Infectious Diseases
INFECTIOUS DISEASES
Staff and volunteers may be exposed to infectious Diseases as part of their work with a Disability Service Provider due to the undertaking of personal care or cleaning activities or due to the close proximity to clients.
Infectious Diseases can be defined as “a disease that can be transmitted from person to person or from organism to organism, and is caused by eg viruses and bacteria.” They may cause a short-term illness such as a cold or a longer term condition such as hepatitis. In either case actions to reduce the risk of transmission through the adoption of suitable work procedures is recommended.
Attached is some general information about common infectious diseases in the workplace. A sample Infectious Diseases policy and safe working procedures follow. Specific safe work procedures should be developed for dealing with specific situations or clients.
SAMPLE INFECTIOUS DISEASES POLICY
An infectious Diseases policy outlines the duty of care of a workplace to provide and maintain a healthy and safe environment for all staff, and to minimize the risk of anyone in the workplace contracting an infectious disease.
Infectious diseases can be airborne, such as meningitis or tuberculosis, blood borne, such as HIV or Hepatitis and faecal-oral borne such as gastroenteritis.
A Comprehensive Infectious disease policy should include:
- Standard workplace practices: washing hands, cleaning up spills, sterilizing shared kitchen utensils, wearing protective clothing, disposing of contaminated waste appropriately and reporting of exposure incidents.
- Immunization/vaccination programs
- First aid policies and post-exposure procedures.
Risk Management
Hazard Identification
Hazard identification should identify activities in the workplace that may put workers or members of the public at risk of exposure/transmission of an infectious disease as a result of work activities. It requires the identification of sources of infection e.g. blood and body fluids/substances and material potentially contaminated with blood or body fluids such as sanitary waste, soiled linen etc. and means of transmission e.g. first aid, cleaning toilets, disposal of used syringes etc. Consult with employees to identify specific activities and transmission modes. Consider workplace factors such as layout, work practices etc.
Risk Assessment
The purpose of risk assessment is to evaluate the risks to workers arising from exposure as a result of work activities and the working environment.
Risk assessment should take into account:
- The type and frequency of exposure including the probability, amount of blood or body fluids/substances, type of body fluid/substance encountered, possible routes of transmission, and potential for multiple exposures,
- Volume and frequency of contact with discarded used needles and syringes
- Factors contributing to exposure and their recurrence
- Risk associated with workplace layout, design and work practices including
- Poor lighting
- Crevices that encourage concealment of used needles and syringes
- Access to relevant medical and first aid services
- The level of knowledge and training of employees regarding infectious diseases and safe work practices
- The availability and use of personal protective equipment (PPE), including rubber gloves, eye goggles and face shields,
- The suitability of equipment for the tasks
- Individual risk factors for each worker, such as damaged/broken skin, dermatitis and eczema
- The number of workers and other persons at risk of exposure
- Availability of vaccines and post exposure prophylaxis (PEP)
- Current risk control measures and the potential need for new risk control measures.
Risk Control
Practical prevention and control strategies appropriate to the workplace should include:
- Safe work procedures, incorporating standard and additional transmission based precautions where appropriate
- Higher level controls such as retractable needles to prevent needlestick injuries and isolation rooms to house infectious clients
- Personal hygiene
- Post-injury testing, counseling and follow-up
- An immunization program for Hepatitis B and flu when relevant
- Availability and use of appropriate PPE
- Good housekeeping
- Appropriate waste management, including sharps handling and disposal
- Supervision and monitoring
- Critical incident planning including planning for Pandemics
- Staff training in risk control measures.
Sharps
The principal risk of occupational exposure to infection of Hepatitis and HIV for most workers is from sharps injuries. Sharps should only be handled with appropriate designed tongs or similar equipment. If this is not available the sharp should be disposed of by holding the barrel of the syringe with a gloved hand. The sharp should be placed in a sealable rigid-walled, puncture-resistant container and the local council or health service should be contacted for collection/disposal information.
The following principles should also apply to the use and handling of sharps:
- Containers should be positioned at the point of use
- The person generating the sharp should be responsible for its safe disposal
- Sharps should not be passed by hand between workers
- Disposable sharps should be used when possible
Workers should be instructed not to:
- Bend, break, recap or otherwise manipulate needles
- Place their hands into areas where their hands or fingers are not clearly visible (e.g. into garbage bags and crevices)
- Manually compress garbage bags, hold garbage bags close to their body
- Hold garbage bags by the base of the bag.
