Download Infectious Diseases Introduction The Health and Safety at Work Act

Infectious Diseases
Introduction
The Health and Safety at Work Act 1974 requires employers to ensure, as far as is
reasonably practicable, that the health, safety and welfare of employees and others is not
prejudiced by their work. This will include taking appropriate action to minimise the risks
associated with infectious diseases. The requirement to undertake risk assessments to
comply with the Management of Health and Safety at Work Regulations 1999 extends this
duty further.
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995
(RIDDOR) require employers, amongst other things, to notify the enforcing authority (usually
Environmental Health) of certain diseases acquired in the workplace.
Thames Reach is an employer and a landlord's agent with responsibilities towards both
service users and employees. These guidelines outline the procedures that should be
followed to protect as far as possible against infection whilst being accommodated by, or
working for, Thames Reach.
General Principles
The important message of these guidelines is that simply knowing if a person has an
infectious disease is no guarantee of protection. What is important is that the guidelines are
followed on every occasion regardless of whether it is known that the service user or worker
involved is carrying an infectious disease.
Provided that a service user’s general support and health needs are appropriate for the
Thames Reach service they are seeking to access, carrying an infectious disease is not, in
itself, grounds for refusing access to that service. If special medical help is required at the
time of taking up an offer of accommodation, or if it is anticipated that it may be necessary in
future, then staff will need to plan for this and ensure it is put in place.
It is important to maintain and encourage good standards of cleanliness and hygiene for the
sake of all who use Thames Reach premises. In some circumstances, those carrying
infectious diseases may be put at risk by poor hygiene practices.
No special precautions or protective clothing or gloves are necessary for usual contact or
activities with clients, other than in the situations outlined below.
Thames Reach's Equal Opportunities Policy Statement states that the organisation will seek
to ensure equality of opportunity and treatment for all our clients and employees in the
provision of services and employment regardless of health status and will not tolerate
harassment or intimidation of any individual or group.
Information about an individual's medical condition is confidential and will not normally be
divulged to a third party without the prior permission of the individual concerned. Amongst
staff, information should only be shared with other staff where this is appropriate to further
the care of the service user concerned. Emergency service crews attending to deal with
Page 1 of 11
accidents or incidents will routinely take all necessary precautions against infection. Thames
Reach's Information Sharing and Confidentiality Policy provides further guidance in this
area.
Assessment of Risk
To minimise the chances of workers or clients contracting an infectious disease in the
workplace, Thames Reach will:
1. Ensure that all workers are fully inducted in the terms of this policy and the steps they
can take to protect themselves against the risks (for example inoculations) before they
commence work for the organisation. On offer of employment, all staff being
recruited into front line posts will receive a letter (Appendix 2) advising of the
need for vaccinations in that post.
2. Carry out a risk assessment of each workplace to identify the potential risks associated
with infectious diseases and ensure that risk assessments are kept live and regularly
reviewed
3. Provide training and information for all staff as required
4. Ensure that appropriate Personal Protective Equipment (PPE) is available for the range
of work activities that may bring workers and clients into contact with infectious diseases.
Appendix 1 contains detailed information about the most commonly occurring infectious
diseases in workplaces similar to those faced by Thames Reach staff and service users.
Routine Practices
Because an individual may be affected by an infectious disease without displaying any
symptoms, it is essential not to rely on special measures that are only brought into effect
when a case of infection is identified, but to assume at all times that infection is present.
Staff should seek to ensure that all service users are aware of the practices that can reduce
the hazards to themselves and others. Some of the following may be more applicable to staff
who are directly involved in hostel work. However, all the guidance is of value to all staff in
as much as it represents good practice in hygiene and the prevention of the spread of
illness.
a) Personal Hygiene
Towels, face flannels, razors, toothbrushes or other articles that could become contaminated
with blood must not be shared. Crockery and cutlery can be shared. Utensils only need to be
hand washed in hot soapy water or in a dishwasher.
