Download infectious Diseases policy

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 as well as a sample Infectious Diseases policy and safe working
procedures. 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 workers, 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 workers to
Version 2, June 2012
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
o Poor lighting
o 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
 Worker 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:
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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. Oilbased 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
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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.
Routine cleaning
Standard precautions must be implemented when cleaning surfaces and facilities.
Workers 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
workers.
I. A large reusable plastic container or bucket with fitted lid, containing-
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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
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Small blood spills
Ensure the worker 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.
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Large blood spills in a 'wet' area e.g. a bathroom or toilet area
Ensure the worker 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.
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Large blood spills in 'dry' areas
Ensure the worker 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 worker has been exposed to potentially infectious
material they should follow the following post exposure steps.
Needle-Stick Injuries
If a worker 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 worker 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 worker 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 worker 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
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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.
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Small amounts of contaminated waste should be placed in a sealed, leakproof bag and disposed of with general waste.
Soiled Clothing
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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.
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Workers 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.
Further information
Hepatitis viruses
Hepatitis is a disease of the liver that is commonly caused by a virus. Symptoms of
hepatitis may include abdominal discomfort, nausea, and loss of appetite, tiredness,
fever, jaundice and dark urine. Blood tests are used to diagnose hepatitis and which
type of Hepatitis virus is causing infection.
Hepatitis B virus
HBV can be found in blood and body fluids/substances such as semen. It can be
passed from one person to another by infected blood or body fluids / substances
entering the body.
This may occur:
• by injection or injury with contaminated injecting equipment (e.g. needle stick
injury or intravenous drug use) or other sharp objects; - by sexual contact (mainly
hepatitis B Virus);
• by transfusion with infected blood or blood products or the transplantation of
infected material;
• by indirect transfer of infected blood through shared razors, toothbrushes and
other personal items;
• through mucosal contact (e.g. splashes of body substances to the mouth, nose,
eyes or non-intact skin);
HBV vaccine is available to everyone. This vaccine consists of three booster
injections over a period of 6 months. The vaccine is recommended for all persons
who live in the same household as a HBV carrier and for babies who are from a
high-risk ethnic group.
HBV patients are at risk of developing Hepatitis D, which can only occur with HBV.
Hepatitis D is a defective RNA virus, which can cause further complications. HBV
can survive in blood and body fluids/substances outside the body. HBV is not usually
transmitted by casual contact between persons.
The risk of an unvaccinated person contracting HBV from a single needle stick or
sharps injury ranges from approximately 6 – 30 per cent* depending upon the
Hepatitis B antigen status of the source individual. Employees who have received a
Hepatitis B vaccine and developed immunity to the virus have a negligible risk of
infection of HBV.
Hepatitis C virus
HCV is transmitted via blood-to-blood contact; the highest risk being when
equipment used to inject drugs is shared, it may also be transmitted via sexual
contact and was in blood transfusions prior to 1990. Occupational infection of HCV
may occur through injury from contaminated sharps or, more rarely, through eyes,
nose and mouth contact with blood.
No vaccine is available for HCV. The risks of contracting HCV from a needle stick or
sharps injury exposure to HCV infected blood is approximately 1.8 per cent.* The
risk of contracting HCV from a splash exposure is not known but is expected to be
very low.
Human Immunodeficiency Virus (HIV)
The Human Immunodeficiency Virus (HIV) can damage the body's immune system
so that it is unable to fight off infection. This is the cause of Acquired Immune
Deficiency Syndrome (AIDS). An important feature of HIV infection is that there is
usually a long period after initial infection during which the person has few or no
symptoms of the disease.
HIV usually progresses through several stages:
• In the initial weeks of infection, the person may experience symptoms similar to
those of glandular fever. Antibodies to the virus are usually formed at this time
(three to twelve weeks after infection occurs).
• Following the initial infection, there is a long period during which the person has
few or no symptoms, but HIV is detectable through the presence of antibodies in
the blood. This period usually lasts from three to eight years after the initial
infection.
• As the virus begins to destroy the immune system, symptoms such as weight
loss, fever, diarrhea and lymph gland enlargement may commence. This usually
progresses to the full AIDS, which develops when the immune system is severely
damaged. The person may become terminally ill with infections, cancers or
neurological disorders.
Infection with HIV can occur through the transfer of infected human blood or other
body fluids/substances during anal or vaginal sexual intercourse, sharps injury
(including needle sticks) and needle sharing related to drug use. HIV is usually not
transmitted through non-sexual, person-to-person contact. However, the virus can be
transferred where infected materials such as blood or other body fluids/substances
come into direct contact with broken skin or the mucous membranes of the eyes,
nose or mouth.
HIV can survive in body fluids/substances outside the body; HIV is much more fragile
than the Hepatitis viruses and cannot survive for long outside the body.
There is currently no vaccine available that protects against the acquisition of HIV.
The risk of contracting HIV from a needle sticks or sharps injury exposure to HIV
infected blood is approximately 0.3 per cent (or 1 in 333)*.
Expressed otherwise, 99.7 per cent of needle stick or sharps injury exposures to HIV
infected blood do not lead to infection.
The risk of infection from HIV after exposure of the mucous membranes of the eyes,
nose or mouth to HIV infected blood is approximately 0.1 per cent (or 1 in 1000)*.
