Prevention of Occupational Exposure to Blood Borne Viruses

Prevention of Occupational
Exposure to Blood Borne Viruses
Beverly Lamb
Specialist Dental Infection Control Nurse

Policy
PREVENTION AND MANAGEMENT OF OCCUPATIONAL
EXPOSURE TO BLOOD BORNE VIRUSES POLICY
The policy should include:
• Types & transmission of BBV’s
• Management of Exposure to BBV – inoculation injury management
• Occupational Health Services
• Risk Reduction and Prevention

Standard Precautions
Everybody should be treated as possibly infectious. All blood and body
fluids are potentially infectious and precautions are necessary to
prevent exposure to them
Standard Principles of Infection Control/Universal Precautions include:
• Hand Hygiene
• Protective Clothing
• Safe Handling of Sharps (including Sharps Injury Management)
• Spillage Management.

How can we reduce the risk
PPE
Immunisation
hand hygiene
Spillage management
Management of sharps
Decontamination
Waste Disposal
Cleaning

Occupational Health
Manchester PCT have arranged access to occupational health services
for dentists who hold NHS dental contracts and their staff
For new staff
• Pre-employment health assessment including HIV,
Hepatitis C, Hepatitis B, TB status checks and blood
tests
• For existing staff
• Vaccination updates including Hepatitis B & TB
• Needle stick/chemical splash injury advice
• Treatment service for work-related problems

Contact Details
For practices based in North and Central Manchester
For practices based in South Manchester
North Manchester General Hospital
The Occupational Health Department
North Manchester General Hospital
Delaunays Road
Crumpsall
Manchester
M8 5RB
Tel: 0161 720 2727
Wythenshawe Hospital
The Occupational Health Office
Wythenshawe Hospital
Southmoor Road
Manchester
M23 9LT
Tel: 0161 291 4209 or
291 2825

Types of PPE
•Disposable gloves
•Disposable plastic aprons
•Protective eye equipment
•Masks
•Visors
•Heavy Duty Gloves

Research
• A study of manual cleaning of instruments showed that
viable bacteria were detected on agar plates attached to
the nurses mask (Eisen et el 2006)
• A survey carried out in Canada in 2006 revealed that out
of 924 sharps injuries recorded 183 were sustained
during manual cleaning of instruments (Shah et el 2006)

PPE
• Selection of PPE will be dependent upon risk of
contamination of staff clothing and skin by patient’s
blood, body fluid, secretions and excretions
No exposure to blood /
bodily fluids
anticipated
Exposure anticipated
but low risk of
splashing
Exposure anticipated
and high risk of
splashing
No PPE
Gloves
Gloves, gown &
Face / eye
protection

Gloves
• Non-latex hypoallergenic gloves must be available for
use with staff with latex allergy (not vinyl)
• Sterile gloves should always be used for aseptic
procedures and all surgical procedures.
• Gloves are NOT a substitute for good hand hygiene
• NEVER perform hand hygiene whilst wearing gloves
including hand rub)
• Remove gloves immediately after use before touching
non contaminated clean areas / items

Gloves
• Gloves protect the hands of healthcare workers from chemicals and
or bodily fluids.
• Heavy Duty gloves for handling contaminated instruments and
during cleaning tasks also give some protection from sharps injury
• Should be well fitting to avoid difficulties with dexterity, excessive
sweating and finger / hand muscle fatigue
• Non-sterile powder free latex gloves should be used for procedures
where this is an actual or potential risk of contact with blood or body
fluids or equipment contaminated with body substances, non-intact
skin, or mucous membrane.

Aprons
• These should be worn to protect clothing from possible
contamination, they must be single patient use, and
removed after the task has been completed and
disposed of as clinical waste.

Face / mouth / eye Protection
• Safety Goggles & mask / Visor
• Full eye / face protection should be readily available for use when there is a
risk of splashing with blood or body fluids or flying debris!
• Masks should fit comfortably over covering mouth and nose and should be
removed when not in use and NOT worn around neck
• Goggles should give full protection “wrap around” the eye area offering side
protection
• Eye / face protection should be disposed of after each use (if single use) or
cleaned with warm soapy water between usage
• IF worn masks are SINGLE USE and should be changed after each patient
• Face protection should not be touched whilst being worn

SELECTION OF PPE
Assisting with routine examination
Transporting instruments to decontamination room
Surgery wash down / cleaning
Packaging sterilised instruments
Assisting in surgical extraction
Manually Cleaning Instruments