During menstruation, tampons and menstrual pads should be disposed of in appropriate
sanitary waste bins, or, in the absence of sanitary bins, disposed of according to local waste
disposal procedures.
b) General Hygiene
Offices and other accommodation premises over which we have direct control should be
kept clean at all times, with particular attention paid to kitchens and bathrooms. The use of
rubber gloves and disposable cloths, with separate ones for kitchens, baths and toilets is
encouraged. Gloves and cloths should be disposed of regularly. Small quantities of paper
towels can be discarded down the toilet.
Page 2 of 11
Anyone with cuts on their hands should ensure that the cut is covered with a waterproof
plaster and should wear gloves for tasks like cleaning or washing-up. If you are in any doubt
ask the local staff member responsible for first aid.
Standard hygiene practices should be followed at all times - in particular anyone dealing with
items contaminated by blood, vomit, urine, excrement, semen and spit, should wear
disposable gloves when doing so.
Spillage of blood, vomit, faeces and urine should be cleared up as quickly as possible. Either
bleach diluted 1:10 in water or Milton fluid should be used. A supply of one or other should
be kept in every office. Other disinfectants may not be effective. The spill should be covered
with paper towels and the bleach or Milton poured on. This should be left for 1/2 hour and
then cleared up, using more paper towels if necessary. Such solutions must not come into
contact with the skin but if they do the affected areas should be washed immediately with
soapy water.
An alternative is to use Safesorb granules to solidify the spillage that can then be swept up.
If this option is chosen, extreme care should be taken to keep the dustpan and brush used
separate from any other used for general household purposes.
Clothes and linen that are stained with blood or semen should be washed in the hot cycle of
a washing machine. Non-washable items should be dry-cleaned. Heavily contaminated
items should be handled with gloves and bagged separately until laundered in a hot wash.
c) Needle stick injuries
All sites should have a supply of appropriately sized sharps' boxes and service users should
be encouraged and enabled to use these to dispose of sharps safely. Where drug users are
routinely accommodated within Thames Reach schemes, staff should make links with
specialist drugs agencies to facilitate the use and collection of sharps' boxes and the general
encouragement of safe practices in this area.
Staff should receive instruction or training around the dangers of sharps and how to avoid
needle stick injuries by exercising extreme caution. Additionally, each team/site should have
needle proof gloves and long handled grabbers available for use when clearing rooms or
handling rubbish that may have been contaminated. Managers should arrange for specialist
companies to clear/clean rooms that have been vacated if the risk of encountering sharps is
high.
If someone suffers a needle stick injury, the following procedure should be followed:
 Allow the wound to bleed freely and encourage bleeding where this is safe to do so.
This will help flush any virus that might be present from the body.
 Run the wound under cold water. This may achieve the same effect.
 If it is safe to do so, retrieve the needle responsible for the injury and safely store it in
a portable sharps' container. It will be useful to take the needle to the hospital so that
it can be tested for the presence of any infectious diseases.
 Immediately go to the local Casualty Department and explain what has happened
and the environment in which the person works/lives.
 The wound will be cleaned and hospital staff will be able to discuss the options
around medication to counter some of the possible infections present and advise the
person about what tests are advisable and when they should be done.
Page 3 of 11

Please refer to the Needle Stick Injuries Policy within the Substance Misuse Policy
Pack.
d) Accidents and First Aid
It is important to remember that dealing with someone who has hurt themselves is very
different from routine cleaning. Tact and calm are necessary so it is important that workers
are confident about what to do. Workers should ensure that any cuts they might have been
covered and should try not to come into contact with any more blood than is necessary,
given the situation. Careful cleaning and disposal of waste afterwards will significantly
reduce risks. When giving first aid disposal gloves should be worn. These can be found in
the first aid kit. Remember: Any accident at work should be recorded in the Accident Book.
