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Infection Prevention and Control Assurance Standard Operating Procedure 27 (IPC SOP 27) Alert Conditions – Blood Borne Viruses [e.g. Hepatitis B and C, Human Immuno-deficiency Virus (HIV)] Why we have a procedure? To ensure employees of the Black Country Partnership NHS Foundation Trust have a standard procedure to follow when caring for patients known or at high risk of carrying blood borne viruses (BBVs), to minimise and manage the risks of transmission. The Health and Social Care Act 2008: Code of Practice for the NHS for the Prevention and Control of Healthcare Associated Infections (revised January 2015) stipulates that NHS bodies must, in relation to preventing and controlling the risk of Health Care Associated Infections (HCAI), have in place appropriate core policies/procedures. Implementation of this procedure will contribute to the achievement and compliance with the Act. What overarching policy the procedure links to? This procedure is supported by the Infection Prevention and Control Assurance Policy Which services of the trust does this apply to? Where is it in operation? Group Mental Health Services Learning Disabilities Services Children and Young People Services Inpatients Community Locations all all all Who does the procedure apply to? This document applies to all staff employed by or working on behalf of the Black Country Partnership NHS Foundation Trust caring for patients as part of their role and job description. When should the procedure be applied? Effective prevention and control of healthcare associated infection (HCAI) must be embedded into everyday practice and applied consistently. This procedure must be applied to reduce the risk of transmission of blood borne viruses. Additional Information/ Associated Documents Infection Prevention and Control Assurance Policy Hand Hygiene Policy Blood Borne Viruses Page 1 of 13 Version 1.0 July 2016 Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions Infection Prevention and Control Assurance - Standard Operating Procedure 2 (IPC SOP 2) - Transmission Based Precautions Infection Prevention and Control Assurance - Standard Operating Procedure 3 (IPC SOP 3) - Surveillance of Infection and Data Collection Infection Prevention and Control Assurance - Standard Operating Procedure 4 (IPC SOP 4) - Reporting Incidents of Infection to Public Health England and/or the Local Authority Infection Prevention and Control Assurance - Standard Operating Procedure 6 (IPC SOP 6) - Isolation – Care of Patients in Isolation due to Infection or Disease Infection Prevention and Control Assurance - Standard Operating Procedure 7 (IPC SOP 7) - Decontamination - Cleaning, Disinfection and Sterilisation Infection Prevention and Control Assurance - Standard Operating Procedure 9 (IPC SOP 9) - A-Z of Infections – A Quick Reference Guide Infection Prevention and Control Assurance - Standard Operating Procedure 14 (IPC SOP 14) - Undertaking a Patient Infection Risk Assessment Aims Preventing the spread of blood-borne viruses (BBVs) is a key public health issue; the Trust aims to reduce the risk of transmission by ensuring staff: Remain alert to the risks of individual patients who are known or suspected of carrying BBVs Aid diagnosis by sending appropriate specimens to the laboratory in a timely manner Ensure patients with BBV infection risk receive appropriate infection prevention and control related care and management, to reduce the risks of transmission and promote adherence to standard and transmission based precautions Administer appropriate treatment as/when indicated Inform other healthcare providers of the patients infectious status (but protecting the patients confidentiality), when any transfers of care are planned either internally within the Trust or to external care providers Report to Occupational Health all exposure incidents and refrain from undertaking any exposure-prone procedures if they are aware that they have or may have a BBV Definitions Contamination injury Exposure of mucous membranes or non-intact skin to blood or other body fluids or a human bite that causes bleeding or punctures the skin Healthcare Acquired Infection (HCAI) Healthcare associated infection (HCAI) refers to infections that occur as a result of contact with the healthcare system in its widest sense – from care provided in the patient’s own home, to general practice, hospital and nursing home care. Infection The presence of microorganisms on/in the body that is causing an adverse effect or host- response – the person is unwell and has signs and symptoms of an infection Infection prevention Processes to prevent and reduce to an acceptable minimum the risk of the acquisition of an infection amongst patients, healthcare workers and and control any others in the healthcare setting IPCT Blood Borne Viruses Infection Prevention and Control Team Page 2 of 13 Version 1.0 July 2016 Mucocutaneous Relating to the eye, mucous membranes of nose, mouth or non-intact skin Pathogenic A medical term that describes micro-organisms that can cause some kind of disease. Percutaneous The passage of substances through unbroken skin e.g. by needle puncture Risk Assessment A process used to identify any potential hazards and analyse what could happen, and to identify steps to be taken to reduce or minimise the risk. Sharps injury