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Lancashire County Council
Occupational Health and Safety Management System
Corporate Guidance
Infection Control
This guidance has been developed to help managers and head teachers to assess the risk of
infections which may affect its employees, service users and pupils and to suggest how these risks
can be managed through preventative and control measures. It also identifies the most common
types of infection and details how these infections may be transmitted in addition to any action which
may be required to control their spread.
What does this guidance cover?
1.
2.
3.
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5.
6.
Introduction
How infections are spread - The chain of infection
Infection Control – Responsibilities of line managers and employees
Infection Control - General advice for all employees
Infection Control – Service Users and Pupils
Infection Control - Female Workers of Child Bearing Age / Pregnant Workers / Nursing
Mothers
7. List of LCC Infection Prevention Guidance documents
8. Common Infections
9. Useful contacts and Information sources
1.
Introduction
Infection control is an essential factor in fulfilling the County Council’s duty of care to
safeguard the health, safety and wellbeing of employees, service users, pupils and anyone
else that may be affected by its work activities.
LCC employees, service users, pupils, members of the public and also contractors working
on premises throughout the County, may be at risk by exposure to persons or objects
carrying infections and also from cuts, bites, nips and scratches etc. sustained at work.
The County Council will take all reasonable steps to raise the awareness of employees to the
potential risks of infection to which they may be exposed during the course of their work
activities and to ensure that appropriate information and guidance is available to enable
employees to deal with these issues.
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2.
How infections are spread - The chain of infection
Micro-organisms
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Micro-organisms (e.g. bacteria and viruses) live in or on some parts of the body (e.g.
skin, mouth, intestinal tract) and are known as the body’s normal flora. Some of these
may cause illness if they find their way into other areas of the body. An example of this
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
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is where micro-organisms normally found in the bowel enter the bladder and may then
have the potential to cause infection.
Normal skin flora is known as ‘resident’ and is there continuously they are essential
for good health. Resident bacteria rarely cause infection except in special
circumstances such as during surgery or insertion of catheters and other invasive
devices. Resident skin flora lives naturally on the skin and is difficult to remove by
normal hand hygiene techniques, although the numbers of micro-organisms will be
reduced by this process.
Many other micro-organisms are acquired or deposited on the skin from other staff or
residents or from the environment and are known as ‘transient’. These do not live
permanently on the skin and are readily removed or destroyed by thorough and
frequent hand hygiene.
The reservoirs of infection
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The reservoirs of micro-organisms may be people, the environment or equipment. The
human body is the most common reservoir for micro-organisms. A person with
salmonella, tuberculosis or hepatitis B may act as a source of infection to others
because the micro-organisms are present in some of the body fluids and can be
passed on to others.
Contaminated food may also act as a reservoir of infection. A common example of this
is the presence of Salmonella spp. If food contaminated with Salmonella is not
thoroughly cooked, individuals who consume it can become infected.
The environment can also be contaminated by micro-organisms shed by people with
an infection. This can then spread to others. Regular cleaning minimises this risk.
Poorly maintained or incorrectly decontaminated equipment can also act as a
reservoir of micro-organisms. For example, inadequately maintained and shared
commodes can be contaminated with micro-organisms that cause diarrhoea.
Point of entry

Every micro-organism needs to have an entry point into the human body; different
micro-organisms have different ways of achieving this. For example salmonella
bacteria need to enter the body through the mouth. Tuberculosis enters our bodies
through the nose and mouth and then passes into the lungs and other parts of the
body. Hepatitis B virus enters the body via the bloodstream. Organisms causing
urinary tract infections may enter during poor catheter care.
Point of exit

As well as needing an entry point, micro-organisms also need an exit point.
Salmonella bacteria are excreted through faeces. A tuberculosis bacterium uses the
same entry and exit point, that is, the lungs, mouth and nose.
Method of spread or mode of transmission
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All micro-organisms need a way of spreading. This varies with different types of
organisms. Hands play a big part in spreading infection. Micro-organisms may be
present in body excretions and secretions. If hands come into contact with these the
micro-organisms may be carried from one person to another unless the hands are
properly decontaminated.
