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SH CP 157 Exposure Prone Procedures (EPPs) and Blood Borne Viruses (BBVs)- Management of the Infected Healthcare Worker Version: 2 Summary: This document provides guidance for clinicians and administrative staff managing cases where healthcare workers (HCW) who undertake exposure prone procedures (EPP) and HCWs infected with a blood borne virus Keywords: Hepatitis B, Hepatitis C, HIV, Blood Borne Virus. Infected Health Care Worker Target Audience: Staff performing surgical procedures or scrub for surgical procedures; staff working in MIU’s and podiatry staff who perform exposure prone procedures. Next Review Date: March 2020 Approved & Ratified by: Infection Prevention & Control & Decontamination Group Date issued: March 2016 Author: Theresa Lewis – Lead Nurse Infection Prevention and Control Jacky Hunt – Infection Prevention Nurse Lorna Straine – OH Assist Occupational Health Specialist Practitioner Clinical Lead - Immunisations & BBV's Sara Courtney – Interim Executive Director of Nursing, AHP and Quality Director: Date of meeting: 11 February 2016 1 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 Version Control Change Record Date Author 06.02.14 Theresa Lewis and Carol Hargreaves - OH Assist Jacky Hunt Lorna Strain Theresa Lewis 22.12.15 Version Page Reason for Change 1 New Policy 2 Previous policy due to expire Reviewers/contributors Name IP&C Team Carol Hargreaves IP&C Group Members Clinical Directors and Professional Leads Louise Jones Nick Sargeant IPC Team Lorna Strain – OH Assist Immunisation Lead Louise Jones Position OH Assist HR Manager Acute Care Pathway Manager - AMH Lorna Straine – OH Assist Occupational Health Specialist Practitioner Clinical Lead - Immunisations & BBV's Senior HR manager Version Reviewed & Date 20.01.14 & 19.03.14 10.01.14 & 06.03.14 07.04.14 07.04.14 28.04.14 22.04.14 29.12.15 29.12.15 29.12.15 2 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 Quick Reference Guide For quick reference, this page summarises the actions required by this policy. This does not negate the need to be aware of and to follow the further detail provided in this policy. The purpose of this policy is to restrict healthcare workers infected with blood bourne viruses from the workplace if their infection poses a risk to the patients in their care. 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 considered to be EPP. 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 staff that perform EPP include: All surgeons FY1 and FY2 doctors who rotate into EPP areas Theatre staff who scrub Midwives Doctors and nurses in Emergency Department Podiatric surgeons Further information on what constitutes an EPP is available in the Immunisation Policy SH HR 59 Staff with a blood borne infection will be restricted from performing EPP unless they meet specific criteria as outlined in section 5 of this policy Routine blood testing for HIV hepatitis C and hepatitis B is required for EPP clearance for : All EPP workers who enter training of EPP dependant specialities All EPP workers new to the NHS or returnees to the NHS in EPP dependent specialities All EPP workers who believe they have been exposed to a blood borne virus where there is a risk of transmission e.g. HCW has had a needle stick injury from a hepatitis positive HCW. All EPP workers who are newly employed by the Trust where their role involves EPP and cannot provide Occupational Health their complete EPP documentation that meets UK Department of Health standards, may require to undergo further EPP serology testing. Occupational Health will make the decision if this is required or not depending on the documentation provided. Managers Managers are responsible for ensuring that staff are aware of this policy. Managers are responsible to ensure that the OHS is made aware of any HCW whose role includes EPP 3 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 If Occupational Health advises that the HCW is not fit to undertake EPP’s a risk assessment of the role will need to be undertaken by OHS. This will identify if the HCW can continue in the role if EPP’s are excluded. Managers are then responsible for ensuring that adherence to any restrictions made by Occupational Health are followed and must make every effort to arrange suitable alternative work and retraining opportunities, or where appropriate, early retirement for infected employees, where indicated after Occupational Health input. Healthcare Workers All healthcare workers who have direct clinical care of patients, have a duty to keep themselves informed and updated on the codes of professional conduct and guidelines on working with a blood borne infection laid down by their regulatory bodies and any relevant guidance issued by the Department of Health. A healthcare worker who has any reason to believe they may have been exposed to infection with HIV, in whatever circumstances, must promptly seek and follow confidential professional advice on whether they should be tested for HIV. Failure to do so may breach the duty of care to patients. Healthcare workers who know or have good reason to believe (having taken steps to confirm the facts as far as practicable) that a