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Specification for a Locally Enhanced Service Pilot Pharmacy Flu Vaccination Introduction This specification outlines a pilot locally enhanced service for flu vaccination for community pharmacy Aims of the service To provide another point of access for patients to obtain ‘flu vaccination To extend the hours during which patients can access influenza vaccination To educate and inform patients about ‘flu vaccination and the signs and symptoms of the illness, highlighting preventative measures to reduce the spread of the illness To increase the number of patients vaccinated against influenza. To reduce the spread of influenza and reduce mortality from it. To reduce episodes of secondary care for complications e.g. respiratory infections 1. Scope of the service to be provided This service is to be offered to all eligible patients defined as ‘at risk’. Patients should only be accepted into the service if the pharmacist is satisfied of the patient’s suitability as outlined Based on the advice of the Joint Committee on Vaccination and Immunization (JCVI), the current at-risk groups are: (i) those of all ages with: (a) chronic respiratory disease, including asthma (b) chronic heart disease (c) chronic renal disease (d) immunosuppression due to disease or treatment (e) diabetes mellitus (ii) those aged 65 and over (iii) those living in long-stay residential and nursing homes or other long-stay facilities. The pharmacist must ensure that an eligible patient is suitable before carrying out vaccination. For the purposes of this LES Pharmacists will be vaccinating only those who are 18 and over. There are some groups for whom it may not be appropriate to vaccinate. There may be many reasons, including that they have already been vaccinated or currently suffering an acute infectious illness. Table 1 Patient exclusion criteria Patient group Patient already vaccinated in current vaccination period (Sept-March) Patient under 18 years Recommended advice Re-assure patient that they are already protected. Patient who is pregnant Patient who is currently suffering a febrile illness or acute infection Patient with history of severe local or general reaction to the vaccine Patient with hypersensitivity to egg products, chicken protein or other constituents of the vaccine. refer to GP Advise patient to return when recovered The Pharmacy service is not available to under 18s. If presented with a baby or young person at risk of influenza, refer to GP Refer to GP practice Refer to GP practice Which patient’s individual service providers target for immunisation will be a matter for negotiation between the service provider, their local GP practices and the PCT, depending on the needs of the local population. The pharmacist must establish that the patient is eligible by taking the patient through the inclusion criteria in the patient leaflet. Once satisfied that the patient is eligible, and then the Pharmacist must establish whether a flu vaccination from the participating pharmacy is the most suitable option by taking the patient through the exclusion criteria in the patient leaflet. If a patient ordinarily has, or is planning to have their flu vaccination at their GP, advise the patient that they should still have it at their GP, unless they prefer to have it in the pharmacy. Follow the flow chart in appendix 4 to determine each patient’s route to vaccination 2. Eligibility of the Service provider The vaccination can only be provided by an accredited pharmacist, working for the service provider, and who has completed the training. All individuals requesting an influenza vaccination should be referred to the trained pharmacist who will carry out an assessment and vaccination, if appropriate, following the agreed patient group direction. The pharmacist will ensure that all members of pharmacy staff are trained on the operation of the scheme & full details will be made available to locum pharmacists. 2.1 Training In order to complete immunisation training, the trainee needs to be on a professional register. The PCT will provide practical and theoretical training which will provide an overview of intra-muscular injection, including: Needle length and needle bevel – research findings on the significance of this; Body mass and choice of needle length; Intramuscular sites and the rationale for this choice; How to administer an intramuscular injection.: including patient assessment, side effects and contraindications to influenza administration; Anaphylaxis – recognition and treatment. Pharmacists wishing to provide this service must have successfully completed the training course provided by the PCT. Pharmacists will then be accredited as approved practitioners for providing this service. Pharmacists should maintain clinical knowledge appropriate to their practise by attending relevant study days, courses and to make themselves aware of appropriate literature. This must include having basic life support and anaphylaxis training on an annual basis if they are administering vaccinations Pharmacists will provide evidence of appropriate