An exposure to blood or body fluids via a sharp implement What are Blood Borne Viruses (BBVs)? Human Immunodeficiency Virus (HIV), Hepatitis B (HBV) and Hepatitis C (HCV) are all blood borne viruses. These viruses can be transmitted when a needle or sharp object contaminated with infected blood or body fluid penetrates the skin in the health care setting. Blood Borne Viruses can also be found in other body fluids such as, urine, faeces, saliva, semen, sputum, sweat, tears and vomit. The risk is minimal unless they are contaminated with blood however care should still be taken as the presence of blood is not always obvious. Acquired Immuno-Deficiency Syndrome (AIDS): AIDS is the final stage of HIV infection, when your body can no longer fight life-threatening infections that is manifested by increased susceptibility to opportunistic infections and to certain rare cancers, especially Kaposi's sarcoma. With early diagnosis and effective treatment, most people with HIV will not go on to develop AIDS Human Immuno-deficiency Virus (HIV) – HIV is a virus that attacks the immune system, and weakens your ability to fight infections and disease a retrovirus that causes AIDS by infecting helper T cells of the immune system. The hallmark of HIV infection is the gradual loss of helper T-lymphocytes from an infected person, ultimately leading to a state of generalised immunodeficiency and AIDS. There are two types of human immunodeficiency virus, HIV-1 and HIV-2. HIV-1 is responsible for the large majority of global HIV infections and cases of AIDS, whilst the relatively less common HIV-2 is mainly restricted to West Africa Hepatitis B – An infection of the liver caused by a virus spread by infected blood (as in transfusions), contaminated hypodermic needles, sexual contact, or by contact with any other body fluid Hepatitis C – A virus that can infect the liver that is caused by an RNA virus is transmitted primarily by blood and blood products, as in blood transfusions or intravenous drug use, and sometimes through sexual contact Hepatitis D - The hepatitis D virus, previously known as the 'delta agent', is a defective virus, which can only infect and replicate in the presence of HBV Other viruses that cause hepatitis (such as hepatitis A and E) are not usually passed on by blood to blood contact and hence do not present a significant risk of blood-borne infection. A patient/carer information leaflet is available in Appendix 3. Blood Borne Viruses Page 3 of 13 Version 1.0 July 2016 What is the Risk of Transmission to a Healthcare Worker? Blood-borne viruses including HIV, Hepatitis B and Hepatitis C can be transmitted from patients to staff during health care procedures. The main risks are from transmission following: Percutaneous exposure to blood or body fluids from a needle stick injury or injury from a contaminated sharp object Mucocutaneous exposure to blood or body fluids (to the eye, mucous membranes of nose or mouth, or non-intact skin) Percutaneous exposure presents the highest risk and exposure to blood is more significant than exposure to other body fluids. Most cases of occupationally acquired HIV have followed injury from a hollow needle in association with a procedure where a needle or cannula is placed in a vein or artery. The risk of transmission to a susceptible healthcare worker from an infected patient following such an injury has been shown to be around: 1 in 3 when a source patient is infected with HBV and is `e' antigen positive 1 in 30 when the patient is infected with HCV 1 in 300 when the patient is infected with HIV There is no evidence that these infections can occur through social contact such as sharing telephones or other office equipment. The outcome of these infections depends on the particular virus: in the case of HIV, it can progress to Acquired Immuno-Deficiency Syndrome (AIDS). Hepatitis B and C infections may clear up completely or lead to a chronic carrier, which can progress to cirrhosis of the liver. BBV infections in psychiatric patients present the mental health services with a number of challenges. Firstly, it is important that patients with BBV infection receive the same standard of care as any other individual suffering from mental disorders. This means that mental health workers should be educated and trained to manage, treat and prevent BBVs. In addition, mental health workers should not display negative attitudes or have any fears when caring for HIV positive patients. These patients should be cared for in the normal way. The transmission of blood borne viruses, from patient-to-patient, or patient to health care workers can have serious consequences not only for the person infected but also for the Trust because of health and safety legislation. In spite of guidance and education, many health care workers continue to be exposed to blood borne viruses from needlestick, sharp injuries and mucosal exposure. Drug users and residents of long term institutions and those certain occupational groups have a higher risk of infection. Hepatitis B is a preventable disease and the Department of Health recommends that staff at risk should be vaccinated. This Trust encourages both staff and patients to be immunised against Hepatitis B. Blood Borne Viruses Page 4 of 13 Version 1.0 July 2016 Body Fluids that may Transmit Blood Borne Viruses Blood Peritoneal fluid