Safe Working Procedures:
Standard precautions:
Compliance with standard precautions has been shown to significantly reduce the risk of exposure. A high standard of personal hygiene is essential and the following practices should apply to all workers and other persons:
- Hands must be washed after contact with blood and body fluids/substances and before eating, drinking or smoking
- A mild liquid hand wash (with no added substances which may cause irritation or dryness) should be used for routine hand washing
- To minimize chapping of hands, use warm water and pat hands dry rather than rubbing them
- Liquid handwash dispensers with disposable cartridges, including disposable dispensing nozzle, are preferable to refillable containers, which may predispose to bacterial colonization.
- Repeated hand washing and wearing of gloves can cause irritation or sensitivity, leading to dermatitis or allergic reactions. This can be minimized by early intervention, including assessment of hand-washing technique and the use of suitable individual-use hand creams.
- Aqueous-based hand creams should be used before wearing gloves. Oil-based preparations should be avoided as these may cause latex gloves to deteriorate.
- Water impermeable gloves must be readily available to all workers and worn when likely to be exposed to blood or other body fluids/substances, or contaminated materials. The wearing of gloves substantially reduces the risk of hands being contaminated with blood or other body fluids/substances.
- Hands must be washed and dried immediately after removing gloves (gloves cannot be guaranteed to prevent skin contamination and may not remain intact during use).
- Gloves should be removed and replaced (if needed) once the specific task is finished.
- Waterproof aprons or gowns should be worn when clothing may be contaminated with blood or other body fluids/substances.
- Surgical masks and/or protective eyewear should be worn where eyes and/or mucous membranes may be exposed to splashed or sprayed blood or other body fluids/substances.
- Cuts or abrasions on any part of a worker’s body must be covered with waterproof dressings at all times.
WHO have a developed a checklist for good hand washing for health care facilities which can be adapted for disability services.
Routine cleaning
Standard precautions must be implemented when cleaning surfaces and facilities. Employees must wear suitable gloves and other protective clothing appropriate for the task. Protective eyewear must be worn where splashing is likely to occur.
Toilets, sinks, washbasins, baths, shower areas, and surrounding areas should be cleaned regularly or as required. Cleaning methods for these items should avoid generation of aerosols. Although environmental surfaces play a minor role in the transmission of infections, a regular cleaning and maintenance schedule is necessary to maintain a safe environment.
Surfaces should be cleaned on a regular basis using only cleaning procedures that minimise dispersal of micro-organisms into the air.
Floors should be cleaned daily or as necessary with a vacuum cleaner. Alternatively, damp dusting or cleaning with a dust-retaining mop is acceptable. Routine surface cleaning should proceed as follows:
- clean and dry work surfaces before and after usage or when visibly soiled.
- spills should be dealt with immediately;
- use detergent and warm water for routine cleaning;
- where surface disinfection is required, use in accordance with manufacturer's instructions;
- clean and dry surfaces before and after applying disinfectants;
- empty buckets after use, wash with detergent and warm water and store dry; and mops should be cleaned in detergent and warm water then stored dry.
Standard Cleaning Materials
This should include a mop and cleaning bucket plus cleaning agents should be readily available for spills management and should be stored in an area known to all staff.
- A large reusable plastic container or bucket with fitted lid, containing-
- large zip seal plastic bags for waste material;
- sturdy cardboard scraper and pan (similar to a 'pooper scooper');
- sodium hypochlorite (bleach) or other suitable (equivalent acting) disinfectant.
- disposable rubber gloves suitable for cleaning;
- eye protection (disposable or re-usable);
- a plastic apron; and
- a mask (for protection against inhalation of powder from the disinfectant granules, or aerosols from high risk spills which may be generated during the cleaning process).
With all spills management protocols, it is essential that the area is left clean and dry.
Blood Spills
Small blood spills
Ensure the employee is wearing latex/rubber gloves and enclosed footwear. Small blood spills can be easily managed by wiping the area immediately with paper towelling and then cleaning the area with water and detergent or a suitable disinfectant such as sodium hypochlorite (bleach).
Small spots or drops of blood or body fluids can be removed immediately by wiping the area with a damp cloth, tissue or paper towelling. A disposable alcohol wipe can also be used.
