This document details Buckinghamshire Council’s Policy on protecting employees from blood borne viruses (BBV’s) in the course of their work.  It provides guidance for employees and Managers/ Head Teachers on the implementation of that policy and the general precautions necessary to protect against BBV’s and their related diseases.

Please note that there is no legal obligation for an employee to disclose they have a BBV or take a medical test for it. If an employee is known to have a BBV this information is strictly confidential and must not be passed on to anyone else without the employee’s permission

For BBV Incident Emergency Action Information see Section 11.

BBV’s are viruses that some people carry in their blood and which may cause severe disease in certain people and few or no symptoms in others. The viruses can spread to another person (if the person has a detectably high level of virus in their body*), whether the carrier of the virus is ill or not. The main BBV’s of concern within the Council are:

• Hepatitis B virus (HBV) and Hepatitis C virus, which cause hepatitis, a disease of the liver;
• Human Immunodeficiency Virus (HIV) which causes Acquired Immune Deficiency Syndrome (AIDS), affecting the immune system of the body.

These viruses can also be found in body fluids other than blood, for example, semen, vaginal secretions and breast milk. Other body fluids or materials such as urine, faeces, saliva, sputum, sweat, tears and vomit carry a minimal risk of BBV infection, unless they are contaminated with blood.

As BBV’s in the workplace are harmful to health, the Control of Substances Hazardous to Health Regulations 2002 apply requiring an assessment of the risk.

 

It is the Policy of Buckinghamshire Council to assess the risk of employees contracting blood borne viruses and reduce the risk as far as is reasonably practical by the introduction of appropriate control measures including vaccination where appropriate.

Following a risk assessment exercise carried out in conjunction with our occupational health provider, the Council has identified that provided normal hygiene procedures are followed, the majority of Council employees are at a minimal risk of infection from blood borne viruses.

The Council’s policy on immunisation for Hepatitis B is that it will adopt a policy of referral to a clinician for post incident treatment, as appropriate.  A decision to recommend vaccination for any group or individual must not be taken without a risk assessment completed by the Line Manager/Manager and occupational health advice (see Paragraph 13.0 for more details).

Managers/Head Teachers will, using the guidance given below:

• Identify any employees who may be at risk from blood borne diseases.

• Carry out an assessment of the risk of infection (blood borne diseases are covered under the Control of Substances Hazardous to Health (COSHH) Regulations 2002) and ensure these are reviewed on a regular basis

• Decide on and implement appropriate control measures, (in consultation with occupational health, if necessary), including whether vaccination is necessary.

• Monitor that employees are following the appropriate control measures.

• Ensure that induction on relevant Health and Safety procedures and regular training is in place to maintain a high level of awareness in the workplace.

• Where vaccination has been assessed as necessary, Managers to keep records of vaccinated employees and when a booster and ensure these records are maintained and kept up to date.

• Advise job applicants prior to recruitment if a Hepatitis B or other vaccination is necessary. Managers to check and record vaccination status prior to offer and as part of pre-employment checks.  

• Adhere to the Health & Safety procedures and policies in place;

• Follow the agreed control measures;

• Attend regular H&S training;

• Follow management instructions;

• Where considered necessary, keep their Hepatitis B vaccination up to date.

There is only a risk where work involves direct exposure with infected blood or other bodily fluids contaminated with infected blood. Infected blood may also spread through contamination of open wounds, skin abrasions, skin damaged due to conditions such as eczema or through splashes to the eyes, nose or mouth (i.e. via contact with the mucous membranes).  In the workplace, most contamination incidents are caused by needle stick, sharp instruments, splash, bite or scratch injuries.

Groups who may be at risk include:

• Social Care staff involved in the care of clients - home carers, residential workers, day care staff, etc.

• Education staff at schools for pupils with severe learning difficulties.

• Countryside Staff who may come across discarded drug user equipment.

• Other Council staff such as street cleaning, COVID Marshals, Street Marshals, Park Maintenance, Waste and Facilities staff.

