporting procedures.

Should you require additional advice or guidance you should make an appointment with the Occupational Health Nurse and can do this through your operational HR team.

8.2 Injuries occurring where hypodermic needles are from a sterile source

Should you suffer a needle stick injury where the needle is sterile i.e. unused, in the sterile packaging etc., the above first aid procedure should be followed and incident reported to your Supervisor/ Manager, there is no need to seek further medical attention.

Complete an accident report form and forward this to your supervisor/manager following the normal accident reporting procedures. However, you can contact Occupational health for further advice and guidance if you have any health concerns regarding the incident.

9.0 Personal Protective Equipment (PPE)

Darlington Borough Council will provide appropriate PPE for employees’ use. Gloves and aprons are not a complete impermeable barrier, however, they reduce the risk of transfer of organisms and in addition to hand washing become an added protection. Within the hierarchy of controls, recommended in the Control of Substances Hazardous to Health Regulations, elimination and engineering controls have priority over the use of PPE, including the use of gloves. However, where it is not possible to achieve adequate control by other means alone, PPE, including gloves should be used, in combination with, and in addition to, other control measures.

The gloves worn should provide protection from blood-borne viruses for the duration of the tasks being undertaken. This may mean having to change them safely mid task if they become damaged, and/ or having to wear a combination of more than one type of glove to provide additional physical protection.

The following information can be found on glove packs;

EN 420:2003 – general requirements for gloves, supplemented by (as appropriate):

EN 388:2003 – protective gloves against mechanical risks (abrasion resistant, blade cut resistant, tear resistant, and puncture resistant)

EN 374-1:2003 – protective gloves against chemicals and microorganisms.

As for EN 420 and EN 388, plus gloves resisting microorganisms must achieve performance level 2 in penetration. Although this cannot infer protection against viruses because they are not used in performance tests, in practical terms this is the highest level of protection afforded against microorganisms.

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Reference shall be made to the Health and Safety PPE arrangement for further guidance.

10.0 Inoculations

It is advisable for employees in some occupations to have the protection of vaccinations. However, since the use of vaccines does not necessarily imply complete protection against infection, immunised individuals must still adhere to infection control procedures, risk assessments and safe systems of work.

Possible exposure must be identified within task based risk assessments. Where there is a high risk of cross infection managers must complete an assessment to assist in determining whether vaccinations are required. Any employee, manager or supervisor who is in doubt about specific employment activities in relation to vaccinations may discuss this with Occupational Health.

Where task based risk assessments identify that employees are at an increased risk of cross infection as a result of contact with pathogens an immunisation risk assessment is required – see appendix five. This risk assessment will aid in identifying whether immunisation is required.

11.0 Information, Instruction, Training, Supervision and Monitoring

There is a legal requirement to ensure employees are provided with suitable information, instruction and training that is relevant to their role. The Health and Safety Team have developed a toolbox talk on Hypodermic Needles in the Workplace. This should be delivered to all employees who may come into contact with Sharps/ Hypodermic Needles in the workplace. Managers must ensure records are maintained and where appropriate documented on the training matrix. (Refer to appendix four for the Toolbox Talk)

Managers are responsible for ensuring that relevant information, safe systems of work, instructions and task based risk assessments identifying cross infection and relevant controls are carried out, communicated to all relevant employees and the implementation monitored.

Further advice and guidance can be sought from the Health and Safety Team

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Wet hands w ith water

right palm over left dorsum with interlaced fingers

and vice versa

6

rotation rubbing of left lhumb c lasped in right palm

and vice versa

dry ttmroughly with a sing le use towel

1

a:APIY enough soap to oover all hand surfaces ..

palm to palm with ingers interlacecl

rotational rubbing, backwards and forwards with clasped fingers of right hancl in left

palm and vice versa.

use towel to tum off faucet

2

Rub hands palm to pa lm

r s

....

backs of fingers to opposing palms with finger,s interlocked

Rir1se hands with water

r 11

... and your hands are safe.


Appendix 1 – Hand Washing Guidance

Hand washing is the single most important factor in controlling the spread of infection. Routine hand washing removes dirt, organic material and most transient micro-organisms found on hands. A hand washing process preferably using liquid soap and warm running water is adequate for this purpose.