Cerebrospinal fluid Pericardial fluid Pleural fluid Synovial fluid Breast milk Semen Amniotic fluid Other bodily fluids containing blood Vaginal secretions Urine, faeces, saliva, sputum, tears, sweat and vomit, present a minimal risk of blood-borne virus infection unless they are contaminated with blood. However, they may be hazardous for other reasons. There is good evidence that taking appropriate prophylaxis after an accidental exposure to infected blood reduces the risk of being infected. N.B. in the event of a contamination incident e.g. needlestick etc. refer to Infection Prevention and Control Assurance – Standard Operating Procedure 8 - IPC SOP 8 - Sharps or Body Fluid Contamination Injury. Key Points to Minimise the Risks of Infection The best way of preventing transmission is to apply precautions to prevent exposure to body fluids whether the patient is known to be infectious or not. Precautions should be based on the likelihood of exposure to body fluid rather than the expected infectious status of the patient. This approach is referred to as “Standard Precautions” [see Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP 1) - Standard Infection Control Precautions]. The risk of transmission of a blood-borne virus from patient to health care worker is generally far greater than the risk of transmission from health care worker to patient. However, the safety of the patient is paramount and the Trust and its employees have a responsibility to protect patients from the risk of infection. In general terms, reducing the risk of transmission to staff will also reduce the risk to patients. Standard Precautions must be used for all patients, regardless of known infection, when there is a risk of exposure to bodily fluids. This negates the need for special procedures when the client is known to be infected with a BBV. Isolation is not normally required unless the patient poses a risk to others through antisocial or inappropriate behaviour with regards to body fluids – patient centred advice can be sought from the IPCT. Care should never be omitted or withheld solely because a client has or is suspected of having a BBV. Effective hand washing is the single most important factor in preventing infection. Use the soap provided, wash all areas of the hands, rinse thoroughly and dry with paper towels. (See Hand Hygiene Policy) Exercise great care with all sharps to prevent puncture wounds, cuts or abrasions disposing of used sharps correctly and immediately after use Protect existing wounds, skin rashes or lesions, conjunctivae and mucosal surfaces from all blood and body fluids. When the use of sharps, is essential, exercise particular care in handling and disposal of same Blood Borne Viruses Page 5 of 13 Version 1.0 July 2016 Only use approved sharps containers. Never put needles or other sharps into hazardous or household waste bags Never re-sheath needles Control surface contamination by blood or body fluids by containment and disinfection by dealing with spillages promptly [see Infection Prevention and Control Assurance Standard Operating Procedure 7 (IPC SOP 7) - Decontamination - Cleaning, Disinfection and Sterilisation] Managers must: Ensure that a risk assessment is carried out with all BBV hazards identified, deciding who might be harmed and how likely it is that BBVs could cause ill health at work Determine if existing precautions are adequate or whether more should be done give employees adequate information, instruction and training on any risks to their health from BBVs at work Record the findings of the risk assessment Review the adequacy of control of BBVs on a regular basis Record incidents involving exposure to blood and other body fluids, and report where required Personal Protective Equipment (PPE) for Care of Patients with Known or Suspected BBVs When anticipated exposure to blood/body fluids PPE Hand Hygiene Gloves Long-sleeved gown Risk assessment Surgical face mask Risk assessment Eye protection Risk assessment Plastic apron (risk of aerosol/splash) (risk of aerosol/splash) (risk of aerosol/splash) N.B. Hand hygiene MUST always take place after removal of personal protective equipment. Environmental cleaning is vitally important in preventing the spread of infection, the cleaning regime incudes the standard daily clean. In the presence of blood spillage this must be decontaminated immediately and correctly using 10,000 PPM available chlorine releasing agent [see Infection Prevention and Control Assurance - Standard Operating Procedure 7 (IPC SOP 7) - Decontamination - Cleaning, Disinfection and Sterilisation]. Healthcare workers infected with BBV All health care 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 HIV infection laid down by their regulatory bodies Any health care worker who has any reason to believe that they may be infected with any blood-borne virus must promptly seek medical advice on the need for testing [See Infection Prevention and Control Assurance – Standard Operating Procedure 8 IPC SOP 8 - Sharps or Body Fluid Contamination Injury] Any health care worker who is infected with a blood-borne virus must cease exposure prone procedures immediately and seek advice from the Occupational Health Service whether they are being treated by another doctor or not. They must not rely on their Blood Borne Viruses Page 6 of 13 Version 1.0 July 2016 own assessment