This article aims to promote safe working practices that help to prevent occupational exposure to blood and bodily fluids that put healthcare workers at risk of infection. Handling sharps safely and putting into practice other infection control measures will reduce this risk. The highest risk of transmission of blood-borne viruses from patients to healthcare workers is through a skin puncture by a needle, blade or sharp tissue contaminated with infected blood or bodily fluids. The other risk of transmission is through splashes to the eyes, mouth or over broken skin with blood or bodily fluid.
What are blood-borne viruses?
Blood-borne viruses are viruses that people carry in their blood, potentially causing severe diseases. These viruses can pass from person to person, even if the carrier is not displaying any signs of illness. The main blood-borne viruses that concern people are hepatitis B, C and D: these all cause hepatitis, which is a liver disease. Another major concern is human immunodeficiency virus, also known as HIV. This causes acquired immune deficiency syndrome (AIDS), which affects the immune system in the body. These viruses can also be found in other bodily fluids such as urine, faeces, saliva, semen and vomit. Care should always be taken when exposed to bodily fluids, as the presence of blood is not always obvious.
How can blood-borne viruses be spread?
It is very unlikely that healthcare workers will become infected through everyday social contact. Blood-borne viruses are mainly transmitted sexually or by direct contact with infected blood or bodily fluids. In the workplace, direct exposure happens through accidental contamination by a sharp instrument or by being spread through damaged skin or through splashes to the eyes, nose or mouth.
Hepatitis B immunisation
Hepatitis B immunisation is strongly recommended for any healthcare workers who may come into contact with blood or bodily fluids, and those who handle sharps containers. Contact your local occupational health department or your local GP for further advice.
Standard infection control precautions
Infection control precautions should always be followed when caring for service users to reduce the risk of transmission of infection. These precautions include hand hygiene, the correct use and disposal of sharps and the use of personal protective clothing.
Use of gloves
Appropriate gloves must always be worn when handling blood, bodily fluids or sharps. Although gloves do not prevent a sharps injury, they may reduce the risk of acquiring a blood-borne virus infection. Gloves, together with the use of waterproof plasters, will also protect cuts and abrasions from exposure.
Safe use of sharps
When the use of sharps is essential, particular care should be taken in handling and disposing of them.
It is the responsibility of the user to dispose of the device safely and to ensure that the sharp is never left lying around.
There are some key principles to adhere to when using sharps.
- Sharps should be disposed of immediately after use, by the person who carried out the procedure.
- Sharps must not be passed from one person to another.
- Needles should never be re-capped after use.
- Needles and syringes should not be dismantled after use but should be disposed of as a full unit.
- Extra care should be taken when undertaking procedures with confused residents.
- Closed footwear should be worn at all times when caring for residents.
- Devices that are designed for patients’ use should not be used by healthcare workers as sharp injuries may occur. Staff should use single-use sharp equipment.
Safe disposal of sharps
A sharps container should always be available when delivering care involving sharps. These bins must be assembled correctly before use, ensuring that the lid is securely attached and that the container has been signed by the person who assembled the bin.
Bins should be stored in a clean, dry area and they must be kept in a secure place above the reach of children, by being placed on top of a bench or held in a wall bracket. These areas must not be accessible to the public unless they are accompanied by a healthcare worker.
Sharps bins must not be used for any other purpose. Once a sharps bin is two thirds full, reaching the marker line, it must be closed, locked and stored in a secure storage area away from the public. Full sharps bins should be labelled, signed and dated. They should then be collected by a registered waste contractor and taken for incineration. If a bin is too full to close, it must not be disassembled; it must be placed in a larger sharps container and the lid of the larger container locked and disposed of appropriately.
When caring for a resident, adequate supplies of hand decontamination equipment should be available such as liquid soap, paper towels and alcohol gel. Protective clothing must be available, including aprons and eye protection, and suitable sharps bins in a range of sizes should be available. These supplies should be kept in a clean, dry area to prevent any contamination before use.
Incidents such as a needle stick injury, or a splash to the eye or an open wound, should always be reported and medical assistance sought. If you are contaminated with blood or bodily fluids the area should be washed immediately with running water. Such circumstances need to be assessed and a decision will be made if any medical treatment is required.
For further guidance about health and safety, visit the Health and Safety Executive’s website: www.hse.gov.uk.
Use the following items in the toolkit to put the ideas in this article into practice:
- Step-by-step guide - Blood borne viruses and occupational exposure (care homes and nursing homes)49 KB
About the author
Suzanne Averill, MSc, RGN, Nurse Consultant, Global Infection Prevention, currently works for the United Nations in South Sudan as the Health and Nutrition Cluster Coordinator. She has previously worked for the Health Protection Agency as the International Lead and in commissioning in the NHS as Head of Infection Control.
This article was first published in the January 2013 issue of Quality & Compliance Magazine.