Infection prevention and control - Royal Marsden Manual of Clinical ...

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Infection prevention and control
risk of infection and the preventive measures to be taken
is essential in promoting a safer work environment ( UK
Health Departments 1998 ).
Bloodborne viruses are present in both the blood and
other high-risk fl uids that should be handled with the same
precautions as blood. High-risk fl uids include:
■ cerebrospinal fl uid
■ peritoneal fl uid
■ pleural fl uid
■ pericardial fl uid
■ synovial fl uid
■ amniotic fl uid
■ semen
■ vaginal secretions
■ breast milk
■ any other body fl uid or unfi xed tissue or organ containing
visible blood (including saliva in dentistry).
Body fl uids that do not need to be regarded as high risk,
unless they are bloodstained, are:
■ urine
■ faeces
■ saliva
■ sweat
■ vomit.
The most likely route of infection for healthcare workers
is through the percutaneous inoculation of infected
blood via a sharps injury (often called a needlestick injury)
or by blood or other high-risk fl uid splashing onto broken
skin or a mucous membrane in the mouth, nose or eyes.
These incidents are collectively known as inoculation injuries.
Blood or another high-risk fl uid coming into contact
with intact skin is not regarded as an inoculation injury.
It carries little or no risk due to the impervious nature of
intact skin.
Evidence-based approaches
If the guidance in Box 3.2 is followed, it has been shown to
reduce the risk of sharps injuries.
Complications
In the event of an inoculation injury occurring, prompt and
appropriate action will reduce the risk of subsequent infection.
These actions are described in Box 3.3 and should be
taken regardless of what is thought to be known about the
status of the patient whose blood has been inoculated. HIV,
for example, has a 3-month ‘window’ following infection during
which the patient has suffi cient virus in their blood to be
infectious but before their immune system is producing suffi
cient antibodies to be detected by the normal tests for HIV
status.
Box 3.2 Actions to reduce the risk of inoculation injury
■ Do not re-sheath used needles.
■ Ensure that you are familiar with the local protocols for the
use and disposal of sharps (e.g. location of sharps bins)
and any other equipment before undertaking any procedure
involving the use of a sharp item.
■ Do not bend or break needles or disassemble them after
use: discard needles and syringes into a sharps bin immediately
after use.
■ Handle sharps as little as possible.
■ Do not pass sharps directly from hand to hand; use a
receiver or similar receptacle.
■ Discard all used sharps into a sharps container at the
point of use: take a sharps container with you to the
point of use if necessary. Do not dispose of sharps into
anything other than a designated sharps container.
■ Do not fi ll sharps bins above the mark that indicates that
it is full.
■ Sharps bins that are not full or in current (i.e. immediate)
use should be kept out of reach of children and with any
temporary closure in place.
■ Sharps bins in use should be positioned at a height
that enables safe disposal by all members of staff and
secured to avoid spillage.
■ Wear gloves in any situation where contact with blood is
anticipated.
■ Avoid wearing open footwear in any situation where
blood may be spilt or where sharps are used.
■ Always cover any cuts or abrasions, particularly on the
hands, with a waterproof dressing while at work. Wear
gloves if hands are particularly affected.
■ Wear facial protection consisting of a mask and goggles or a
face shield in any situation that may lead to a splash of blood
or other high-risk fl uid to the face. Do not rely on prescription
glasses – they may not provide suffi cient protection.
■ Clear up any blood spillage promptly and disinfect the
area. Use any materials or spillage management packs
specifi cally provided for this purpose in accordance with
the manufacturer’s instructions.
( UK Health Departments 1998 )
Management of waste in the
healthcare environment
Defi nition
Waste is defi ned as ‘any substance or object the holder discards,
intends to discard or is required to discard’ ( European
Parliament 2008 ).
Evidence-based approaches
Rationale
Waste material produced in the healthcare environment
may carry a risk of infection to people who are not directly