e) Mouth to Mouth Resuscitation
No case of HIV or hepatitis infection has been reported as a result of giving mouth-to-mouth
resuscitation. However, a disposable facemask or disposable airway can be used to avoid
direct mouth-to-mouth contact if preferred. Managers are advised to invest in portable First
Aid kits (contained within a pouch or a key fob attachment) for staff who are routinely called
upon to give First Aid or respond to accidents - these can significantly reduce the delays that
might occur when workers go to fetch the First Aid kit and make it more likely that gloves and
face masks will be used.
f) Cleaning Rooms
Apart from the risk of needle stick injury, there are other, less serious, risks present when
staff are engaged in cleaning the living area of service users (for example MRSA or
impetigo). The following guidelines should prevent the spread of infection:
- Gloves and disposable aprons should be worn when beds are changed or made
- Bed linen must be washed on a very hot wash cycle
- Mattresses and bed areas should be washed down with a sanitising solution before re-use
g) Deaths on Thames Reach Premises
Staff should not normally need to have any physical contact with a body; the Coroner and
undertakers should take responsibility. In cases of violent or unexpected death, the police
should always be informed. Special procedures apply to death resulting from certain
diseases. Separate guidance is available on this matter in Thames Reach's Health and
Safety Manual.
h) Notification of Certain Infectious Diseases
Any GP made aware of a person suffering from TB has a responsibility to notify the relevant
authorities.
Sections 37 and 38 of the Public Health Act 1984 provide that people suffering from TB (but
refusing treatment or otherwise creating a public health risk) can be detained but the
provisions of this Act do not mean that those detained can be forced to take drugs.
Please refer to Thames Reach's RIDDOR policy for details of the circumstances when it is
necessary to report other diseases occurring in the workplace to the authorities.
Personal Protective Equipment (PPE)
The following items should be available in every workplace:
 Rubber and Disposable Gloves
 Disposable Cloths/Paper Towels
Page 4 of 11









Bleach or Milton Fluid
Disposable Aprons
Strong black plastic bags
Coloured plastic bags for soiled refuse
Sharps box for disposing of needles
Face masks/resuscitation aids
Syringe Proof Gloves
Antiseptic wipes for telephones
Portable First Aid kits for those routinely working away from the office
These items are in addition to those we are required to have in our existing first aid boxes.
Date adopted and last review(s)
Date and Type of last review
Type of Service user Involvement/Consultation eg
 Consultation: forum or individual
 Response to survey/listen scheme feedback
 Policy Review group member
 Committee membership
 Other
Name of ratifying SMT member/group
01/12/1998 ; 01/11/09
Nov 2009; Standard Review.
Consultation with external
expert and H&S committee
None
Author: Michelle Binfield
Reviewed by: external H&S
consultant: Eileen Speight
Service Improvement Group
Audrey Mitchell
Date Ratified
1 June 2010
Suggested earliest date of next review
Annual Review required?
January 2011
no
Date policy updated on pulse
For H&S policy feedback Contact:
17th June 2010
Audrey Mitchell
[email protected]
Page 5 of 11
Appendix 1
INFECTIOUS DISEASES AND RISKS
1) Viral Gastroenteritis (diarrhoea and sickness)
Highly infectious, this viral infection is closely related to the common cold. It is spread
by coughing and sneezing and also by contamination with faeces. Sufferers are
advised to stay off work in the feverish and watery diarrhoea stage. Recovery usually
occurs within 3 days.
2) Food Poisoning
Usually acquired from contaminated food or water. Symptoms almost always starts
within 24 hours of infection but may occur within an hour. Sufferers may become
carriers and will need to take extra care with personal hygiene to prevent a further
outbreak. Carriers should not handle food. Medical advice should always be sought.
3) Influenza
A virulent and highly infectious virus spread by coughing and sneezing. Dangerous to
the elderly and malnourished. Some strains are preventable by vaccination and this
should be considered by both staff and service users in shared environments when
infection is more likely.