CPD based on their training needs assessment, to the Pharmacy team by the end of each financial year. 2.2 Pharmacist Training All pharmacists will be required to have completed training to cover the National Minimum Standards for Immunisation Training, as specified by the Health Protection Agency or similar. They will also be required to demonstrate their clinical and professional competence through the maintenance of relevant CPD records. All pharmacists will be trained on how to operate the system and will commit to train all relevant staff members, including locum pharmacists, on the mechanics of the scheme. All pharmacists will maintain a record of the names of trained, competent staff, who can take part in the scheme. This will be maintained as part of the Standard Operating Procedure. 2.3 Staff Training All staff should be advised by the accredited Pharmacist of the workings of the scheme by their pharmacist. Staff should be clear about the scheme, which patients are in the at risk categories and the purpose of flu vaccinations. This can be achieved by asking them to read through the supplied information leaflet. Useful information about the National flu campaign can be seen here: http://www.immunisation.nhs.uk/Vaccines/Flu Staff will only work within their own levels of competence and will have clear guidelines on the referral procedures for any cases outwith their competence 2.4. Premises The service can only be provided in an approved pharmacy, which must have a suitable area for consultation with the patient. This must be a quiet area within the shop where it is cordoned off and not be accessible to other members of the public. Ideally this should be a consultation area, as sued for MUR. This area must be clear of any items placed there for storage this area must have impermeable flooring for Health and safety reasons. This area must have a chair for patients to sit in following the flu jab; it must likewise have impermeable seating, which is able to tolerate a chlorine releasing agent for disinfection purposes. This area must also have facilities for patients to be able to lie down in the event of a simple faint or an anaphylactic reaction There will need to be dedicated hand washing facilities on the premises with liquid soap and disposable paper towels in a wall mounted paper towel dispenser and foot operated pedal bin. Ideally this should be in the consultation area. Where it is not, infection control procedures and hand hygiene procedures must be followed rigorously The Pharmacy will need to have vomit bowls available in the vaccination area. The Pharmacy will also need to have a sharps bin and a sharps collection procedure in place.1 3. Clinical Governance Pharmacies providing the service in Leicester will comply with the national clinical governance requirements as described in the National Health Service Pharmacy Regulations 2005. The pharmacist and staff with the pharmacy should be trained to deal with cases of anaphylactic shock and always have adrenaline (Epinephrine) immediately available. The PCT will supply these for participating pharmacies. The Pharmacist must explain the service to the patient at the outset. The pharmacist must explain any potential side effects to the patient and what to do if they do develop any. The pharmacist will stress the need and reasons for the patient to remain in the pharmacy for 15 minutes after the vaccination. Following administration of the influenza vaccination the pharmacist will ensure that the GP is made aware it has been given to the patient, within 24 working hours of vaccination. See Appendix (1) In the event of an adverse incident or near miss, the pharmacist will fill in an incident reporting form and forward a copy to the PCT. (See appendix 2) The pharmacy will also need to have in place the following SOP’s: Infection control Sharps disposal Flu immunisation procedures CPR policy anaphylaxis2 All patients who wish to receive a flu vaccination in a pharmacy must be informed of their right to a chaperone. The patient has a right to bring a third party with them for the vaccination. 4. Patient confidentiality Pharmacists should ensure full patient confidentiality and compliance with data protection requirements Medicines, Ethics and Practice - A Guide for Pharmacists. No 29. July 2005; Code of Ethics and Professional Standards: Part 2: Standards of Professional Performance, Section C: Confidentiality 1 2 This can be facilitated by the PCT on request. An anaphylaxis procedure is included in the PGD which will be available on 16/10/08 “The public expects pharmacists and their staff to respect and protect confidentiality. This duty extends to any information relating to an individual, which pharmacists or their staff acquire in the course of their professional activities. Confidential information includes personal details and medication, both prescribed and not prescribed.” The General Medical Council (GMC) has also issued a statement about the duty of confidentiality: “Patients are entitled to expect that the information about themselves or others, which a doctor learns during the course of a medical consultation, investigation or treatment, will remain confidential. Any explicit request by a patient that information should not be disclosed to particular people, or indeed to any third party, must be respected save in the most exceptional circumstances, for example where the health, safety or welfare of the patient or someone other than the patient would otherwise be at serious risk.” The patient must be asked to sign the declaration form that they consent to information being sent to their GP. The service is to be refused without this consent. 