Some micro-organisms may be spread in the air. The viruses that are responsible for
colds and influenza are found in nasal secretion, saliva and sputum. Coughing or
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sneezing near another person may pass on these viruses in the droplets or aerosol
produced. Touching your face will contaminate your hands with these viruses.
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Modes of transmission include:
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Aerosol;
Droplet;
Faecal–oral;
Direct contact (person-to-person), often by contaminated hands;
Indirect contact (food, water, fomites [inanimate objects], the environment);
Blood and body fluid; and
Insects and parasites.
Susceptible host
Susceptibility to infection may vary from person-to-person and risk factors for infection
include:
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3.
Age (the very young and very old are more vulnerable to infections);
Immune status;
Physical well-being;
Psychological well-being;
Hygiene;
Underlying or chronic diseases or medical conditions (e.g. diabetes, chronic chest and
heart problems or cancer);
Other existing infections;
Medical interventions (e.g. an indwelling medical device);
Medical therapies (e.g. cancer chemotherapy or steroids).
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Infection Control - Responsibilities of Managers/Head teachers and
Employees
Manager / Headteachers must

Ensure local risk assessments (under COSHH) for activities where there is a significant
risk and have procedures in place for reducing the risk of cross infection. The risk
assessments must then be implemented and all relevant staff must be informed as to
their contents and, in particular, the control measures / working practices they are
required to follow.
Risk Assessments must be reviewed periodically and following a related incident;

Ensure Individual risk assessments (under COSHH) are carried out on all staff and
people using the service who carry infections that are transmitted through blood and
bodily fluids such as hepatitis, HIV etc.;
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Ensure that appropriate Personal Protective Equipment (PPE) is readily available when
required; such as disposable gloves and aprons and also that employees are aware of
the circumstances under which PPE should be used;
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
Ensure that employees are aware of the need to cover open wounds such as cuts,
scratches, grazes etc. with appropriate dressings when carrying out personal care or
when involved in food preparation activities;
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Ensure that appropriate precautions are taken with regard to the cleaning of blood and
bodily fluids and the disposal of contaminated waste;
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Ensure that employees raise any concerns immediately to the appropriate line
manager;
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Ensure that, as identified by risk assessment, employees have the appropriate
immunisations see Guidance on vaccinations against blood borne viruses and other
infections
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Ensure employees who are known to be suffering from infections, do not expose others
to potential risks;
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Ensure RIDDOR reports are completed. Under the Reporting of Injuries, Diseases and
Dangerous Occurrences Regulations 1995 (RIDDOR) certain infectious diseases, e.g.
Hepatitis and TB are reportable. Full details of all reportable diseases can be found on
the Government's Legislation website at Reportable Diseases;
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Outbreaks of minor infections etc. such as diarrhoea and vomiting, flu, scabies, etc.,
must be reported to the appropriate authority (Local Environmental Health (Local
Council) or Health Protection Team (contact details at Cumbria & Lancashire HPT) .An
outbreak can be defined as “two or more linked cases of the same illness or when the
number of cases of the same illness unaccountably exceeds the expected number.”
Outbreaks of infectious disease may occur from time to time in social care settings,
nurseries, pre-schools and schools.
See Public Health England Guidance on Infection control in schools and other
childcare settings
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Employees
Employees working with vulnerable people may be at risk of contracting infections from
them, and vice versa.
As a general rule, young children and vulnerable adults may be easily susceptible to
infections as they may lack immunity, general awareness and good hygiene practices.
These groups, particularly children, also interact more closely with each other increasing
the risk of the spread of infection. This is especially true of infections spread by direct
touch e.g. scabies, or infections spread by coughing or sneezing etc.

Employees who have young children of their own or who care for elderly or sick
relatives may put them at risk from infections they may pick up at work. Where
appropriate, immunisation will reduce this risk. (see Guidance on vaccinations against
blood borne viruses and other infections ) All employees should be vigilant for signs of
infections within people using the service, especially within residential and respite
accommodation where prolonged contact is inevitable.