medical colleague or healthcare worker who has, or may have, a serious communicable disease (such as hepatitis B, hepatitis C or HIV), is practicing, or has practiced, in a way which places patients at risk, they must inform an appropriate person in the healthcare worker’s employing authority, for example an Occupational Health Physician, the Trust’s medical director, the Director of Public Health or where appropriate the relevant regulatory body. Healthcare workers may wish to seek advice from their regulatory and professional bodies before passing on such information; such cases are likely to arise very rarely. Wherever possible, the healthcare worker should be informed before information is passed to an employer or regulatory body. HCW’s have a duty to comply with this policy and undertake any appropriate screening deemed necessary for the position. Any HCW who is involved in EPP’s and refuses to follow the policy will not be allowed to undertake EPP’s. The Manager will be informed that the HCW is not fit to undertake EPP’s. Failure by staff to comply with this policy may be regarded as gross misconduct and may lead to Disciplinary Action. 4 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 Contents Section Title Quick reference guide Page 3 1. Introduction 6 2. Who does this policy apply to? 6 3. Definitions 6 4. Duties and responsibilities 8 5. Main policy content 9 6. Training requirements 12 7. Policy review 13 8. Associated trust documents 13 9. Supporting references 13 Appendices Appendix 1 Equality Impact Assessment Tool 14 Appendix 2 Hepatitis B Infected HCW and Anti-Virals - Best Practice Guidance 15 Appendix 3 Hepatitis C Infected HCW – Best Practice Guidance 15 Appendix 4 Proforma for Testing Blood Samples 15 Appendix 5 DoH Health Clearance for Tuberculosis, Hepatitis B, Hepatitis C and HIV: New Healthcare Workers – Best Practice Guidance Management of HIV infected Healthcare Workers who perform exposure prone procedures: updated guidance January 2014 (PHE 2014) 15 Appendix 6 15 5 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 Exposure Prone Procedures (EPPs) and Blood Borne Viruses (BBVs) Management of the Infected Healthcare Worker 1. Introduction The overall aim of this policy is to control the risk to patients from healthcare workers infected with blood borne viruses (BBV). The purpose is also to restrict healthcare workers infected with blood borne viruses from the workplace if their infection poses a risk to the patients in their care This guidance recommends that all new healthcare workers have checks for tuberculosis disease/immunity and are offered hepatitis B immunisation, with postimmunisation testing of response and the offer of tests for hepatitis C and HIV. These standard health clearance checks should be completed on appointment (See Immunisation Policy SH HR 59) For new healthcare workers who will perform exposure-prone procedures (EPPs), additional health clearance should also be undertaken. Additional health clearance means being non-infectious for HIV, hepatitis B (surface antigen negative or, if positive, e-antigen negative with a viral load of 103 genome equivalents/ml or less) and hepatitis C (antibody negative or, if positive, negative for hepatitis C RNA). These checks should be completed before confirmation of an appointment to an EPP post, as the healthcare worker will be ineligible if found to be infectious. This guidance does not apply to healthcare workers who are already employed in the NHS, with the exception of those moving to a post requiring the performance of EPPs for the first time in their career. This guidance is supplementary to routine occupational health checks/immunisations for other infectious diseases (eg for rubella and varicella as outlined in Immunisation policy SH HR 59) (Department of Health (2007) Health Clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New Healthcare Workers). 2. Who does this policy apply to? This policy applies to all healthcare workers (HCWs) who would be performing exposure prone procedures for the first time. This would include existing HCWs who are moving post or training that involves EPPs and those returning to the NHS dependent on what activities they have engaged in while away from the NHS. This policy does not apply to HCWs who are already employed in the Trust with the exception of those moving to a post requiring performance of EPPs for the first time in their career. 3. Definitions New Health Care Worker – for the purpose of this policy a new healthcare worker (HCW) is defined as an individual who has direct clinical contact with Trust patients, whether as an employee or with Trust agreement (visiting fellow, student placement) for the first time. Existing healthcare workers who are moving to a post or training that involves exposure prone procedures (EPP) are also considered new. Returning healthcare workers may also be regarded as ‘new’ depending on what activities they have engaged in while away from the NHS. 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 6 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 times. Other situations, such as pre-hospital trauma care should be considered to be EPP. 