5. Health and Safety All bodily fluids should be regarded as potentially infectious as it is not always possible to identify people with infections. Anyone who comes into contact with blood and bodily fluids may be exposed to pathogens including blood borne viruses such as HIV, hepatitis B and hepatitis C (see appendix 3 for further information). Blood borne infections can be transmitted through any sharps injury or needle stick injury. Blood borne infections can also be transmitted through contact with broken skin or mucous membranes. All staff involved in the vaccinations must have access to, and use, Personal protective Equipment3 When carrying out vaccination in the pharmacy there is a risk of exposure to blood from the patient. The pharmacist carrying out the vaccination should adhere to the following points in order to minimise the risk of infection from blood borne viruses: 3 Any cuts or abrasions on exposed skins should be covered with a waterproof dressing Hands must be washed with liquid soap (rather than bactericidal soap) soap and water and dried with disposable paper towels and disposed of into a footoperated pedal bin o After removing gloves o Between patient contacts o After any contact with blood or other bodily fluids o Before handling food or drinks. As per Pharmacy Contract Essential service 3.7 Vaccination against hepatitis B is advised, in line with current NHS recommendations for all staff involved in delivering this service If blood is accidentally spilled onto any surface, it should be cleaned immediately In clinical areas it is the responsibility of staff to ensure that spillages of blood, vomit, urine, faeces and other body fluids are cleaned up immediately and effectively. . It is vital that all staff take all reasonable precautions to protect themselves and patients from transmission of infections. In non-clinical areas – responsibility of domestics who have undergone an appropriate level of training. Blood Spillage ALL spilled blood or blood stained body fluids should be regarded as potentially infectious, and should be treated accordingly. When treating a spillage, staff must wear disposable non-powdered latex gloves and a disposable plastic apron. Eye/face protection is required if there is a risk of splashing. (a) Minor spillages: Drips or splashes of blood on inanimate surfaces should be wiped up using a paper towel soaked with sodium hypochlorite 1% (10,000 ppm) or Milton solution. Wipe surface with a paper towel soaked in detergent and water. Rinse and dry. Dispose of used apron, gloves, and paper towels in a yellow clinical waste bag. (b) Major spillages: More extensive spillages of blood must be treated with absorbent, chlorinereleasing granules. Because free chlorine gas is released during the inactivation process, windows should be opened to ensure adequate ventilation; if the spillage is in a confined, poorly ventilated area, staff and patients (where possible) should not remain in the vicinity of the spillage during the inactivation process. Granules should be sprinkled evenly over the spillage until the whole surface is covered, leave undisturbed for 2 minutes. If any areas of liquid blood remain after this period, more granules should be applied and left for a further 2 minutes, to ensure complete disinfection. Once all liquid blood has been absorbed, the granule mass can be scooped up and placed together with the scoop and spatula in a yellow clinical waste bag. Wipe surface with a paper towel soaked in sodium hypochlorite 1% (10,000 ppm) or Milton solution. Wipe surface with a paper towel soaked in detergent and water. Rinse and dry. Dispose of used apron, gloves, and paper towels in a yellow clinical waste bag. The granules will ensure that the active disinfecting agent comes into contact with any micro organisms throughout the spillage and will also limit the spread of liquid blood. Attempts to treat significant volumes of blood with a conventional solution will merely spread the spillage, without achieving homogenous mixing and effective disinfection. Blood Spillage on Absorbent Surfaces (Carpets/Soft Furnishings) If using chlorine-releasing granules on carpets eye protection and facemask must be worn to protect against granules being propelled into the face when being scraped from the carpet surface. Disposable non-powdered latex gloves and a plastic apron must be worn. If blood is splashed or spilled onto soft furnishings sodium hypochlorite 1% (10,000 ppm) or Milton solution must be used, relying on the absorbent nature of the surface to achieve