of the risk that they pose to patients. Their confidentiality will be protected by the Occupational Health Service Health care workers infected with a blood-borne virus who continue to provide clinical care must remain under regular Occupational Health supervision so they may receive appropriate occupational advice if circumstances change. This is particularly important in the case of HIV-infected workers Infected health care workers who are appointed to new posts within or outside the Trust should complete health questionnaires honestly Incident Reporting, Investigation and Action Plans All staff are responsible for reporting any incident or near miss in relation to an blood/body fluid exposure incident testing [See Infection Prevention and Control Assurance – Standard Operating Procedure 8 - IPC SOP 8 - Sharps or Body Fluid Contamination Injury] If a health care worker believes that they have, or may have performed, exposure - prone procedures while infected with a blood-borne virus they, or their representative must inform the Director of Public Health (Public Health England, Midlands and East) as soon as possible, on a strictly confidential basis. Phone: 0344 225 3560 option 2 then option 3. Out of hours for health professionals only: please phone 01384 679 031 The Medical Director of the Trust should also be informed, with the consent of the health care worker. In these circumstances everything possible will be done to protect the confidentiality of the health care worker and their family. If consent is not given further consultation will be required Managers are responsible for ensuring that a suitable investigation is carried out according to the consequence of the incident and action plans are created and carried out in a suitable time frame. The ward or team manager is also responsible for ensuring that the Datix report contains a full history of the process followed on each occasion and the eventual outcome Managers are responsible for ensuring that incidents are investigated promptly, within the timescales given in the Trusts standard reporting procedures Where do I go for further advice or information? Infection Prevention and Control Team Physical Health Matron Your Service Manager, Matron, General Manager, Head of Nursing, Group Director Your Group Governance Staff Occupational Health Department (SWBH) Training Staff may receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust’s Mandatory and Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies. Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment Please refer to overarching policy Data Protection Act and Freedom of Information Act Please refer to overarching policy. Blood Borne Viruses Page 7 of 13 Version 1.0 July 2016 Appendix 1 Protocol for the Employment of Staff in Relation to Blood Borne Viruses (BBVs) General The Trust will adhere to the requirements of the Disability Discrimination Act. In practice this means the Trust will not discriminate against any applicant for a job solely on the ground that a person is infectious with a blood-borne virus Appointed staff that are, or may be infectious with a blood-borne virus, must be assessed by the Occupational Health Service prior to appointment to assess if they may pose a risk to patients, and if so advise whether modification to work may avoid this risk. It should be recognised that applicants who are infectious with a blood-borne virus will not normally be able to undertake work involving exposure-prone procedures Any existing employee found to be infectious with a blood-borne virus will be offered advice and support from the Occupational Health Service. Where they are unable to continue with their normal employment advice on modification of their work, retraining or redeployment will be recommended by the Occupational Health Service who can seek advice from the UK Advisory Panel for Health Care Workers Infected with Blood-borne Viruses. The health care worker’s confidentiality will be maintained by the Occupational Health Service Hepatitis B All employees who will, or may be expected to undertake exposure-prone procedures, must provide suitable documentary evidence of their Hepatitis B immunity status, or submit to a blood test taken by a doctor or nurse of the Occupational Health Service, to determine their immune status before being accepted as fit for work. See Appendix 1 and 2 for further information Any blood samples for the purpose of establishing immunity status for exposure-prone procedure work must be taken by the staff of the Occupational Health Service who may ask for confirmation of identity of the applicant. Testing will follow national guidelines Any employee who is deemed to be infectious for Hepatitis B will not be permitted to undertake exposure-prone procedures. This will include individuals who are Hepatitis B e-antigen positive. Individuals who are Hepatitis e-antigen negative but surface antigen positive will be considered on an individual basis taking into account current advice of the Department of Health All new staff not previously vaccinated, who may be exposed to blood or body fluids, will be offered Hepatitis B vaccination according to the Occupational Health Service procedure, which is based on national guidelines Any member of staff who has been associated with the transmission of Hepatitis B to a patient will not be allowed