• First Aiders in all areas.

It is the responsibility of managers to identify those staff that may be at risk, assess the level of risk, introduce appropriate control measures, maintain appropriate records and monitoring and ensure staff are provided with adequate induction, information and training.

Care should still be taken as the presence of blood is not always obvious. Please note immunisation is only available for Hepatitis B not for other BBV’s.

There are three main blood-borne viruses to which Council employees may be exposed Hepatitis B and C and HIV.

6.1 Hepatitis B and C

• Hepatitis B and C are viral infections affecting the liver. They can occasionally be fatal or result in long term liver disease. 

• Approximately 0.1% - 0.5% of the UK population are Hepatitis B carriers, though this can be higher in residential settings. Within the UK there is a very low prevalence of Hepatitis B with only approximately 0.3% of the population infected (approximately 180,000 people)¹

• Hepatitis C prevalence has reduced by 20% since 2015, with an estimated 118,000 people living with Hepatitis C in 2020²

• The proportion of carriers may be greater among certain high- risk groups, e.g. intravenous drug users, people with a learning disability who live within residential institutions and this may also apply to children and adults in day care/schools or centres for those with a severe learning disability³

The most common route of transmission is through:

• Needle stick injuries.

• Laceration with blood or body fluid-stained objects.

• Contamination of cuts with blood or body fluid

• There is a potential for transmission by being bitten but the risk is very low if the bite is cleaned immediately.
  

• The potential for infection through eyes and other mucous membranes through splashes or contact is also low.
  

• The virus can remain infectious in dried blood for several months.
  
  

6.2 HIV

HIV is a virus which can damage cells of the immune system, and as a result cause the body to lose its ability to fight certain diseases.  HIV can lead to the development of Acquired Immune Deficiency Syndrome (AIDS) where a person becomes more susceptible to a variety of infections and illnesses. Not all individuals who become infected with HIV will develop AIDS.

Some people may develop less severe illnesses which are not fatal and some may not have any symptoms at all and therefore be unaware that they are infected.

The HIV virus is much less infectious than Hepatitis B and in the work environment can only be spread through blood to blood contact i.e. if the blood of a carrier comes into contact with the open wound of another person.

There is no immunisation or post incident antigen treatment available for HIV, but post exposure prophylaxis (treatment given or action taken to prevent disease) is available following high risk incidents (see 11.0 for procedure).

• The normal good hygiene precautions used to protect against any infection are sufficient to protect against blood borne diseases and should be used where appropriate for example the wearing of disposable gloves and apron when changing.

• The aim should be to prevent blood or other body fluids coming into contact with any cut, broken skin or mucous membrane (eyes, nose, mouth).

• Any member of staff likely to come into contact with blood or body fluids should always cover any cuts or breaks in the skin with a waterproof adhesive dressing.

• If this is not practicable, i.e. due to the nature of the injury then medical advice should be sought.

• For children/clients with complex care needs which may involve contact with blood and body fluids special precautions may be necessary and should form part of the training for those procedures. Any concerns should be addressed to the appropriate health service contact.

The risk of being infected with a BBV while carrying out first aid duties is small. The following precautions can be taken to reduce the risk of infection:

• Ensure any cuts or grazes are covered with a waterproof dressing

• Use the disposable gloves provided when dealing with blood or any other body fluid

• Use a mouthpiece if possible when giving mouth to mouth resuscitation, but only if you have been trained to use them

• Wash hands after giving treatment

• Clean any surfaces which may have been contaminated

Whenever possible, people should clear up their own blood or body fluids. Where this is impracticable other staff dealing with blood/body fluids should follow the procedure outlined below.

Spillages of blood and body fluids which may contain blood

• Disposable gloves should always be worn and disposable aprons should be used where appropriate.

• The spillage should be mopped up using paper towels, other disposable material, or a proprietary spill kit can be used.

• Once soiling has been removed the area should then be disinfected using a freshly prepared dilute hypochlorite solution (e.g. bleach or Milton). This should be one part hypochlorite solution to ten parts water. Alternatively sodium dychloro-cyanurate granules or tablets can be used and reconstituted with water at the time of use.