contact between the blood and disinfecting agent. After allowing at least two minutes contact time, the spillage should be cleaned up using neutral detergent and hot water. Gloves, apron and all paper towels, J-cloths etc., must be discarded into a yellow clinical waste bag for incineration. If blood is spilled onto clothes, treat as infected linen. Blood Spilled on Staff (a) On intact skin. The spilled blood should be washed off with copious warm water and liquid soap, paying particular attention to the fingernails. No further action is necessary. (b) On broken skin. The spilled blood should be washed off with copious warm water and soap. The incident must then be reported. Follow the PCT Management of Exposure to Blood Borne Virus Policy. (See appendix 3) (c) On mucous membrane. Splashes of blood or body fluids entering the eye should be removed by immediate irrigation. Ideally sterile saline "eye-wash" packs should be used if available, but if not, running mains water (drinking water) can be used instead. Irrigation should be continued until all traces of the contaminating material have been removed. The incident must then be reported. Follow the PCT Management of Exposure to Blood Borne Virus Policy. Body Fluid Spillage At the present time, the risk of blood-borne virus transmission through body fluids other than blood is low. Following spillages of non-blood stained urine, faeces, vomit or sputum: Wearing gloves and disposable plastic apron, all traces of body fluid/solid should be removed with a paper towel. The area should then be cleaned with neutral detergent and hot water then wiped with sodium hypochlorite 1% (10,000 ppm) or Milton solution, rinsed and dried or use Chlorclean. All sharps e.g. lancets and all waste contaminated with blood or bodily fluids must be disposed of into a sharps container at the point of use. Care must be taken when using and disposing of all sharps, and sharps should not be ‘re- sheathed’. Ideally all clinical waste should be disposed in front of the patient in order to reassure them that the pharmacy is taking all measures to minimise the risk of contamination and potential infection. In the event of a sharps injury, bleeding from the wound should be encouraged. Do not rub or suck the wound. The wound area should be thoroughly washed with liquid soap and water, dried using paper towels and then covered with a waterproof dressing. Ring your GP or the Infectious diseases unit at LRI The pharmacy should have an agreement in place for the provision of sharps bins and the regular collection of sharps and clinical waste It is a legal requirement to sign a consignment note for all sharps waste that is collected from the pharmacy. All consignment notes must be retained at the pharmacy and this documentation kept for at least 3 years. Staff must be briefed and be aware of what to do should a patient vomit or faint following vaccination and there should be a corresponding guideline or SOP. 6. Record keeping Service providers must keep records of who has been immunised. Ideally computerised records should be kept. Client records must be kept by the accredited pharmacy for 8 years. To minimise the risk of patients receiving double immunisation, service providers must ensure that details of who has been immunised are returned to the patient’s GP within 24 hours (or by the next working day if patients are immunised on Friday or Saturday, or on bank holiday weekends). A template letter for sending to the patients GP practice is attached in appendix one. 7. Payments Service providers will receive a fee of £7.51 per vaccination. In addition the cost of all used vaccines will be reimbursed at drug tarrif cost. Reimbursement will be dependent on submission of completed claims forms to the PCT. The GP letter in appendix one is to be submitted as the claim form to the PCT Pharmacy team, Directorate of Primary and Community Care, 4th Floor St Johns House, 30 East Street, Leicester, LE1 6NB. 8. Termination of Service Either party may terminate this agreement by providing written notification of their intention to do so. A notice period of 28 days shall be given. 9. Duration of pilot The terms above apply the pilot for the duration of Flu vaccination season 2008/9. After this point, any or all of the above points will be changed following evaluation by the PCT and Community Pharmacies Specification for a Locally Enhanced Service Pilot Pharmacy Flu Vaccination Appendix 1: Letter to inform GP practice of flu vaccination Pharmacy stamp Dear Practice The above pharmacy is one of a number participating in Leicester City PCTs Flu vaccination pilot. This letter is to inform you that your patient (s) received an influenza vaccination on at this pharmacy as detailed below. Could you please record this in their patient details ? Name D.o.B. Yours sincerely 4 LR = Left arm, RR = Right arm Vaccination location4 Date of vaccination Vaccine batch number Vaccine manuf Specification for a Locally Enhanced Service Pilot Pharmacy Flu Vaccination Appendix 2: Incident reporting form Datix ID No.: IRF 1/C Note: 1. To be used only by Independent Contractors