Large blood spills in a 'wet' area e.g. a bathroom or toilet area
Ensure the employee is wearing latex/rubber gloves and enclosed footwear. The spill should be carefully washed down the sink and the area flushed with water and detergent.
After the area is cleaned and if there is a possibility of bare skin contact with the surface, the area should be disinfected as above with sodium hypochlorite (bleach) or other suitable (equivalent acting) disinfectant.
Large blood spills in 'dry' areas
Ensure the employee is wearing latex/rubber gloves and enclosed footwear
The area should be decontaminated and the area of the spill contained. (no access to clients)
A scraper and pan should be used to remove the absorbed material if required. The area of the spill should then be cleaned with a mop and bucket of water with sodium hypochlorite (bleach) or other suitable (equivalent acting) disinfectant.
The bucket and mop should be thoroughly cleaned after use and stored dry.
Post exposure procedures
Where it is believed that an employee has been exposed to potentially infectious material they should follow the following post exposure steps.
Needle-Stick Injuries
If a staff member accidentally pricks themselves with the needle of a used syringe, the following first aid measures must be taken:
- encourage the puncture point to bleed by gently squeezing around it;
- wash away any blood or body substances using soap and water (if available);
- cleanse puncture point with a Medi-Prep antiseptic wipe (first aid kit item);
- apply a fabric strip (eg band aid) to puncture point;
- a doctor should be seen as soon as possible for an assessment;
Other Exposures
If a staff member is exposed to (is in direct contact with) blood or body fluids the following first aid measures should be taken:
- Skin – wash with soap and water
- Eyes – rinse eyes with copious amounts of water
- Mouth – spit out and repeatedly rinse with water
Incident Management
Following a needle-stick injury or exposure where there has been a possibility of blood or body fluid entering the body (ie via cut or broken skin, eyes or mouth):
The responsible Manager must:
- Immediately accompany the staff member to a doctor – take the needles or syringe if safe to do so for potential testing.
- The doctor will assess the risk of disease transmission and discuss what tests and/or treatment may be necessary;
- Inform the staff member about their access to appropriate professional counselling
- The manager is to notify and investigate the incident
- The manager is to ensure confidentiality of all investigations and related documents.
Waste Management
- All waste generated from first aid treatments or the clean up of spills should be handled with care, so as to avoid contact with blood and body substances. Medical latex gloves should be worn when handling contaminated waste.
- Small amounts of contaminated waste should be placed in a sealed, leak-proof bag and disposed of with general waste.
Soiled Clothing
- Latex medical gloves must be worn when handling soiled clothing. Soiled clothing should be identified as such and placed in a leak proof bag separate from other materials.
- Staff should be advised to take home any soiled clothing belonging to them and to wash as soon as possible. Normal washing procedures and detergents are adequate for decontamination of most laundry items.
Hepatitis and HIV Testing and Counselling
Testing for HIV/AIDS/Hepatitis antibodies involves a blood test.
In the case of HIV/AIDS/Hepatitis a positive test indicates the person is infected with HIV/AIDS /Hepatitis. A negative result may mean either the person is not infected or is infected but has not yet developed antibodies to HIV/AIDS/Hepatitis.
It usually takes about three months for HIV/AIDS/Hepatitis antibodies to appear after exposure to HIV/AIDS/Hepatitis, so if a person has recently been at risk, a second test is recommended after three months.
PANDEMIC PLANNING
A Pandemic if/when it occurs arises rapidly, spreads quickly and usually comes in waves, each of which can last for months. Service Providers need to have a plan in place to ensure that they are in the best position to manage the effects of a pandemic should one eventuate. A Pandemic occurs when a new strain of influenza spreads around the globe, infecting many people at once as there is no immunity. Up to 25-30 percent of the world's population could be infected. Strategies need to be developed before the Pandemic strikes. Good Hygiene practices and social distancing is one of the key first measures. This means limiting interaction among groups of people. People will be encouraged to stay at home and avoid public places. You will need to determine how you will continue to deliver services without placing staff and clients at extra risk. Fahscia has developed two publications to help non-government organisations plan for a Pandemic - Building Resilience Through Business Continuity and Pandemic Planning and an associated practical workbook.
REFERENCES:
NSW Health "A-Z of Infectious Diseases"
Better Health Channel “Work Issues – Infection Control”
Washing Hands Poster