• Clean the area with general purpose detergent, rinse and dry.

• Disposable gloves must be washed before removal with a fresh hypochlorite solution, then disposed of with any other waste generated by the incident.

• Wash hands thoroughly afterwards.

Spillages of other body fluids

• Household gloves should be worn and a disposable apron where necessary.

• Small spillages or splashes on floors and hard surfaces should be cleaned with general purpose detergent.

• Larger spillages should be mopped up using paper towels, other disposable material or a proprietary spill kit can be used.

• Clean the area with general purpose detergent, rinse and dry.

For all spillages

Ensure cuts and grazes of the person cleaning are covered with a waterproof dressing.

Disposable items unless very small or capable of being flushed away, should be sealed in a plastic bag, and disposed of. Disposable items used in spillages where clinical waste is unavailable can be placed in domestic waste as long as it is within a bin liner that has been tied up. For blood spillages it should be double bagged and placed in an outside bin.

In places where such spillages occur regularly then a spill kit should be available.

When clearing up urine spills care must be taken as the use of hypochlorite solution can result in chlorine gas being produced which is harmful if inhaled. Chlorine fumes are also released when using dichloroisocyanurate granules or tablets. Ventilate the area well in both cases.

In outside areas e.g. playgrounds wash/hose down with a large amount of water.

 

Contaminated clothing should be removed as soon as possible.  Clothing contaminated with blood or body fluids that may contain blood can be cleaned in an ordinary washing machine if specialist cleaning services are not available, using the hot cycle (80°C) or they can be dry cleaned at elevated temperature or dry-cleaned cold followed by steam pressing. If none of these are suitable the clothing may need to be incinerated. Clothing contaminated with other (non blood) body fluids can be washed in an ordinary washing machine at 60°C.

Splashes of blood or body fluids should be washed off the skin immediately, using soap and warm water.   Unless the skin is broken no further action will be required.

Where splashes come into contact with lips, mouth, nose or eyes, then the affected area should be washed with cold tap water or if not available an eye wash bottle – do not swallow the water.  If wearing contact lenses wash eye both before and after removing lenses.

PAM Assist have a specific Needlestick Helpline service (tel: 0330 660 0365) which offers 24/7 advice and guidance from a qualified nurse in the event of an injury and is available to all corporate services and schools which have bought the occupational health service from the Council.   Employees can call at any time to get information and reassurance, and can arrange appropriate support from initial blood tests to Hepatitis B vaccination and annual boosters, and also blood tests at 6, 12 and 24 weeks post incident (please note some of these may incur an additional charge to the service or school).  The helpline is an immediate source of advice and support for any sharps or needlestick injury, bite or scratch.

11.1 Further Action Post Incident 

If the Source is known to have a BBV, urgent medical advice should be sought by attending the local A&E department.

Advice can also be obtained from 

• Thames Valley Health Protection Team via: 0344 225 3861 of for out of hours urgent enquiries on 0844 967 0083. Or they can be contacts via email at:  via tvphec@phe.gov.uk. 
• The local infection control officer or on call virologist at the local hospital.

All available information on the source, the incident and the vaccination/immunisation status of the individual should be communicated to the clinician. This will enable a post exposure clinical assessment to be undertaken with the offer of passive immunity and treatment as appropriate to minimise the risk of infection. The window for these treatments is small (within 24 hours but ideally should start within an hour) hence the need for urgency. Incomplete information should not delay the seeking of advice/referral to A&E.

The BBV Status of the Source is unknown

• Further medical advice should be sought as described above.

If the Source is not known to have a BBV

• The risk is minimal but further medical advice should be obtained as described above to provide further reassurance for the individual.

Any of these incidents should also be reported using the normal Buckinghamshire Council internal accident report procedure via ASSESSNET. A report to the HSE under RIDDOR may also be required (the Health and Safety Team will advise on this once an internal report is received). The Manager is responsible for reviewing the risk assessment and safe systems of work following any incidents.