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 such non-EPP procedures include: Taking blood Setting up and maintaining intravenous lines or central lines (provided any skin tunneling procedure used for the latter is performed in a non-exposure prone manner) Minor surface suturing Incision of external abscesses Routine vaginal or rectal examinations Simple endoscopic procedures Examples staff that perform EPP include: All surgeons FY1 and FY2 doctors who rotate into EPP areas Theatre staff who scrub Midwives Doctors and nurses in Emergency Department Podiatric surgeons Further information on what constitutes an EPP is available in the Immunisation Policy SH HR 59 Blood Borne Virus (BBV): viruses that are carried in the blood and may cause severe disease in certain people and few or no symptoms in others. The main BBVs of concern are: Hepatitis B virus (HBV) and Hepatitis C (HCV) which cause hepatitis, a disease of the liver Human Immunodeficiency Virus (HIV) which causes Acquired Immune Deficiency Syndrome (AIDS), affecting the immune system of the body. United Kingdom Advisory Panel for Health Care Workers infected with Blood Borne Viruses (UKAP). UKAP gives advice on guidance on healthcare workers infected with HIV, hepatitis B and hepatitis C. The panel also provides support for local incident management teams and maintains a register of infected healthcare workers. See www.gov.uk email contact [email protected] Health Care Worker (HCW): all staff including medical and nursing staff as well as others who may have direct patient contact, Viral Load – Viral load, also known as viral burden or viral titre, is a measure of the severity of an active viral infection, and can be calculated by estimating the live amount of virus in an involved body fluid. cART – Combination antiretroviral therapy Identified Validated Sample (IVS) - is defined by Association of NHS Occupational Physicians (ANHOPS) and the Association of NHS Occupational Health Nurses (ANHONS) as meeting the following criteria: (a) The HCW must show a proof of identity with a photograph - Trust identity badge, new driver’s licence, passport or national identity card - when sample is taken; (b) The sample of blood must be taken in the occupational health department; 7 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 (c) Samples must be delivered to the laboratory in the usual manner, not transported by the healthcare worker; (d) When the results are received from the laboratory, the clinical notes must be checked for a record that the sample was sent by the occupational health department, at the relevant time. Elite Controller– is defined as a person living with HIV who is not receiving antiretroviral therapy and who has maintained their viral load below the limits of assay detection for at least 12 months, based on at least three separate viral load measurements. 4. Duties and responsibilities Chief Executive The chief executive has overall responsibility for ensuring that the Trust meets its statutory and non-statutory obligations for staff health clearance for Hepatitis B, Hepatitis C and HIV of the HCW. Director of Human Resources Director of Human Resources is responsible for ensuring that the requirements of this policy are effectively managed via the Occupational Health Department. Giving assurance that healthcare workers’ infected with HIV hepatitis B or C status and rights as employees will be safeguarded so far as practicable Occupational Health Occupational Health is responsible for the implementation and monitoring of this Policy. Occupational Health has a responsibility to ensure that prior to any blood tests being undertaken that the HCW understands what tests are being undertaken and why. Occupational Health has a responsibility to ensure the HCW is fully informed of any implications on their role in the event of a positive test; so that the HCW must give informed consent. Occupational Health will be responsible for advising the Manager of any role exclusions that are required. Occupational Health will be responsible for considering the impact of HIV positivity on the individual’s resistance to infection when advising on suitability for particular posts, especially if the duties involve exposure to known or undiagnosed TB Managers Managers are responsible for ensuring that staff are aware of this policy. Managers are responsible to ensure that the OHS is made aware of any HCW whose role includes EPP If Occupational Health advises that the HCW is not fit to undertake EPP’s a risk assessment of the role will need to be undertaken by OHS. This will identify if the HCW can continue in the role, if EPP’s are excluded. Managers are then responsible for ensuring that adherence to any restrictions made by Occupational Health are followed and must make every effort to arrange suitable alternative work and retraining opportunities, or where appropriate, early retirement for infected employees, where indicated after Occupational Health input. Healthcare Workers All healthcare workers who have direct clinical care of patients, have a duty to keep themselves informed and updated on the codes of professional conduct and guidelines on working with a blood borne infection laid down by their