reporting incidents 2. Please forward to Incidents Team when complete Section 1: Details of Practice/Organisation reporting the incident (complete as appropriate) Title: Mr / Mrs / Miss / Ms / Dr First Name: Practice/Organisation Address: (Site/premises – full address) Surname: Postcode: Person Affected: Male/Female Status: PCT Employee Disability Yes / No /Not known Patient Relative/Carer Contact number: Ethnic Group: (Please use codes provided) Visitor Independent Contractor or staff Section 2: Incident Information Date of incident (dd / mm / yyyy): Date incident reported (dd / mm / yyyy): Location Type (e.g. Health Centre, patient’s home): Location Address: Time (24 hour clock): Reported to whom: Postcode: Exact Location (e.g. treatment room, reception etc): Section 3: Type of Incident Patient Safety Incident Clinical Non-Clinical Health & Safety Near Miss Yes No Nature of Incident (Tick all that apply): Accidental Injury (incl. manual handling, slips, trips & falls Communication Damage, loss, theft, fire, security Needlestick Violence, aggression, harassment (verbal or physical) Staffing issues Work related ill health Other clinical incident inc. discharge Records management, consent & confidentiality Road Traffic Accident Research Other (describe below) Equipment failure, malfunction or availability. Please state manufacturer, model & serial number: ………………………………………………………………………………………………………………. Type of error: Prescribing Administration Supply Other (please specify) Name and dose of drug administered: Medication error Section 4: Incident details Please state clearly the facts of what happened (not opinion). Include detail of equipment involved, description of injuries (part of body affected), etc. Section 5: Details of Immediate Action Taken / proposed action(s) following incident Detail of action(s) undertaken or to be taken and timescales: If Police informed Incident No. …………….. Section 6: Details of Immediate Action Taken following injury / risk of injury (where applicable): Was injured party taken to / treated by (please tick): First Aider: Accident and Emergency: Ambulance Service / paramedics Treatment given on site: Treatment / advice provided: No treatment given / treatment not required: Treatment offered but declined: Other details: Reason(s) for no treatment: Reason(s): Section 7: Learning Outcomes following incident What advice would you give to professional colleagues to avoid a repeat of this scenario in their organisation? Section 8: Signature of person completing sections 1 - 7: Date: Details of person completing sections 1 – 7 (If not the person in Section 1) Title: Mr / Mrs / Miss / Ms / Dr First Name: Surname: Address and Postcode: (for staff – work base address) Contact number: Job title: (for PCT and Independent Contractor staff) Reported to at time of incident (state name and post): Please return completed forms to: Incident Reporting Team (Quality Directorate) Leicester City PCT St John’s House 30 East Street, Leicester LE1 6NB. Tel: 0116 2958478 Fax: 0116 2958490 Specification for a Locally Enhanced Service Pilot Pharmacy Flu Vaccination Appendix 3: Blood borne virus process PROVIDER SERVICES GUIDELINES FOR THE MANAGEMENT OF PATIENTS WITH BLOOD BORNE INFECTIONS IN INPATIENT AREAS Reference: NP 0175 Version: Ratified by: Public Health Date ratified: 31st October 2006 Name of originator/author: Karen Smith; PCT Infection Control lead Name of responsible committee/individual: Debbie Poole Clinical Governance Committee Date issued: Review date: 31st October 2008 Target audience: All Provider Staff Final Sign off Paul Miller Chief Operating Officer This policy can only be considered valid when viewed via the Leicester City PCT intranet. If this document is printed into hard copy or saved to another location, you must check that the version number on your copy matches that of the one online. GUIDELINES FOR THE MANAGEMENT OF PATIENTS WITH BLOOD BORNE INFECTIONS IN INPATIENT AREAS Index Page No 1.0 Introduction 2 2.0 Scope of the guideline 2 3.0 Aim of the guideline 2-3 4.0 Management of a patient with a Blood Borne Virus (BBV) 3-4 5.0 Notification of patients with a confirmed BBV 4 6.0 Vaccination of staff 5 7.0 Exposure prone procedures 6 8.0 Immediate Management of a Percutaneous Injuries 6 References 7 1.0 INTRODUCTION 1.1 Prevention and control of healthcare associated infection is part of the overall clinical governance and risk management strategy within the healthcare setting. Leicester City Primary Care Trust is committed to improving the quality of care throughout the Trust and promoting high standards of infection prevention and control practice. 1.2 All staff must possess an appropriate awareness of their role in the prevention and containment of infection in their area of work. Not only is this part of their professional duty of care to the patients with whom they are involved, but it is also their responsibility to themselves, to other patients and members of staff under the Health and Safety at Work Act (1974). The Control of Substances Hazardous to Health (COSHH) Regulations (2002), require actions to be taken to control the risk of hazardous substances, including biological agents. 