11.2     Types of Post Exposure Treatment

• Hepatitis B - Depending on risk assessment options are:
  
  - No Prophylaxis
  
  - Hepatitis B vaccine
  
  - Hepatitis B vaccine plus HB immunoglobulin
  

• Hepatitis C – monitoring for 6 months and if evidence of infection anti-viral therapy will be offered.

• HIV – post exposure prophylaxis – a regime of 3 anti-HIV drugs taken for 4 weeks and monitoring.
• * prophylaxis - treatment given or action taken to prevent disease

It is essential that staff do not treat employees, clients or pupils differently because they are known or suspected to be carriers of a blood borne disease such as Hepatitis B or are HIV positive.

Information about known carriers must be handled confidentially and will only be given to staff who need to know, because of the nature of their work and the risk of accident.  Normal hygiene precautions should be adequate protection for staff, clients and pupils, but care may be required to ensure that washing, shaving equipment and toothbrushes are never shared.

There will not normally be any screening of clients or pupils for blood borne disease such as Hepatitis B or HIV. In particular, there will not be any screening of children thought to be at risk unless there are symptoms requiring medical treatment.

Whilst dentists and medical staff have their own Codes of Practice for protecting against infectious diseases, if a client is known to be a carrier of a blood borne disease e.g. Hepatitis B or are HIV positive then that information, although confidential, should be made available where necessary to medical and dental staff.

A decision to recommend vaccination for any group or individual should not be taken without a risk assessment and occupational health advice.

The following groups may, subject to advice, be at sufficient risk to need vaccination:

• Residential care workers for clients with special learning difficulties where there is a known high risk of Hepatitis B.

• Staff in special learning difficulties schools or schools with children who exhibit challenging behaviour.

• Certain youth/outreach workers.

The following staff, although they may be exposed to blood/body fluids, are considered to be at low risk from blood borne viruses. Good hygiene precautions and prompt post exposure action, if required, are considered to be sufficient control measures. Therefore, on current medical advice a Hepatitis B vaccination is not necessary for:

• Home carers.

• Countryside workers and other Council employees as mentioned in Section 5.0.

• First aiders.

The Hepatitis B vaccine consists of a course of three injections followed by a blood test to check that the vaccination has been effective (further vaccination may be necessary if it has not).  The vaccination is ineffective in a small number of people. 

Vaccination should be arranged through an individual GP however, GP’s are not required to do this and may charge for this service.  The cost of the course of injections and follow up blood test should be met from Service area/ establishment budgets or for Special Schools by the SEN Team, subject to prior agreement that it is appropriate. The employee can claim the cost of the vaccination via expense claims on SAP and will require a receipt.

Records of staff receiving the vaccination should be kept by Managers to ensure that they remind employees to receive a booster five years later and for post incident as necessary to assist with a clinician led post exposure assessment.

• Health & Safety Team on 01296 674412 or via email at healthandsafety@buckinghamshire.gov.uk

• The Public Health Team by email via publicheath@buckinghamshire.gov.uk

• Occupational Health Provider available via HR. Further information is available via HR or here
  
  Thames Valley Public Health England Team on 0344 225 3861

• Sue Nicholls Centre, Complex Care 01296 564112 (advice and training on children with complex care needs.)

• HSE Guide - Advisory Committee on Dangerous Pathogens Protection against blood-borne infections in the workplace: HIV and Hepatitis: Blood-borne viruses (BBV) - Blood borne viruses (BBV) (hse.gov.uk) and Advisory Committee on Dangerous Pathogens - GOV.UK (www.gov.uk)

• HSE Guidance INDG342, Blood Bourne Viruses in the Workplace, Guidance for Employers and Employees: Blood-borne viruses in the workplace INDG342 (hse.gov.uk)
  
  Hepatitis B, The Green Book, Chapter 18: Hepatitis B: the green book, chapter 18 - GOV.UK (www.gov.uk)