Download Hepatitis C Virus: Protecting Employees and Patients

Hepatitis C Virus: Protecting Employees and Patients
Reference Number
1.10
Version
3
Name of responsible (ratifying)
committee
Health and Safety Committee
Date ratified
14th March
Document Manager (job title)
Consultant & Clinical Lead, Occupational
Health & Safety Service
Date issued
02/04/2012
Review date
March 2015
Electronic location
Health and Safety policies
Related Procedural Documents
Hepatitis B Virus: Protecting Employees &
Patients; HIV infected health care workers.
Guidance on management & patient
notification; Prevention and Management of
Needlestick Injuries & Contamination Incidents
Key Words (to aid with searching)
Hepatitis B virus; occupational health;
exposure prone procedure; pre-employment
health assessment; hepatitis C virus; HIV
CONTENTS
1.
2.
3.
4.
5.
6.
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9.
QUICK REFERENCE GUIDE ...................................................................................................... 3
INTRODUCTION ......................................................................................................................... 4
PURPOSE ................................................................................................................................... 4
SCOPE........................................................................................................................................ 4
DEFINITIONS.............................................................................................................................. 4
DUTIES AND RESPONSIBILITIES ............................................................................................. 5
PROCESS ................................................................................................................................... 6
TRAINING REQUIREMENTS...................................................................................................... 7
REFERENCES AND ASSOCIATED DOCUMENTATION............................................................ 7
MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF,
PROCEDURAL DOCUMENTS .................................................................................................... 8
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QUICK REFERENCE GUIDE
This policy must be followed in full when developing or reviewing and amending Trust
procedural documents.
For quick reference the guide below is a summary of actions required. This does not
negate the need for the document author and others involved in the process to be
aware of and follow the detail of this policy.
1. Hepatitis C virus (HCV) is a blood borne virus which causes inflammation of
the liver. Many people who are infected have no symptoms and are unaware
that they are carrying the virus.
2. Since a new Department Health recommendation in 2007 and as part of the
Work Health Assessment process carried out by Occupational Health, HCV is
screened for in Healthcare Workers (HCW) who are new to the NHS and who
will be performing Exposure Prone Procedures (EPP) or new to (EPP).
3. For HCW who commenced their post prior to 2007 the requirements are that
those who know that they are carriers of HCV must refrain from EPP; those
with hepatitis C antibodies must be tested for HCV RNA; those intending to
undertake professional training for a career that relies upon the performance
of EPP must be tested for HCV, and those who perform EPP and who believe
they could have been exposed to HCV must seek professional advice on
whether they should be tested.
4. Employment restrictions are required for HCW who are carriers of HCV and
who wish to perform EPP. HCW who are treated for HCV with appropriate
anti-viral medication and who remain hepatitis C virus RNA negative 6
months after cessation of treatment will be allowed to return to performing
EPP at that time. As a further check, they must be shown still to be RNA
negative 6 months later.
5. Transmission of HCV can occur in the occupational setting e.g. after
Needlestick injury from a contaminated source patient. It is therefore essential
that all Needlestick injuries and contamination incidents are managed as per
the Trust policy on the correct management of Needlestick injuries and
contamination incidents.
6. In the occupational setting, general measures to prevent infection from HCV,
as well as other blood borne viruses such as hepatitis B and HIV, include: use
of personal protective equipment (gloves, face visors etc) to minimise
exposure to blood or body fluids; safe handling and disposal of sharps and
good adherence to appropriate hand hygiene policies
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1. INTRODUCTION
Hepatitis C virus is a blood borne virus which causes inflammation of the liver.
Many people who are infected have no symptoms and are unaware that they
are carrying the virus. The World Health Organization estimates that there are
170 million carriers of HCV worldwide. The United Kingdom is considered to be
a relatively low prevalence country with a prevalence of chronic hepatitis C
infection in England of around 0.4%.
Today, injecting drug use is the most common way to acquire HCV. Individuals
who inject drugs acquire their infections when they share contaminated
injecting equipment. In the UK blood donations have been screened for HCV
since September 1999, but prior to this, and in countries that do not screen
donor blood, it was possible to acquire the virus through contaminated blood
transfusions. HCV can also be acquired during body piercing, tattooing, and
acupuncture if sterile needles are not used. The risk of sexual transmission is
relatively rare. Transmission can occur in the occupational setting e.g. after
Needlestick injury from a contaminated source patient.
There is no vaccine available to prevent HCV infection. Treatment can be
undertaken with a combination of interferon and ribavirin. Employment
restrictions are required for HCW who are carriers of HCV and who wish to
EPP.