2.0 SCOPE OF THE GUIDELINE 2.1 This guideline applies to all staff employed within Leicester City PCT as well as staff working in a contracted capacity. The guideline is supported by the following documents: PCT Hand Hygiene Policy PCT Universal Precautions Policy PCT Waste Management Policy PCT Policy for the Management of a Patient Requiring Source PCT Isolation Procedures (including a complete list of conditions requiring isolation) PCT Guideline for the use of Sharps. PCT Guideline for Cleaning and Decontamination PCT Guideline for the Management of Hospital Linen. PCT Guidelines for Use of Personal Protective Equipment 3.0 AIM OF THE GUIDELINE 3.1 This guideline is directed towards the provision of precautionary measures to minimise the risk of transmission of (BBV’s) to health care personnel and others in contact with patients known or suspected to have a BBV. 3.2 Exposure of healthcare staff to a BBV is by: Percutaneous Exposure - where the skin of the health care worker is cut or penetrated by a needle or other sharp object (for example a scalpel blade, trochar, bone fragment or tooth), which is contaminated by blood or body fluid. Mucocutaneous Exposure - 3.3 where the eye(s), the inside of the nose or mouth, or an area of non-intact skin of the health care worker are contaminated by blood or body fluid. The risk of infection following exposure from an infectious carrier via one of the above routes: For Hepatitis B Virus (HBV) - up to 30% For Hepatitis C Virus (HCV) – up to 3% For (Human Immunodeficiency Virus (HIV) – approximately 0.3% 4.0 MANAGEMENT OF A PATIENT WITH A BBV 4.1 Infection Control Precautions to minimise the risk of exposure to BBVs from a patient. Healthcare staff must: 4.1.2 Follow Standard (universal) infection control precautions. These are precautions that should be practised by all clinical staff without exception at all times. (See Policy for Standard Infection Control Precautions). 4.1.3 Ensure effective hand hygiene practices are adhered to. 4.1.4 Cover existing wounds or skin lesions with waterproof dressings. 4.1.5 Avoid performing invasive procedures if suffering from chronic skin lesions on hands and or arms. 4.1.6 Personal Protective Equipment should be used at all times when there is a risk/or potential risk of exposure to blood or body fluids, for example disposable aprons and gloves. 4.1.7 Protect the mucous membranes of eyes, mouth and nose from body fluid splashes by the use of appropriate personal protective equipment, for example face masks, visors or goggles. (See Guidelines for Use of Protective Equipment) 4.1.8 Follow safe procedures for the handling and disposal of needles and other sharps. (See Guidelines for the use of sharps). 4.1.9 Follow PCT procedures for sterilisation and disinfection of re-usable instruments and re-usable equipment. 4.1.10 Follow PCT procedures for the spillage of blood and other body fluids. (See the Guidelines for Cleaning and Decontamination). 4.1.11 Follow PCT procedures for the safe disposal of contaminated waste and linen. 4.2 Known or suspected patients with a BBV may be nursed on the open ward. A risk assessment should be undertaken if there is a possibility that health care staff, the environment or other patients may be contaminated with blood and/or body fluids. Depending upon the result of the risk assessment a single room and source isolation precautions may be required. Some examples may include: - i) ii) iii) iv) v) Bleeding or likely to bleed. Post-operative with open or drained wounds. Incontinent of urine or faeces. Unconscious. Uncooperative. 4.3 Inform all staff who may be exposed to infected body fluids. a) The consent of the patient should be sought prior to informing other staff. It is the responsibility of the clinician in charge of any patient with known or suspected BBV infection, to inform all staff who may be exposed to body fluids from a patient with a known or suspected blood borne virus including staff in other Departments who may be exposed to body fluids, especially blood. b) Pocket masks or ventilation bags should be available in close proximity to the patient as mouth-to-mouth resuscitation is not recommended. c) Laundry contaminated with blood or other body products must be managed as infected linen. (See the Guidelines for the Management of Hospital Linen). d) Clinical specimens must be dealt with as ‘High Risk’ samples. Biopsy material should be sent to the laboratory in fixative. If examination of fresh or frozen material is essential for diagnostic reasons, a suitable procedure must be discussed and agreed with the receiving pathologist. Inspect specimen containers for faults before collecting blood or other samples. Samples must be placed into a biohazard bag and it must be stated that they are high-risk samples on the accompanying form(s) and on specimen containers. e) In the event of a patient dying with a known or suspected BBV the patient must be placed in a clear body bag and identified as high-risk. 5.0 NOTIFICATION OF PATIENTS WITH A CONFIRMED BBV 5.1 An alert sticker must be placed on the front cover of the patient’s notes and a Hazard Alert form completed following consultation with the Infection Control nurse. In addition the patient information system (HISS) will be flagged to identify the patient has a blood borne virus. 