regulatory bodies and any relevant guidance issued by the Department of Health. The General Medical Council, General Dental Council and the Nursing and Midwifery Council all provide statements about the ethical responsibilities of healthcare workers towards 8 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 their patients and the full statements can be obtained directly from these organisations. A healthcare worker who has any reason to believe they may have been exposed to infection with HIV, in whatever circumstances, must promptly seek and follow confidential professional advice on whether they should be tested for HIV. Failure to do so may breach the duty of care to patients. Healthcare workers who know or have good reason to believe (having taken steps to confirm the facts as far as practicable) that a medical colleague or healthcare worker who has, or may have, a serious communicable disease (such as hepatitis B, hepatitis C or HIV), is practicing, or has practiced, in a way which places patients at risk, they must inform an appropriate person in the healthcare worker’s employing authority, for example an Occupational Health Physician, the Trust’s medical director, the Director of Public Health or where appropriate the relevant regulatory body. Healthcare workers may wish to seek advice from their regulatory and professional bodies before passing on such information; such cases are likely to arise very rarely. Wherever possible, the healthcare worker should be informed before information is passed to an employer or regulatory body. All HCWs who are HIV positive and wish to perform EPP must meet the following criteria: must be under the care of a designated consultant occupational physician; must accept that it is a condition of undertaking EPP that they consent to ongoing monitoring while they continue to practice exposure-prone procedures, including: a. the registration of their details and monitoring data on the UKAP-OHR b. the release of monitoring information to the consultant occupational physician and the treating physician c. to provide an IVS for viral load monitoring at the appointed times d. to seek advice if a change in health condition may affect their fitness to practise or impair their health e. to notify OH when they are changing their practice or their place of employment HCW’s have a duty to comply with this policy and undertake any appropriate screening deemed necessary for the position. Any HCW who is involved in EPP’s and refuses to follow the policy will not be allowed to undertake EPP’s. The Manager will be informed that the HCW is not fit to undertake EPP’s. Failure by staff to comply with this policy may be regarded as gross misconduct and may lead to Disciplinary Action. 5. Routine testing for EPP clearance and interpretation of results Routine testing for EPP clearance is required for: All EPP workers who enter training of EPP dependant specialities All EPP workers new to the NHS or returnees to the NHS in EPP dependent specialities All EPP workers who believe they have been exposed to a blood borne virus where there is a risk of transmission e.g. HCW has had a needle stick injury from a hepatitis positive HCW. 5.1 Hepatitis C Healthcare workers who are infected with the hepatitis C virus (HCV) and are RNA positive must not perform EPPs. As there is no vaccine for hepatitis C it is not possible to ensure permanent non-infectivity. 9 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 All HCWs who know they are infected with HCV or believe they may have been exposed to hepatitis C infection should seek advice from the Occupational Health Services. Hepatitis C screening is mandatory for: All EPP workers who entered in training of EPP dependant specialities from January 2003 All EPP workers new to the NHS or returnees to the NHS in EPP dependent specialities from August 2007. All EPP workers who believe they have been exposed to hepatitis C where there is a risk of transmission e.g. hepatitis C positive needle stick injury. Screening consists of a hepatitis C antibody blood test (Anti HCV) and if positive hepatitis C virus RNA blood test. If screening tests identify an individual who is Anti HCV positive a referral will be made to the Occupational Health Consultant. HCWs who respond successfully to treatment with antiviral therapy will be allowed to resume EPP work or training. Successful response is defined as remaining HCV negative for 6 months after the cessation of treatment. There will be ongoing assessment by the OH Consultant every 6 months until advised accordingly. In the following cases EPP clearance will not be authorised: Anti HCV positive, HCV RNA positive Anti HCV positive, HCV RNA negative but more than 6 months since last test. The following table indicates Occupational Health monitoring dependent on the outcome of the screening. Status Anti HCV negative Anti HCV positive, HCV RNA negative EPP Clearance Expiry None 6 months from date of last HCV RNA test It is a requirement for healthcare workers new to the NHS (after March 2007) who will be undertaking EPP and HCW new to EPPs to undergo routine blood testing prior to employment to determine non infectivity to Hepatitis B (HBV), Hepatitis C (HCV) and HIV. HCWs who apply for a post or training which requires the performance of EPPs and who decline to be tested for HIV, HBV or HCV should not be cleared for EPP work. The outcomes of significant results are as follows but please consult the attached guidance for further detail: Hepatitis C (HCV) RNA positive- Restrict in accordance with HSC 2002/010 guidance (Appendix 2) and refer to a liver unit for specialist intervention. Hepatitis C infected HCWs who have been treated with antiviral therapy and who remain hepatitis C virus RNA negative for at least 6 months after cessation of treatment may resume EPPs following consultation with a consultant Occupational Physician. 