The risk of infection after exposure of intact skin is below 0.1 per cent. However the
risk may increase where broken/damaged skin is present, large areas of skin have
been exposed or prolonged exposure has occurred.
*(Statistic from NOHSC Control of Work-related Exposure to Hepatitis and HIV)
Common infectious diseases
Chickenpox (Varicella) & Herpes Zoster (Shingles)
Chickenpox may have a few symptoms, outbreaks of small raised rose-pink spots on
the head, face, trunk, arm, arm-pits, and legs and inside the mouth. Spots are
followed by small blisters.
Shingles infection is caused by the virus that causes chickenpox that often recurs.
Symptoms are pain and numbness.
Chickenpox has a much higher rate of infection and via direct contact, droplet or
airborne spread. Shingles has a lower rate of transmission; if a person has not had
chickenpox previously they may develop chickenpox from a person with shingles.
To control the spread of chickenpox, avoid touching the weeping sores or shingles. If
contact is made, wash hands well with soap and water. Articles of clothing should be
disinfected when washed.
Diarrhoea
Diarrhoea results in watery bowel movements, abdominal cramping, dehydration and
often vomiting and fever.
Diarrhoea can be transferred by eating or drinking contaminated food or water and
through poor hygiene practises. It is recommended that good hygiene, such as
washing hands should be maintained at all times. People affected by diarrhoea are
not to work in food preparation areas until that are healthy again.
Glandular Fever
Glandular Fever symptoms include headache, sore throat, mental and physical
fatigue, severe weakness and sometimes skin rashes may occur.
Glandular Fever is spread by saliva from person to person. This can also be in the
form of saliva on persons hand to another person.
Head Lice (Pediculosis)
Head Lice and nits (eggs) will infest the head, other hairy areas of the body and
clothing (especially along the seams of inner surfaces of the clothes) As a result of
infestation, the skin can have severe itching and abrasions. Head lice are transmitted
by direct contact with an infected person.
Eggs of lice usually hatch in a week and reach maturity in approximately 8-10 days.
All material, clothes, bed lines need to be washed in hot water for 20 minutes to
destroy the lice and eggs.
Measles
Measles is a highly communicable viral disease with fever, sneezing, runny nose,
redness and watering of the eyes. The dry cough is present during the first days and
a distinctive rash appears 3-7 days after the early symptoms. Red spots and
blotches on the forehead and face spread progressively downwards toward the feet
until the whole body is affected.
Susceptive individuals should see their own doctor. Those who have had measles
will be permanently immune to the disease.
Meningococcal Meningitis
Meningococcal Meningitis is an acute bacterial disease with symptoms of a sudden
onset of fever, intense headache, nausea and vomiting, stiff neck and a rash. It is
transmitted via direct contact, including respiratory droplets from the nose and throat
of an infected person.
All material, clothes, bed linen needs to be washed in hot water for 20 minutes.
Scabies
Scabies result in severe itching that continues for days, weeks and becomes worse
at night. The itching is caused by a tiny mite who burrows under the skin. Warm
parts of the body such as wrists, armpits, elbows, back of shoulders, buttocks and
groin are most affected.
Scabies is transmitted by skin to skin contact or through contaminated clothing and
bedding. It is important to use hot water cycles in washing and the dryer. Clothes can
also be placed in direct sunlight to dry.
Avian Influenza
Avian influenza is an infectious disease of birds caused by type A strains of the
influenza virus. The disease occurs worldwide. While all birds are thought to be
susceptible to infection with avian influenza viruses, many wild bird species carry
these viruses with no apparent signs of harm.
Since 1959, instances of human infection with an avian influenza virus have been
documented on only 10 occasions. Of the hundreds of strains of avian influenza A
viruses, only four are known to have caused human infections: H5N1, H7N3, H7N7,
and H9N2. In general, human infection with these viruses has resulted in mild
symptoms and very little severe illness, with one notable exception: the highly
pathogenic H5N1 virus.
All evidence to date indicates that close contact with dead or sick birds is the
principal source of human infection with the H5N1 virus. Whilst the incubation period
is longer the development of respiratory symptoms is much more rapid. Health
authorities continue to monitor Avian Influenza due to the risk of a pandemic
developing.
Colds and flu
Generally a virus transmitted from person to person through breathing droplets from
sneezes or coughs or touching body parts such as hands or objects contaminated
with mucus material.
Avoid transmission by:
• Covering your nose and mouth when sneezing or coughing
• Keeping your hands away from your eyes, nose and mouth to stop infecting
yourself
• Use paper tissues and throw away after use
• Wash hands with soap thoroughly and frequently, especially before preparing
and eating food and after blowing nose
• Wipe down your telephone handsets and dial buttons, keyboards and mouses
• Avoid sharing pens and telephones
REFERENCES:
Australian Government: Department of Health and Ageing: “The Flu and You: Help
stop the spread at home, work and school”
World Health Organisation “Infectious Diseases Factsheets”
Better Health Channel “Work Issues – Infection Control”
National Occupational Health and Safety Commission “National Code of Practice for
the Control of Work-related Exposure to Hepatitis and HIV (Blood-borne) Viruses”
2nd Edition, December 2003