Hand drying is as important as a good hand washing technique, as wet surfaces transfer micro-organisms more effectively than dry ones. Disposable paper towels are advised because they are quicker and more thorough to use. They also rub away transient organisms and because they are single use they assist in minimising/reducing cross contamination. Appropriate and immediate disposal of used paper towels should prevent contact by anyone else.

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Appendix 2 - Additional advice for employees providing a care role.

This appendix is to give advice and guidance to those employees providing a service that involves caring for people. The information below shall be taken into consideration when completing task based risk assessments and safe systems of work. Further advice and guidance is available from the Health and Safety Team and Occupational Health.

Controlling the Spread of Infection

Infection can spread rapidly in communal settings and it is therefore important that all employees comply fully with the guidelines. The chronically ill, the very old and the very young and certain vulnerable individuals can be particularly prone to infection, and employees dealing with any of these groups should be aware of that.

An infectious disease is not seen and anyone can carry infection without always knowing e.g. in the incubation period or sometimes there are no outward signs.

When working in the care settings undertaking tasks which may expose you to blood, urine, faeces vomit, sputum, which is a potential source of infection, it is important to always follow safe systems of work and wear the appropriate protective clothing (disposable gloves and aprons), when necessary.

Infection can be spread by a variety of means including the inhalation of contaminated droplets, the ingestion of contaminated food or drink, direct contact with a contaminated environment, another infected person or by contact with blood or other body fluids. You must inform your manager and your GP if you become ill, in particular with dermatitis, gastrointestinal illness, eczema, and skin conditions where integrity of skin is compromised. You can be assured of help and consideration of strict confidentiality. You must remain off work until you are advised that you may return and referral to Occupational Health may also be appropriate.

In preventing the spread of further infection it is important that employees react quickly to initial cases if infection. Managers and supervisors must ensure that guidance and control measures identified in risk assessments and safe systems of work are fully implemented and monitored i.e. vomiting and gastroenteritis cases where isolation/ barrier care is required until at least 48hrs symptom free.

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Appendix 3 - Safe Working Procedure for Dealing with Hypodermic Needles

The below safe system of work is in place to remind you what to do should you come across a hypodermic needle in the course of your employment. Please remember that your service area/ team may also have specific arrangements in place that are to be followed. If you are unsure seek further advice from your manager or supervisor.

Be aware of the possible presence of hypodermic needles at all times whilst undertaking work activities.

If you find hypodermic needles in your work area, STOP WORK IMMEDIATELY.

Never touch a hypodermic needle, sheathed or unsheathed, with your bare hands.

Assess if the hypodermic needle creates a danger to anyone else. If it does, cover it with a heavy object, e.g. a brick, stone, phone book etc. Warn anyone in the area, i.e. members of the public or other workers. Depending on the location you may be able to close a door to the room it is located in and/ or have the ability to lock the door to prevent anyone coming into contact with the sharp.

If you are trained to do so and have the correct equipment present, dispose of the hypodermic needle. Where there is a large quantity you shall contact your supervisor/ manager for further guidance. On completion of the task you shall contact your supervisor/ manager giving the exact location and how many needles have been found.

Where you are not trained to dispose of hypodermic needles advise your supervisor/ manager of the presence of hypodermic needles, giving exact location and how many have been found. Your supervisor/ manager will be able to identify someone that is suitably trained to clear the area.

Do not attempt to remove or dispose of the hypodermic needle unless you have received the appropriate training and are in possession of suitable equipment to carry out the task safely.

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Appendix 4 – Dealing with Hypodermic Needles and Sharps Toolbox Talk

The Health Protection Agency regards needle stick injuries from an unknown source e.g. discarded hypodermic needles in the community as LOW RISK. Employees should not panic and be reassured that transmission of blood borne viruses following a needle stick injury are rare.

Typical locations where discarded needles may be found:

They may be found in many places but are most commonly found in parks, recreational areas, public buildings, multi-storey car parks, vacant properties, houses, gardens and garages. They may also be found in litterbins, cardboard boxes and bin bags. Finds can range from single items to larger quantities. Known locations should be reported and communicated to all those who may have to work in these areas.

Risk reduction measures:

Where it is thought that there may be a risk of contact with discarded needles, then safe systems of work should be adopted. These will typically involve the use of mechanical aids such as litter pickers and other hand tools identified through task risk assessments. Avoid putting your hands in areas that you can’t see. PPE should only be relied upon as a last line of defence, however the correct level of protection (Cut, Puncture) must be provided. If there is any doubt about this; seek advice from your supervisor.