5.2 Hepatitis B (HBV) Healthcare workers participating in EPP must undergo testing for Hepatitis B surface antigen (HBSAg) on an identified validated sample before being cleared by OH Service to commence EPP. Those who are HBSAg negative are fit to undertake EPP. Those who are HBSAg positive should undergo further tests to assess infectivity. Staff found to be Hepatitis B e Antigen positive, are not fit to undertake EPP. 10 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 Staff who are e antigen negative and have viral loads of hepatitis B (HBV) DNA levels below 200IU/ml can continue to undertake EPP as long as they are monitored annually by the Occupational Health Service. Sampling should entail two separate blood samples (identified and validated –IVS standards) one week apart. Special arrangements will be put in place by the Occupational Health Service for HBV infected HCW with pre-treatment results of above 200IU/ml and below 20,000IU/ml. HCW with baseline viral load above 20,000 IU/ml will be declared ineligible to perform EPP while taking oral antiviral therapy on the grounds of patient’s safety, by the Occupational Health service. If the staff member discontinues antiviral treatment they have a duty to inform the Occupational Health Service Any healthcare worker who is associated with the transmission of Hepatitis B to a patient must cease EPP regardless of their viral load. Staff found to be infected with Hepatitis B will be referred for appropriate investigation and treatment. The Occupational Health Service will advise the Trust about necessary work restrictions and the Trust will explore temporary or permanent job modification, redeployment or retraining as appropriate. HCWs who refuse to comply with testing will be considered unfit for EPP. Healthcare workers would be under a professional and ethical obligation to immediately cease performing exposure prone procedures should they stop treatment for any reason 5.3 HIV HIV positive employees were all previously considered permanently unfit for EPP work, but this advice has now changed in line with PHE guidance 2014. HCWs on appropriate treatment and management, with plasma viral load level < 200 copies per ml can now undertake EPP work. HIV infected HCWs must meet the following criteria before they perform EPPs: be on effective combination antiretroviral therapy (cART), and have a plasma viral load <200 copies/ml Or be an elite controller And HIV infected HCW must not rely on their own assessment of the risk they pose to patients but must promptly seek expert medical advice. They must accept that it is a condition of undertaking EPPs that they consent to ongoing monitoring while they continue to practise EPP, including: i. The registration of their details and monitoring data on the UKAP-OHR ii. The release of monitoring information to the consultant OHP and the treating physician iii. The provision of an IVS for viral load monitoring at the appointed times iv. Seeking advice if changes in their health condition may affect their fitness to practise or impair their health v. Notification to the Occupational Health Service when they are changing their practice or their place of employment NB hat by seeking to and undertaking EPPs, HIV positive staff are giving implied consent to i and ii above and they are undertaking to satisfy iii, iv, v as well. 11 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 Viral load monitoring and ongoing clearance by the Occupational Health Service for HIV infected HCWs performing EPPs HIV infected HCWs who are cleared to perform EPPs are subject to viral load testing every three months while continuing to perform such procedures. The three month period should be taken from the date the previous IVS was drawn, and not from the date the result was received. If a HCW’s plasma viral load rises above 1000 copies/ml, they should be restricted immediately from carrying out EPPs until their viral load returns to being consistently below 200 copies/ml in at least two tests done no less than three months apart. The significance of any increase in plasma viral load above 200 copies/ml and below 1000 copies/ml should be assessed jointly by the occupational health and treating physicians with input from local experts (eg consultant microbiologist or virologist) The table below sets out the expected course of action for viral load test results below and above the level of EPP clearance (200 copies/ ml) Viral load count test result <50 copies/ml or below 50-200 copies/ml >200 copies/ml