6.0 VACCINATION OF STAFF 6.1 All health care workers should be offered a course of Hepatitis B vaccine. (Health care workers are defined as "persons, including students and trainees and visiting academics, whose activities involve contact with patients or with blood or other body fluids from patients in a health care setting") Vaccination is given at the Occupational Health Department at Glenfield Hospital. 6.2 It is ultimately the responsibility of the Chief Executive to ensure that all staff that are occupationally at risk of acquiring Hepatitis B are offered immunisation against this disease. 7.0 EXPOSURE PRONE PROCEDURES 7.1 Exposure prone procedures are those 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. These procedures include those where the worker's gloved hands may be in contact with sharp instruments, needle tips and sharp tissues (spicules of bone or teeth) inside a patients open body cavity, where the hands or fingertips may not be completely visible at all times. 7.2 All newly appointed health care workers whose work involves 'exposure prone invasive procedures' must have their Hepatitis B status determined before their employment is confirmed. 8.0 IMMEDIATE MANAGEMENT OF PERCUTANEOUS INJURIES 8.1 If an injury occurs involving a used needle or sharp which is/has been contaminated with blood or other body fluids: The area should be washed under running water. Bleeding should be encouraged Report it immediately and complete an incident form. Blood should be taken from the source patient and tested with consent for hepatitis B Virus hepatitis C Virus and HIV, Occupational Health must be informed. within 24 hours and staff attend the department on the next working day. The Line Manager should also be informed. Management of staff exposed to body fluids from a patient with known or suspected blood borne virus will be undertaken by occupational health. In the case of known HIV source the staff member must contact infectious diseases consultant on call. (LRI switchboard) to obtain post exposure prophylaxis within two hours of the injury. REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Centres for Disease Control Recommendations for Prevention of HIV Transmission in Health-Care Settings. Morbidity & Mortality Weekly Report 1987; 36:3 (Suppl.), 3-18 Department of Health. Guidance for Clinical Health Care Workers: Protection against Infection with HIV and Hepatitis Viruses. Recommendations of the expert advisory group on AIDS. London: HMSO 1990. Health and Safety at Work Act 1974 Health and Safety Executive, Health Services Advisory Committee. Safe Disposal of Clinical Waste. HMSO, London, 1992. MHRA SN 2001(19) - Safe Use and Disposal of Sharps The epic Project 2001 Developing National Evidence-based Guidelines for Preventing Healthcare Associated Infection Journal of Hospital Infection 47(Supplement) PCT Guideline for Cleaning and Decontamination PCT Guideline for the Management of Hospital Linen. PCT Guideline for the use of Sharps. PCT Guidelines for Use of Personal Protective Clothing PCT Hand Hygiene Policy PCT Policy for the Management of a Patient requiring Source Isolation Procedures (including a complete list of conditions requiring isolation PCT Universal Precautions Policy PCT Waste Management Policy Wilson, J. 2002 Infection Control in Clinical Practice, London. HIV Infected Health Care Workers: Guidance on Management and Patient Notification. London: Department of Health, July 2005) Specification for a Locally Enhanced Service Pilot Pharmacy Flu Vaccination Appendix 4: Route to vaccination flow chart Flu Vaccination Flow Chart Is the patient in an at Risk Group? YES Don’t Know NO Question further. If still unclear, refer to GP. If clear, proceed as per ‘yes’ or ‘no’ Not eligible for the flu vaccination Take the patient through the Exclusion Criteria Yes to any Not suitable for vaccination. Unless patient chooses pharmacy over GP No to all Eligible for the jab Would they like the jab later? Arrange suitable time Would they like the jab now? Vaccination Authorisation to the Agreement Community Pharmacy provision of flu vaccination (PILOT) I/we agree to the terms outlined in this specification and its appendices, for the term of this contract, after which time the service will be reviewed by the LPC (on behalf of participating pharmacies) and the PCT Pharmacy Stamp: (to include name and address of pharmacy, telephone number, email address) Signed on behalf of the Pharmacy Contractor Signature ……………………………………………… Print Name …………………………………………….. Position ………………………………………………… Date …………………………………………………….. Details of those providing the service from the contractors premise Name……………………………………………… RPSGB number………………………………….. Signed on behalf of Leicester City PCT Signature ……………………………………………… Print Name …………………………………………… Position …...…………………………………………… Date …………………………………………