to continue exposure-prone procedures Hepatitis C At present there are no national guidelines on the employment of healthcare workers with Hepatitis C. All appointed staff who have evidence of Hepatitis C infection will be assessed on an individual basis by the Occupational Health Service before a decision is made on fitness for work. See Appendix 1 and 2 for further information Any member of staff who has been associated with the transmission of Hepatitis C to a patient will not be allowed to continue exposure-prone procedures Blood Borne Viruses Page 8 of 13 Version 1.0 July 2016 HIV Applicants who are infectious with HIV will be considered on an individual basis but will not be allowed to enter jobs where exposure-prone procedures are required. See Appendix 1 and 2 for further information Any member of staff who has been associated with the transmission of HIV to a patient will not be allowed to continue exposure-prone procedures Practical Guidance on Notifying Patients in Relation to a BBV Infected Healthcare Worker In the event of an infected healthcare worker in direct contact with patients being identified, the Medical Director will immediately inform the Director of Public Health or Consultant in Communicable Diseases Control at the local Public Health England (PHE) area office. Thereafter, the plan for notifying patients exposed to an infected healthcare worker by PHE will be followed – this will be led by PHE. Blood Borne Viruses Page 9 of 13 Version 1.0 July 2016 Appendix 2 Compensation for Occupationally Infected Healthcare Workers National Health Service Injury Benefits Scheme The NHS Injury Benefits Scheme provides temporary or permanent benefits for all NHS employees who lose remuneration because of an injury or disease attributable to their NHS employment. The scheme is also available to medical and dental practitioners. Under the terms of the scheme it must be established that the injury or disease was acquired during the course of work. Blood-borne disease cases will be treated no differently. The scheme administrators would deal sympathetically with applications but work-related infection would have to be established. A record of a specific injury and evidence of zero-conversion are not regarded as essential but would be helpful in proving causation. Any health care worker who suspects contamination of blood-borne disease infected patient is encouraged to have serum sample taken at the time of injury for storage and possible future testing and follow-up samples at appropriate intervals. Each claim would be considered on its merit. The administrators would look carefully at the circumstances surrounding the claim, taking note of the duties undertaken in the employment and claimant’s description of how he or she thought the infection was contracted and the medical evidence available. There would be no intrusive enquiries into personal lifestyle and relationships. The Department’s medical advisers would then consider all the information against the ways in which infection may be contracted. Where doubts existed, further expert medical opinion would be sought and the claimant referred to a consultant specialising in blood-borne diseases who would be asked to determine on balance of probability whether it was more likely than not that the infection had been acquired in the course of NHS employment. Injury benefits are payable to infected workers, whether symptomatic or not, and are intended to compensate for loss of earning ability. For those having to give up their employment the scheme provides a guaranteed income of up to 85% of pre-injury NHS earnings. The benefits are index linked. Temporary allowances are taxable but the permanent allowance payable on retirement from service is not. If employment has to be terminated because of the relevant injury or disease, a lump sum is also payable and where death occurs dependants’ benefits are payable. Further information is available on the web site: http://www.nhsbsa.nhs.uk/InjuryBenefitScheme.aspx Blood Borne Viruses Page 10 of 13 Version 1.0 July 2016 Appendix 3 Sometimes patients are asked to have a test because a healthcare worker has been exposed to the patients’ blood or body fluid, for example following a needlestick injury – this is routine following this type of incident. Issue Date: XXX Ref.No: XXX Patients and visitors all have an important role to play in preventing the spread of infection. Remember good hand hygiene at all times especially when: entering and leaving the hospital, ward or department before eating and drinking after using the toilet, changing nappies or pads after having a cigarette after touching your pet e.g. any animal, reptile, bird or fish Information for patients and carers Department: XXX Infection prevention and control is everyone’s responsibility. Blood Borne Viruses Author: XXX Is there a vaccine for BBV infection? A vaccine for HBV is available to protect anyone who is at increased risk of infection. There is currently no vaccine for HCV or HIV infection. Review Date: XXX Is there any treatment for BBV? Yes medications are available that can treat BBV’s with good results for many patients. New treatments are continually being developed. If you require further advice or information, please contact the Trust’s Infection Prevention and Control Team or a member of the ward / department