How to remove and dispose of discarded hypodermic needles:

Prior to commencement, visually check the area for any additional needles or anything else that could cause you harm. Identify the appropriate PPE required which may include foot and leg protection as well as hands. Remove discarded needles using the kit provided. These should be carried in all vehicles or provided at work locations and comprise of gloves, large tweezers, antiseptic spray and a clinical waste container. Most of these kits are single use and once used the whole kit should be disposed in a clinical waste skip. Records should be kept of the quantity of needles found and the precise location.

Immediate actions to take should you suffer a needle stick injury:

Stop work immediately

Apply pressure around the wound to encourage bleeding; pushing the blood back out of the wound (this will assist in preventing foreign material being carried around the blood stream.)

Clean the wound with soap and water where possible; if not available use antiseptic wipes from the first aid kit. Apply an adhesive dressing to keep the wound clean

After initial first aid treatment (self-administered or administered by a qualified first aider), notify your Supervisor/Manager (if you have not already done so). Give the exact address or location of where the incident occurred, giving details of where the needle was found and how many were present.

When you have notified you Supervisor/ Manager you should attend your GP where an assessment of the injury should be made. Your GP will require details such as where the needle was located, was it sheathed/ un-sheathed, was the needle from a known source or unknown source.

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Most injuries are deemed as LOW risk therefore treatment may not be given for transmission of blood borne viruses. Your GP will explain why the injury is deemed as LOW risk and why treatment is not given.

Should the injury occur out of your GP’s normal hours employees should attend the local NHS walk in centre or the local Accident and Emergency Department where an assessment of the injury should be made.

You will need to complete an accident report form and forward this to your supervisor/manager following the normal accident reporting procedures.

Should you require additional advice or guidance you should make an appointment with the Occupational Health Nurse and can do this through your HR operational team.

KEEP THIS PAGE AS A RECORD OF COMPLETION

Test of Understanding

Are most needle stick injuries high risk of infection or low risk of infection?

a. High Risk b. Low Risk

What is the first thing you should do if you receive a needle stick injury?

a: Phone your manager to complain b: Stop work immediately c. Apply antiseptic cream

When should PPE be considered to help prevent needle stick injuries?

a. When all other control measures have been considered? b. When you see needles on site or are handling needles? c. Always, PPE must be worn all the time during the working day?

Who should accidents, incidents and near misses be reported to?

…………………………………………………………………………………………………………………………

Name and Date

Name: …………………………………………………………………………………

Date: …………………………………………………………………………………

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~-~~- DARLINGTON 1111 w ii BOROUGH COUNCIL


Appendix Five – Immunisation Risk Assessment

Yes No Not known

What further action is necessary?

Action by who?

Action by when?

Complete

Influenza

Does the staff member provide personal care? In this context personal care is taken to mean: Physical assistance given to a person in connection

with: Eating or drinking (including the administration

of parenteral nutrition); Toileting (including in relation to the process of

menstruation); Washing or bathing; Dressing; Oral care; or The care of skin, hair and nails (with the

exception of nail care provided by a chiropodist or podiatrist).

Or

The prompting, together with supervision, of a person, in relation to the performance of any of the activities listed in above where that person is unable to make a decision for themselves in relation to performing such as activity without such prompting and supervision

If yes, staff should be offered seasonal influenza immunisation. Refer to occupational health

Hepatitis

Has the staff member previously had hepatitis B infection?

If yes, refer to occupational health for assessment

Has the staff member previously had hepatitis B If yes, refer to occupational

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~-~~- DARLINGTON 1111 w ii BOROUGH COUNCIL


immunisation? health for antibody titre check to check level of immunity. If no, continue with risk assessment.

Does the staff member provide personal care for persons with known hepatitis B infection?

If yes, hepatitis B immunisation is recommended – refer to occupational health.

Does the staff member have direct contact with any patient’s blood, blood-stained bodily fluids or tissues?


Does the staff member handle sharps, for example, cannulas, lancets etc. which may be contaminated with the blood of others?


Tetanus

Has the staff member previously been fully vaccinated against tetanus?

If yes, and there is a definitive recorded history, no further action is needed – the staff member can be considered to be protected.

If no, immunisation is recommended – refer to occupational health.

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cross infection control and dealing with hypodermic needles · hypodermic needles and carry out...

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