4) Infestations
Scabies is a common infestation caused by a mite burrowing under the skin, usually
attacking the webs of the fingers and the wrists before spreading to the rest of the
body. The mite is easily passed by close contact and commonly starts at the wrist,
presumably having been picked up through holding hands. Scabies is easily treated
with a variety of liquid treatments available through a GP
Lice are larger insects. Head lice are common and, in those who regularly wash their
hair, can be very sparse. Pubic lice are sexually transmitted, quite itchy and visible as
black moving dots. Body lice are larger and persist only where hygiene has been
very poor. Lice are acquired by hair-to-hair contact. The problem is usually obvious
and easily treated with liquid treatments available from the pharmacist or on
prescription.
5) Skin Infections
Eczema, psoriasis and dermatitis are common in the alcoholic and malnourished.
These are not skin infections and are not contagious in any way. The skin may be
discoloured, scaly, inflamed or even ulcerated over large or small areas, without any
risk to others.
Impetigo is a bacterial skin infection that may affect skin anywhere on the body but
commonly occurs in the area around the nose and mouth. Impetigo is characterized
by blisters that may burst, ooze fluid, and develop a honey-coloured crust. Impetigo
can be spread by scratching and can spread to other people on clothing, towels and
Page 6 of 11
bed linens that have touched the infected person's skin. Impetigo is treated with
antibiotics.
6) Tuberculosis (TB)
Tuberculosis (TB) is caused by a germ that usually affects the lungs, but may also
affect the bones and joints. It is caught by breathing in the germ or by swallowing
contaminated food (only pulmonary TB can be caught in this way, TB of the bones
and joints is not infective). Droplets of sputum sprayed by an infected person during
sneezing or coughing spread the germ directly to others. Outside the body, the germ
does not survive for very long and providing normal preventative measures are taken
whilst cleaning there is little or no risk from rooms or bathrooms.
TB is still a very common infectious disease and is curable although treatment is
usually lengthy. The body's natural defences usually overcome the disease; often
immunity develops protecting individuals against infection for the rest of their lives.
However, some factors do lower the body's natural resistance, including change of
climate, cigarette smoking, poor living conditions, poor diet, alcoholism, general poor
health, old age and past infection. These increase the risk of infection.
The most common symptom is a productive cough. Where this persists unexplained
for over three months, seek medical advice. Unfortunately, this is a common
symptom amongst middle-aged smokers and a diagnosis can easily fail to be made.
A sufferer may also cough up blood, or there may be weight loss, lethargy,
indigestion, fever, night sweats and general ill health. In the early stages, lung TB
(pulmonary) is often symptomless, but is will show up on a chest x-ray, so if you think
you may have been in contact with someone who has TB, your GP will probably
recommend an x-ray. If an individual is diagnosed as having pulmonary TB, the
hospital will attempt to trace all their known contacts, and ask them to be tested.
There is a test that may give some indication of your natural immunity and a vaccine
is available for those who are vulnerable to infection. However, some doctors do not
advocate giving the BCG vaccine to anyone over 18, so if you are interested in being
vaccinated, get medical advice.
7) Tetanus
Tetanus is a bacterial disease affecting the nervous system that is commonly
contracted through a cut or wound becoming infected with the tetanus bacteria. The
bacteria can get in through even a tiny pinprick or scratch, but deep puncture wounds
or cuts like those made by nails or knives are especially susceptible to infection with
tetanus. Infection with tetanus causes severe muscle spasms, leading to "locking" of
the jaw so the patient cannot open his/her mouth or swallow, and may even lead to
death by suffocation. Tetanus is not transmitted from person to person. Vaccination
is the best way to protect against tetanus. A combination shot, called the Td vaccine,
protects against both tetanus and diphtheria. A Td booster shot is recommended
every 10 years. Adults who have never received immunization against tetanus should
start with a 3-dose primary series given over 7-12 months.
Tetanus vaccine and the combination Td vaccine are very safe and effective. Most
people have no problems with either. When side effects do occur, they usually
include soreness, redness or swelling at the injection site and a slight fever. As with
any medicine, there are very small risks that serious problems could occur after
getting a vaccine. However, the potential risks associated with tetanus disease are
Page 7 of 11
much greater than the potential risks associated with the tetanus vaccine. You
cannot get tetanus from the vaccine.