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Employees should seek medical advice regarding a return to work if they are suffering
from an infection which is easily transmitted to vulnerable groups. They should explain
the full nature of their work to their GP who will be able to provide appropriate advice. In
particular anyone suffering from diarrhoea and /or vomiting may need to stay away from
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work until all symptoms have cleared completely, this may need to be discussed with
the appropriate line manager. Employees who attend work when they may be at risk of
spreading infection may do more harm than good.
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Anyone suffering from non-infectious diarrhoea and /or vomiting may need to stay away
from work until all symptoms have cleared completely. This will need to be discussed
with the appropriate line manager. The line manager can speak to the LCC
Occupational Health Service for advice or the employee can discuss the matter with
their General Practitioner. For further guidance on diarrhoea and vomiting see Public
Health England Factsheet on Diarrhoea and Vomiting
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Food handlers are reminded of their statutory obligations under the Food Hygiene
(England) Regulations 2006 to notify the food business operator immediately if they are
suffering with a disease likely to be transmitted through food or afflicted, for example,
with infected wounds, skin infections, sores or diarrhoea. Examples of diseases
include: Typhoid Fever, Paratyphoid Fever, Other Salmonella infections,
Staphylococcal infections likely to cause food poisoning e.g. impetigo See Food
Standards Agency Food handlers: fitness to work guidance
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If there are any concerns with regard to an infection carried by a particular person using
the service, these should be discussed with the appropriate line manager, head
teacher, parent/guardian and/or Social Worker etc. Where appropriate, medical advice
should be sought. Further advice on infection prevention may be sought through the
Infection Prevention team at Public Health within Lancashire County Council – Contact
details
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4.
Infection Control - General advice for all employees

Standard Precautions are actions taken by staff in order to limit the risk of spread of
infection. They protect both staff and general public, and must be carried out
regardless of perceived or known infection risk. These precautions mainly apply to
blood and other body fluids and are widely accepted and practiced nationally and
internationally. Due to the fact that it is not always possible to identify people who may
spread infection to others, it is important that these precautions must be followed at all
times.
Standard Precautions Include:
o Hand washing and skin care
o Protective clothing
o Safe Handling of sharps
o Spillage management
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Hand washing is the single most important activity for preventing cross infection. How
often you wash your hands depends on your risk assessment of the procedure you
have just completed and the procedure you are about to start. Routine hand washing
removes dirt, organic material and most transient micro-organisms found on the
hands. Hand washing Technique document - Directorate link or Schools Portal link
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5.
Infection Control - Service Users and Pupils
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
To ensure the safety and protection of the vulnerable users of the service, it is
generally recommended that their immunisations are up to date. However it is
acknowledged that the County Council is unlikely to have any involvement in this.
Health visitors or GP’s should be contacted for further information.
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When parents/guardians etc. have omitted/decided not to update immunisations,
particularly amongst children this may have an impact upon employees and other
users of the service.
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If a person is not well, it may be more appropriate for them to be at home rather
attending services provided by the County Council as infections can spread quickly
amongst vulnerable groups. Any request to exclude a person using the service must
be discussed with the appropriate line manager.
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When a user of the service is suffering from vomiting/diarrhoea, it is important, if
practicable to exclude them whilst symptoms persist, this should be discussed with the
appropriate line manager.
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Certain people using the service may have specific health problems.
Parents/guardians etc. should notify the appropriate manager of these as necessary.
This information will be treated in the strictest confidence and/or only disclosed to third
parties with their consent and as necessary.
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6.
Infection Control - Female Workers of Child Bearing Age / Pregnant Workers /
Nursing Mothers
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Female workers of child bearing age should ensure that they are immune to rubella
(German measles) and chickenpox as they may be at risk of exposure to these
infections.
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A blood test can confirm immunity if unsure of previous vaccination status or exposure
to the disease. Such women are advised to seek the advice of their family doctor (GP)
regarding this and consider any necessary immunisation e.g. MMR prior to pregnancy.