but < 1000 copies/ml 1000 copies/ml or above 6. Action No action-retest in three months A case-by-case approach based on clinical judgement would be taken which may result in no action (as above) or a second test may be done 10 days later to verify the first result. Further action would be informed by the test result. A second test must be automatically being done 10 days later on a new blood sample to verify the first result. If the count was still in excess of 200 copies/ml, the HCW would cease conducting EPPs until their count, in two consecutive tests no less than three months apart, was reduced to <200 copies/ml. The HCW would cease conducting EPPs immediately. A second test must be done on a new blood sample 10 days later to verify the first result. If the count was still in excess of 1000 copies/ml, a full risk assessment must be initiated to determine the risk of HCW to patient transmission. At a minimum, this will include discussion between the consultant OHP physician and the treating physician on the significance of the result to the risk of HIV transmission. Following a risk assessment exercise, a Patient Notification Exercise (PNE) may be conducted. UKAP advice may be sought at this stage. Training requirements All occupational immunisations and tests that are referred to within this policy are administered by qualified Occupational Health Staff who have received appropriate 12 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 information and training. Immunisations requirements will be covered as part of the individual’s pre-employment health screening by Occupational Health Service. 7. Policy review This policy will be reviewed by the OHS and IP&C team every 4 years or earlier to meet with national guidance 8. Associated trust documents Immunisation Policy SH HR 59 9. Supporting references Hepatitis B Infected HCW and Anti-Virals - Best Practice Guidance (DH 2007) Hep B infected HCW and anti-virals.pdf Hepatitis C Infected HCW – Best Practice Guidance (DH 2002) HSC 2002/010 Hep C infected healthcare workers.pdf Proforma for Testing Blood Samples DoH Health Clearance for Tuberculosis, Hepatitis B, Hepatitis C and HIV: New Healthcare Workers – Best Practice Guidance (DH 2007) Management of HIV infected Healthcare Workers who perform exposure prone procedures: updated guidance January 2014 (PHE 2014) Pre-emp clearance.pdf Management of HIV Infected HWC Practicing EPP_Interim Guidelines_January 2014[1 13 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 Appendix 1: Equality Impact Assessment The Equality Analysis is a written record that demonstrates that you have shown due regard to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations with respect to the characteristics protected by the Equality Act 2010. Stage 1: Screening Date of assessment: Name of person completing the assessment: Job title: Responsible department: 22.12.15 Jacky Hunt Infection Prevention and Control Occupational Health, Infection Prevention and Control and Human Resources Intended equality outcomes: Who was involved in the consultation of this document? OHS, HR, H&S Officer, IPC Group, Immunisations Group Please describe the positive and any potential negative impact of the policy on service users or staff. In the case of negative impact, please indicate any measures planned to mitigate against this by completing stage 2. Supporting Information can be found be following the link: www.legislation.gov.uk/ukpga/2010/15/contents Protected Characteristic Age Positive impact Disability Gender reassignment Marriage & civil partnership Pregnancy & maternity Risk assessments will be carried out by OHS Race Religion Sex Sexual orientation Negative impact No adverse impacts have been identified at this stage of screening No adverse impacts have been identified at this stage of screening No adverse impacts have been identified at this stage of screening No adverse impacts have been identified at this stage of screening No adverse impacts have been identified at this stage of screening No adverse impacts have been identified at this stage of screening No adverse impacts have been identified at this stage of screening No adverse impacts have been identified at this stage of screening No adverse impacts have been identified at this stage of screening Stage 2: Full impact assessment What is the impact? Mitigating actions Monitoring of actions 14 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016 Appendix 2 Appendix 3 Hepatitis B Infected HCW and Anti-Virals - Best Practice Guidance (DH 2007) Hepatitis C Infected HCW – Best Practice Guidance (DH 2002) Appendix 4 Proforma for Testing Blood Samples Appendix 5 DoH Health Clearance for Tuberculosis, Hepatitis B, Hepatitis C and HIV: New Healthcare Workers – Best Practice Guidance (DH 2007) Appendix 6 Management of HIV infected Healthcare Workers who perform exposure prone procedures: updated guidance January 2014 (PHE 2014) Hep B infected HCW and anti-virals.pdf Hep C infected healthcare workers.pdf Pre-emp clearance.pdf Management of HIV Infected HWC Practicing EPP_Interim Guideli 15 Exposure Prone Procedures (EPPs) and Blood Borne Viruses – Management of the Infected Healthcare Worker Version: 2 March 2016