8) Methicillin Resistant Staphylococcus Aureus (MRSA)
Staphylococcus Aureus is a bacterium that commonly occurs. For example, at any
one time, between 20-40% of the population will have the bacterium present in their
noses. Usually this causes no harm to the person carrying it or anyone else. In some
instances, Staphylococcus Aureus causes a range of illnesses, including boils or
other infections. It can, when seeded in the bloodstream, cause pneumonia or lung
abscesses and, rarely, lead to other complications affecting the brain.
The bacterium can cause particular problems for those in hospital with open wounds
following surgery as the wounds will increase susceptibility to the infection and the
infection prevents the wounds from healing. The problem is compounded by the fact
that some strains of Staphylococcus Aureus have become resistant to the methicillin
anti-biotics that are usually used to fight off the infection.
Transmission of the disease is usually by unwashed hands. Transmission by other
routes is extremely rare but it is advised that care is taken to avoid sharing washing
bowls, baths or pillows with an infected person. Staff with eczema or psoriasis or cuts
to their hands should not undertake intimate nursing care of known MRSA carriers.
All cases of suspected MRSA infection should be urgently discussed with managers
and health professionals and steps put in place to minimise the risks to others.
Service users with open sores/wounds, moving into Thames Reach accommodation
from hospital or from the streets, should be advised and assisted to practice good
hygiene and to keep sores and wounds covered with clean dressings.
9) Hepatitis A
Hepatitis A is an infectious viral illness acquired through contaminated food or water.
It is usually a transient but unpleasant illness characterised by a fever, feeling unwell
and yellow jaundice of the eyes or skin. A complete recovery almost always occurs,
though the patient may feel unwell for several months. In this country, it is most
commonly seen after unhygienic holidays abroad but it does occasionally occur in
epidemics, particularly in institutions.
There is a vaccine available for Hepatitis A and good hygiene, particularly good food
hygiene, will substantially reduce the chances of an outbreak.
10) Hepatitis B
Hepatitis B is a viral infection, causing a similar illness to Hepatitis A. However, it is
acquired by blood-to-blood transfer (for example from sharing needles, razors,
toothbrushes; contact with open sores or unprotected sex). It is mildly infectious
through saliva and care must therefore be taken with drinking and catering utensils.
Most people who get Hepatitis B recover fully, but one in ten will go to be a carrier of
the disease. Carriers remain infectious, even when feeling completely well and will
always be a risk to others - as well as being at much greater risk themselves from
serious liver conditions.
Vaccination against Hepatitis B is available on the NHS from GPs for people who are
considered to be at high risk of catching the disease. This includes people who work
with injecting drug users.
Page 8 of 11
11) Hepatitis C
Hepatitis C is also an infectious blood-borne virus that can be transmitted by
exposure to contaminated blood and plasma derivatives. Hepatitis C is a hardy virus
that can survive for approximately 3 months outside the body. There is no vaccine
available for Hepatitis C.
The most significant risk behaviour for Hepatitis C infection is drug use, particularly
intravenous drug use. This is responsible for about 30-40% of all identified cases of
Hepatitis C. As with HIV, the sharing of contaminated needles and other drug
paraphernalia increases the chance of infection dramatically. Incidence of infection
among IV drug users has surpassed 50 percent in many studies, and reached 100
percent in others. Cocaine users have also been shown to transmit the virus by
sharing snorting straws. In more than 40% of all cases, the infected individuals
cannot identify a source for their infection. It is believed that most of these are due to
known risk factors - however, in more than 10% of all cases, no risk factor can be
identified. There are clearly other, as yet unidentified modes of transmission.
12) Hepatitis D
The Hepatitis D virus cannot propagate in the absence of another virus. In humans,
Hepatitis D virus infection only occurs in the presence of Hepatitis B infection.