In the occupational setting, general measures to prevent infection from HCV,
as well as other blood borne viruses such as hepatitis B and HIV, include: use
of personal protective equipment (gloves, face visors etc) to minimise exposure
to blood or body fluids; safe handling and disposal of sharps and good
adherence to appropriate hand hygiene policies.
2. PURPOSE
This policy has been developed to inform the Trust’s employees of the
background and risks of hepatitis C virus infection in the workplace and the
requirements needed in terms of safe working and the protection of staff and
patients.
3. SCOPE
This policy applies to all staff of Portsmouth Hospitals NHS Trust, the MDHU
(Portsmouth) and Carillion, including bank, agency and locum, whilst
acknowledging for staff other than those of the Trust the appropriate line
management or chain of command will be followed. Whilst the policy outlines
how the Trust will manage hepatitis C in employees, implementation does not
replace the personal accountability of all staff in this regard.
‘In the event of an infection outbreak, flu pandemic or major incident, the
Trust recognises that it may not be possible to adhere to all aspects of this
document. In such circumstances, staff should take advice from their
manager and all possible action must be taken to maintain ongoing patient
and staff safety’
4. DEFINITIONS
HCV: hepatitis C virus
HIV: Human Immunodeficiency virus
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Health Care Worker (HCW): Includes all staff working in hospitals and primary
care who have direct patient contact, e.g. domestics on wards, some catering
staff, ambulance staff, some reception and clerical staff, as well as medical and
nursing staff.
Exposure Prone Procedures (EPP): invasive procedures where there is a risk
that injury to the worker may result in the exposure of the patient’s open tissues
to the blood of the worker (bleed-back). These include procedures where the
worker’s gloved hands may be in contact with sharp instruments, needle tips or
sharp tissues (e.g. spiccules of bone or teeth) inside a patient’s open body
cavity, wound or confined anatomical space where the hands or fingertips may
not be completely visible at all times. Other situations, such as pre-hospital
trauma care should be avoided by health care workers restricted from
performing exposure prone procedures, as they could also result in the
exposure of the patient’s open tissue to the blood of the worker.
Non-exposure Prone Procedures: where the hands and finger tips of the
worker are visible and outside the patient’s body at all times, and internal
examinations or procedures that do not involve possible injury to the worker’s
gloved hands from sharp instruments and/or tissues, are considered not to be
exposure prone provided routine infection control procedures are adhered to at
all times.
Examples of non-EPP:
 Taking blood
 Setting up and maintaining intravenous lines or central lines (provided
any skin tunneling procedure used for the latter is performed in a nonexposure prone manner)
 Minor surface suturing
 Incision of external abscesses
 Routine vaginal or rectal examinations
 Simple endoscopic procedures
Obstetric/ intrapartum care:
Normal vaginal delivery in itself is not an Exposure Prone Procedure but an
infected health care worker must not perform procedures involving the use of
sharp instruments such as infiltrating local anaesthetic or suturing of a tear or
episiotomy, since the fingertips may not be visible at all times. Neither can they
perform an instrumental delivery requiring forceps or suction if infiltration of
local anaesthetic or internal suturing is required.
Renal Dialysis/ Transplantation Units
Activities undertaken on renal units are not regarded as EPP. However the
possibility of transmission of Hepatitis B virus cannot be entirely ruled out.
Therefore HCW who are HBeAg positive or HBeAg negative with a hepatitis B
virus DNA level exceeding 10³ genome equivalents per ml should not
undertake clinical duties on renal units. HIV and HCV infected HCWs may
continue to perform clinical duties on renal units.
5. DUTIES AND RESPONSIBILITIES
Trust Board and Executive Directors
The Trust Board and Executive Directors are responsible for effective risk
management within the Trust and recognise the need for appropriate
prevention and management of hepatitis C in employees in the organisation.
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Line Managers
Line Managers are responsible for ensuring that hepatitis C infected staff are
managed appropriately as set out in this policy and that staff attend
Occupational Health as required after the pre—placement work health
assessment process.
Occupational Health Department: responsible for:
 Ensuring HCV risks to employees and patients are managed
appropriately as set out in the Process section of this policy
 Giving health clearance for EPP work after the pre-placement Work
health Assessment process and for the administration of all relevant
and required immunisations or other processes
 Auditing occupational health data for compliance, evidence from OPAS
matched with ESR
 Reporting on compliance to the Health and safety Committee
Health and Safety Committee
Responsible for receiving the results of Occupational health audits and taking
action as required.