Good Practice
• Kept at point of use (Keep in clean zone in appropriate container to
reduce risk of contamination with aerosols)
• Stock should be stored in a clean, dry place above floor level,
• Keep PPE in original boxes so with expiry dates can be observed
and their integrity maintained.
• DO NOT keep gloves in pockets
• Dispose of used PPE immediately in appropriate bin
• Re-usable PPE should be cleaned after use (goggles / visors) and
should never be placed on clean surfaces
• Remove PPE before leaving area / moving to a different area or
before contact with clean areas / surfaces

Removal of PPE
1. Gloves
2. Apron
3. Eye protection
4. Mask

Inoculation Injury - Definition
• Needle-stick or Sharps injury:
• Human bites and scratches which break the skin and
involve visible blood
• Contamination or splashing of the conjunctiva and
mucous membranes (eyes, nose, mouth) with blood or
body fluids.
• Contamination or splashing of any open wound or skin
lesion e.g. eczema or psoriasis with blood or body fluids

Safe Management of sharps
GROUP ACTIVITY
What precautions should be taken when dealing with sharps :
whether preparing to carry out or during a procedure or when
handling or disposing of sharps.

Safe Management of sharps
• Never leave sharps lying around
• Place containers at point of use positioned safely (not on floor or
above shoulder height)
• Never force equipment of any kind into sharps containers.
• Never attempt to retrieve anything from inside sharps containers.
• Never place sharps containers in public access areas (e.g.
corridors, entrances, exits, within easy reach of children, etc.).
• Ensure temporary closure of the sharps bin during transportation.
• Secure and replace containers when they are ¾ full or are
approaching this level.

Safe Management of Sharps
• Do not “pass” sharps – You use it You bin it!
• Use safe devices if re-sheathing
• Use gloves where possible-cannot prevent percutaneous
injury but may reduce the risk of acquiring a BBV infection
• Ensure competence
• Discard disposable syringes and needles as a single unit
• Place all disposable sharps in UN approved sharps
containers immediately after use

Guidance for Clinical Health Care Workers: Protection Against
Infection with Blood-borne Viruses
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/docume
nts/digitalasset/dh_4014474.pdf

Spillage Management
• Viruses such as Hep B, Hep C and HIV can be
transmitted through blood and other bodily fluids
• Quick and effective management will reduce the risk of
transmission of infection

Management
• Written protocol
• Appropriate products
• Provision of training
• Staff immunised against Hep B
• COSHH assessment
• Incident reporting

Cleaning agents
• Chlorine-releasing agents are chemicals disinfectants
which are effective against blood-borne viruses
• Use fresh solution according to manufacturers
instructions and discard after use
Chlorine-releasing agents fall into two groups:
• Sodium dichloroisocyanurate (NaDCC) e.g. Haz tabs,
Presept
• Sodium hypochlorites e.g. Domestos, Milton

Chlorine Concentrations
• 10,000 ppm used for decontamination of spillages of
blood or bodily fluids stained with blood
• 1,000ppm used for disinfection of surfaces following
contamination with other bodily fluids (to be used after
cleaning with a detergent)

Safety
• Keep area well ventilated
• Chlorine-releasing agents are corrosive to many materials e.g.
metals, and will bleach carpets, fabrics and soft furnishings.
• Chlorine-releasing agents can damage the skin and mucous
membranes, therefore gloves and aprons should be worn for any
contact. If there is a risk of splashing eye protection should be worn.
• Chlorine-releasing agents must not be used on spills of urine
as chlorine gas will be released.

Protocol – non blood bodily fluids
• Prepare equipment
• Put on PPE
• Remove heavy soiling with paper towels
• Clean with GPD and hand hot water with single use wipes (paper
towels) in jug/bowl
• Disinfect with 1,000ppm solution
• Rinse and dry
NEVER USE SODIUM HYPOCHLORITE DIRECTLY ON URINE SPILLAGE

Protocol – blood spillage
• Cover spillage with NaDCC (chlorine-releasing) granules
& leave for 2 minutes.
• Scoop up the spillage with scoop and scrapper and
discard as clinical waste
• Clean area with hot water and detergent using paper
towels then rinse
• Use a solution of 10,000ppm sodium hypochlorite with
paper towels to wipe the area of any remaining spill
• place all materials, gloves last of all in clinical waste

Minor blood spills - Splashes / drips
• Drips or splashes of blood on inanimate surfaces should
be wiped up using a paper towel soaked with sodium
hypochlorite 1% (10,000ppm)
• Wear PPE and ventilate the room
• Dispose of all waste into clinical waste bag
• Ensure that area is rinsed using cold water following
disinfectant