Download Leicester City PCT

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 …………………………………………