Pregnant employees will require additional precautions as certain infections are
particularly hazardous during pregnancy or can have serious consequences for
unborn children, in particular;
o Chickenpox can be unusually severe in pregnant women and it poses a threat of
congenital defects and death in the unborn child.
o Rubella while usually trivial in adults, an infection in early pregnancy can result in
congenital defects in the unborn child.
o Measles because they have low immunity against infectious diseases pregnant
women are especially susceptible and the unborn child may also be at risk.
o
Slapped Cheek Syndrome (parvovirus B19) can result in acute arthritis and in
early pregnancy it can seriously affect the unborn child causing miscarriage or
other serious complications.
o Toxoplasmosis is a strain of the toxocariasis infection and is usually found in cats.
If the infection is contracted in early pregnancy it can lead to death or deformation
of the child. This is not generally an issue within Council locations, however, if
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there are cats in or around the premises pregnant women should avoid handling
the excrement, in particular, cleaning any cat litter trays.
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7.
List of LCC Infection Prevention Guidance documents
Guidance documents on the specific aspects of Infection control are available (as
Appendices to this document) to assist managers and head teachers and / or to issue
to appropriate employees. They are:
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Dealing with Bodily Fluids Guidance
Disposal of clinical waste
Hand Washing Technique advice / poster
Latex Gloves – Guidance on use
Outbreak procedure – Social care setting
Outbreak guidance (Public Health England)– Schools and nurseries
Sharps and Needle stick injuries Guidance
Vaccinations against blood borne viruses and other infections
Related guidance, available on the Health, Safety & Wellbeing site:
o LCC Guidance for schools on the prevention, detection and treatment of head lice
at Directorate link or Schools portal link
o LCC Guidance on Provision and Use of Personal Protective Equipment (PPE) at
Directorate link or Schools Portal link
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8.
Common Infections
The following links provide guidance and advice on the Public Health England and NHS
Choices websites. These provide general, brief information about common infections that
employees may encounter during the course of their day to day work.
The information should not be used as a tool for self-diagnosis or treatment. In all cases if an
employee believes they, or a colleague have contracted one of the following infections,
medical advice should be sought as soon as possible.
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
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xi.
xii.
xiii.
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Campylobacter
Chicken Pox
Head Lice
Hepatitis A
Hepatitis B
Hepatitis C
HIV / AIDS
Impetigo
Influenza
Legionnaire's Disease
Leptospirosis
Listeria
Measles
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xiv.
xv.
xvi.
xvii.
xviii.
xix.
xx.
xxi.
xxii.
xxiii.
xxiv.
xxv.
xxvi.
xxvii.
xxviii.
Meningitis
MRSA
Mumps
Ringworm
Rubella (German Measles)
Salmonella
Scabies
Scarlet fever
Slapped Cheek Syndrome / Parvovirus B19
Tetanus
Threadworms
Toxoplasmosis
Tuberculosis
Typhoid
Whooping cough
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9.
Useful Contacts and Information Sources
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Public Health England Guidance on infection control in schools and other childcare
settings
Public Health England - Website or local North of England Regional Office on Tel:
0113 305 9427
Infection Prevention and Control Team, Public Health Lancashire County Council email: [email protected] Telephone as below:
Central Lancashire
and West
Lancashire
Vanessa Morris
01772 539875
[email protected]
East Lancashire
Kathleen Healy
01772 539910
[email protected]
North Lancashire & Anita Watson
Wyre and Fylde
01772 539892
[email protected]
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Health, Safety and Wellbeing Team at [email protected] or on 01772
538877
 Occupational Health - Atos Helpdesk on Tel: 0845 130 9490.
 Public Health England (PHE) - Infectious diseases fact sheets
 Approved County Council Contractor for the disposal of clinical waste and sharps
containers: PHS Ltd Tel: 01204 704633
 NHS choices website
 Health, Safety and Wellbeing Team at [email protected] or on 01772
538877
 Occupational Health - Atos Helpdesk on Tel: 0845 130 9490.