staff. Blood Borne Viruses Page 11 of 13 Version 1.0 July 2016 How long does it take for symptoms to appear? For HBV infection it is usually about 11 weeks, but can be as long as 7 months. For HCV infection it is usually about 10 weeks, but can be as long as 6 months. Mild flu like symptoms can develop 2-6 weeks after infection with HIV, it may be years before further symptoms then develop. How do you know you have a BBV? A blood test can check for HIV, HBV or HCV infection. Each virus has its own blood tests that tell us different things about the infections. HIV - The first test is an antibody test detecting the body’s immune reaction to the virus. If this test for HIV is positive it means that you are infected with the virus. Other tests called the CD4 count and the viral load will be then taken to see if the immune system has been damaged yet and how much virus is in the blood. Hepatitis C - The first test is also an antibody test. If this is positive another test (PCR or viral load) is carried out to see if the virus is still present in the body. Up to 80% of infected people can become long term carriers of this virus with risk of liver damage. Hepatitis B - A blood test works out if there is an ongoing infection. This can also show if the person has fought off the infection and is now protected against future Hepatitis B infection. Some of these viruses take 3-6 months to show up in the blood – if you have been at risk during this time you may be advised to get a repeat test even if your first result is negative. If you put yourself at risk again you should consider having a further test. Why have a test? All three viruses can cause serious illness and death after a long infection. In the early stages many people feel well and do not realise that they are infected. There is now treatment for Hepatitis B and C that can often cure the infection, and treatment for HIV that can control it. The treatments can be difficult to take and can have side-effects. For HIV, treatment will be lifelong but treatments are improving all the time. Knowing about an infection allows you to protect your health – for example by stopping drinking alcohol if you have Hepatitis B or C. You can also protect others from getting the infection from you, by avoiding unsafe sex and not sharing injecting equipment. Women can also make choices about pregnancy and protecting their unborn child from HIV and Hepatitis B. Blood Borne Viruses Page 12 of 13 What is a Blood-borne virus? Blood-borne viruses (BBVs) are viruses that can be carried in the blood and can spread from one person to another through blood and other body fluids. The most common BBVs are Hepatitis C virus (HCV), Hepatitis B virus (HBV), and Human Immunodeficiency Virus (HIV). How common are BBVs? They are not very common. About 4 in every 1,000 people in the UK may be Hepatitis C carriers and around 3 people in every 1,000 may be Hepatitis B carriers. About 1 in every 1,000 people may be HIV carriers. How are BBVs spread? BBVs are spread when the blood or body fluids from an infected person gets into the bloodstream of another person. They are passed between people through: unprotected sex heterosexual or homosexual from mother to baby, before or during birth. sharing of any injecting equipment including needles, syringes, spoons, filters and water when injecting drugs blood to blood contact from an infected person e.g. in a fight unsterile medical treatment unsterile body piercing or tattoos HIV and Hepatitis B are more common in men who have sex with men and in people who have lived abroad, especially in Southern Africa, the Far East and Eastern Europe. Hepatitis C is common in drug users who have ever injected. Hepatitis C is less likely to be transmitted through sex. Blood-borne viruses cannot be spread through normal day-to-day things like holding hands, coughing, sneezing, sharing toilets, or using crockery and kitchen utensils. What are the symptoms of BBVs? People who have HBV or HCV infection may have little or no symptoms, others may experience symptoms which include tiredness, abdominal pain nausea, vomiting and jaundice (a condition in which the whites of the eyes go yellow and in more severe cases the skin also turns yellow). People who have HIV infection can experience flu like illness 2-6 weeks after being infected. These symptoms disappear after about 2 weeks and HIV may not cause any symptoms for many years. However the virus continues to be active and causes progressive damage to the immune system. Version 1.0 July 2016 Standard Operating Procedure Details Unique Identifier for this SOP is BCPFT-COI-POL-05-27 State if SOP is New or Revised New Policy Category Control of Infection Executive Director whose portfolio this SOP comes under Policy Lead/Author Job titles only Committee/Group Responsible for Approval of this SOP Executive Director of Nursing, AHPs and Governance Infection Prevention and Control Team Infection Prevention and Control Committee Month/year consultation process completed June 2016 Month/year SOP was approved July 2016 Next review due July 2019 Disclosure Status ‘B’ can be disclosed to patients and the public Review and Amendment History Version 1.0 Date July 2016 Blood Borne Viruses Description of Change New Procedure established to supplement Infection Control Assurance Policy Page 13 of 13 Version 1.0 July 2016