Hepatitis D virus infection is transmitted by blood and blood products. The risk factors
for infection are similar to those for Hepatitis B virus infection. The Hepatitis D virus
most often infects intravenous drug users. A patient can acquire Hepatitis D virus
infection at the same time as he/she is infected with the Hepatitis B virus. This is
called co-infection. There is no vaccine for Hepatitis D.
13) Hepatitis E
The Hepatitis E virus is similar to Hepatitis A. It is not common or typical in countries
or areas with clean drinking water and adequate environmental sanitation. Typically,
people diagnosed with Hepatitis E have become infected during travels to or stays in
geographical areas lacking clean water or sanitation. Hepatitis E is transmitted
through oral contact with faeces. This is primarily through contaminated water
sources and a lack of sanitation. Symptoms of Hepatitis E resemble those of
Hepatitis A. There is no vaccine for Hepatitis E.
14) Hepatitis G
Hepatitis G is a virus that is very similar to Hepatitis C. However, it has not been
associated with any chronic liver disease. In fact, it seems to be a benign virus that is
widely present throughout the world. There has been no association between poor
outcomes of patients who are infected with Hepatitis C and Hepatitis G at the same
time.
15) HIV and AIDS
HIV (Human Immunodeficiency Virus) is a virus that may lead to a breakdown of the
body's natural ability to fight off infection and to a person developing AIDS (Acquired
Immune Deficiency Syndrome). If someone has HIV, it can be detected by the
presence of antibodies in the blood (antibody positive).
Whilst HIV infection is a serious condition, it can only be a transmitted through
contaminated blood and blood products and semen. HIV can be detected in other
body fluids like tears, saliva, urine and faeces, but there have been no known cases
of transmission through absorption of these fluids.
Page 9 of 11
All the evidence indicates that HIV is transmitted only in very specific ways, either by
unsafe sexual contact with an infected person, or by taking infected blood into your
own bloodstream, for example, by using contaminated syringes and needles for drug
injections. Because certain bodily fluids directly entering the bloodstream transmit
HIV, it is theoretically possible for transmission to occur through spillage of these
fluids directly entering the bloodstream of another through a cut, abrasion or mucous
membrane. However, there have been no known cases of transmission through
spillage.
HIV infection is not spread through the air, for example by sneezing, coughing or
spitting; nor by touch; nor by cooking; eating and drinking utensils or other articles in
general use.
Page 10 of 11
Appendix 2 - Pro-forma Letter for New Employees
Dear
As you are aware, your work with Thames Reach will bring you into contact with service
users who have slept rough. A number of these clients may have come into contact with
others with TB or may be TB carriers themselves.
In addition, some may be injecting drug users, or be otherwise considered at risk of Hepatitis
B.
We have taken medical advice and recommend that as these diseases are preventable by
vaccination, you protect yourself from the small risk of contracting either by undergoing
vaccination treatment.
In the case of Hepatitis B, vaccination against the disease can be given at your local GP’s
surgery. Thames Reach is willing to pay the cost of the prescription, on production of a
receipt. The vaccination takes 6 months to complete and involves three injections. Some
GPs do not consider non-health care workers to be enough at risk to warrant the vaccination
so you need to discuss with him/her your duties in detail. If your GP is unable to give you
the vaccination, please speak with your line manager, who will refer you to our Occupational
Health Provider.
In the case of TB, a skin test will be necessary to assess the extent of your existing immunity
to the disease. If it is assessed that your immunity is not high enough, an injection may be
recommended. The skin test, the vaccination and, if necessary, a chest x-ray can all be
obtained by contacting the chest clinic of your local hospital. Your GP may be able to advise
you of the details.
Thames Reach will not take responsibility for ensuring that you have taken the steps
described above – we recommend that you do so but accept that staff must take
responsibility for their own health while working with us.
Please make sure your new line manager discusses this issue with you in more detail during
your induction. You should feel free to ask her/him about any concerns you have in this
regard.
Yours sincerely
Sarah Haldane/Tarrance Downes
Human Resources Officer
Page 11 of 11