Healthcare Workers: have ethical and legal obligations to take all proper steps
to safeguard the interests of their patients and this includes ensuring all
appropriate steps are taken to protect patients from transmission of infection;
HCW must ensure that they are safe to practice and must inform Occupational
Health in confidence if they believe they may be carriers of any blood borne
virus, including HCW. Blood exposure incidents to both HCW and patients
must be managed appropriately as set out in the relevant Trust policy
(Prevention and Management of Needlestick (‘sharps’) Injuries and
Contamination Incidents).
6. PROCESS
In March 2007, it became a requirement of the Department of Health that HCW
who are new to the NHS and who will perform EPP, and existing HCW who are
new to EPP, are required to have HIV and HCV screening blood tests in
addition to the standard pre-employment health checks.
For HCW who commenced their post prior to 2007 the requirements are that
those who know that they are carriers of HCV must refrain from EPP; those with
hepatitis c antibodies must be tested for HCV RNA; those intending to
undertake professional training for a career that relies upon the performance of
EPP must be tested for HCV, and those who perform EPP and who believe
they could have been exposed to HCV must seek professional advice on
whether they should be tested.
The blood tests will be carried out by Occupational Health with appropriate pre
test discussion and consent. Employees with positive HCV antibody tests will
be further tested for ongoing HCV carrier status in the blood. HCW with
confirmed on-going carrier status (hepatitis C virus RNA positive) will be
restricted from performing EPP.
HCW who are treated for HCV with appropriate anti-viral medication and who
remain hepatitis C virus RNA negative 6 months after cessation of treatment
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will be allowed to return to performing EPP at that time. As a further check,
they must be shown still to be RNA negative 6 months later.
Blood tests for hepatitis B, HCV and HIV must be Identified Validated Samples
(IVS) i.e. the HCW must show proof of identity with a photograph (e.g. Trust ID
card, new drivers license, passport) when the sample is taken; blood should be
taken in the occupational health department and be delivered to the lab in
usual way (i.e. not carried by the HCW).
Managers and recruitment personnel will be informed of employees who are
not cleared to perform EPP, although the specific reason may not be given, if
requested by the employee. HCW who apply for a post or training which may
involve EPP and who decline to be tested for HIV, hepatitis B and HCV will not
be cleared to perform these procedures.
Occupational Health will refer HCV infected HCW to their General Practitioners
for onward referral to a liver specialist for clinical assessment and treatment
where indicated, since there is evidence to suggest that early treatment of
acute hepatitis C infection may prevent chronic hepatitis C infection.
With regard to Patient Notification exercises: whenever a transmission of HCV
from an infected HCW to a patient is detected, notification of other patients of
that HCW who have undergone EPP, with the offer of serological testing,
should normally follow. Most new infections with HCV are asymptomatic. It has
yet to be determined whether there is a need for patient notification exercises
when a HCV carrier HCW is identified in the absence of evidence of
transmission. Until more precise indications for patient notification in this
situation can be defined, the UK Advisory Panel for Healthcare Workers
Infected with Blood-borne Viruses (UKAP) should be approached for advice
whenever patient notification is being considered, and before preparations for
such an exercise are put in place.
7. TRAINING REQUIREMENTS
The Occupational Health Department provides training on prevention and
management of blood borne viruses, including hepatitis C infection, at staff and
junior doctor inductions and by provision of leaflets and written information, as
set out in the Trust’s training needs analysis document and during preplacement health checks.
Training in hand hygiene, use of personal protective equipment, safe handling
and disposal of sharps and reporting of Needlestick injuries is provided in
Health and Safety and Infection Control regular training packages and updates.
8. REFERENCES AND ASSOCIATED DOCUMENTATION
Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New
healthcare workers. London: Department of Health, March 2007.
Hepatitis C Infected Care Workers: Health Service Circular; HSC 2002/010.
London: Department of Health, 14 August 2002
Hepatitis C Infected Health Care Workers. Department of Health, August 2002
Guidance for Clinical Healthcare Workers: Protection against Infection with
Blood-born Viruses. London: UK Health Departments, 1998
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9. MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF,
PROCEDURAL DOCUMENTS
Audit within the occupational health department will be undertaken to ensure
compliance with screening procedures as set out in process of this policy. The
results will be monitored by Health and Safety Committee.
Data is monitored within the organisation on staff numbers attending Health &
Safety and Infection Control training, which both include information on safe
handling and disposal of sharps and reporting of sharps injuries.
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