 Public Health England – website (link)or local Cumbria and Lancashire Regional
Office on Tel: 0844 225 0602

NHS choices website
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Corporate H&S Guidance on dealing with Bodily Fluids
This guidance is designed to inform managers and head teachers on how to protect themselves and
their employees from the risks arising from exposure to bodily fluids
Also see Cleaning up Bodily Fluids General Risk Assessment – Intranet link or Schools portal link
What does this guidance cover?
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What are 'bodily fluids' and why are they hazardous?
How can bodily fluids enter the body?
How can staff and others be protected when cleaning up bodily fluids?
Action in the event of bodily fluid spillages
Personal Hygiene procedure
First Aid arrangements in the event of an incident
Disposal of waste involving bodily fluids
Colour coding of cleaning equipment
Further advice and guidance
What are 'bodily fluids' and why are they hazardous?
Bodily fluids are liquids originating from the people's bodies and include blood, urine, faeces,
vomit, saliva, phlegm, eye discharges, etc. They can transmit infectious diseases if they enter
the body.
How can bodily fluids enter the body?
Bodily fluids can easily enter the body via:
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an open wound, broken skin or abrasion that comes into contact with contaminated
bodily fluid e.g. during the handling of bodily fluids or even through someone spitting
at you;
 splashes or the transfer by hand of bodily fluids into eyes, nose or mouth;
 a human bite where the skin is penetrated; or,
 a contaminated sharp object penetrating the skin e.g. needle or broken glass.
How can staff and others be protected when cleaning up bodily fluids?
A risk assessment (For assistance see Cleaning up Bodily Fluids General Risk Assessment
– Intranet link or Schools portal link) must be completed by managers whose employee may
have to deal with the cleaning up of bodily fluids and a safe procedure put in place. The risk
assessment and procedure must be communicated to employees and the manager should
ensure that the procedure is followed.
The procedure should be particular to the workplace but there are general points to consider.
When developing your procedure you should include the following:
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Other persons should be kept away from the contamination until it is effectively dealt
with;
Waterproof gloves and apron should be worn when cleaning up body fluids or
handling contaminated objects;
Appropriate eye protection should be used if necessary;
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All cuts/abrasions/wounds should be covered with waterproof dressings;
A colour coded system for cleaning equipment should be used;
Consideration of the use of a spillage kit, which should be used as per manufacturer's
instructions;
The safe handling and disposal of all contaminated materials;
A personal hygiene procedure is in place and observed;
Suitable first aid arrangements are in place;
Consideration of vaccination against Hepatitis 'B' – if high risk area. Follow link for
further guidance on Vaccinations – Intranet or Schools Portal
Action in the event of spillages
The following action should be taken in the event of spillages:
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Soak up the spillages using paper towels;
'Solids' should be carefully flushed down the toilet;
(Alternatively a spillage kit could be used as per manufacturer's instructions)
Clean the area with hot water containing soap or detergent;
Clean the area with a disinfectant solution - use as directed by manufacturer and
recorded in the COSHH assessment;
Thoroughly wash any equipment you have used to clear up bodily-fluids, such as a
dustpan or shovel, with hot soapy water.
After you have disinfected and removed the spillage, you must make safe the surfaces
that were covered by the spillage.
o All surfaces should be washed with plenty of hot water and soap/detergent, or
approved disinfectant in order to remove any traces of germs which might
remain.
o Any floor areas that become wet during cleaning should be clearly marked to
warn people of the slipping hazard.
o After cleaning, floors and steps must be left dry before use.
If you have been wearing an apron, take it off whilst still wearing your gloves, and
dispose of it as infected waste.
Then wash your hands in hot soapy water with your gloves still on, dry with absorbent
material available and remove the gloves by peeling them off from inside to out. They
should also be disposed of as infected waste.
If the spillage is very extensive, as for example in a toilet with a lot of urine on the
floor, the entire area should be mopped with plenty of very hot water containing soap
or detergent then clean the area with a disinfectant solution if available.
Personal Hygiene procedure
It is important that any employee who may clean up bodily fluids should follow good
personal hygiene practice at all times in order to reduce the risk of exposure to all
infections. The following precautions should be taken:
o Care should be taken when removing contaminated aprons and gloves;
o Wash hands thoroughly with hot soapy water and dry well;
o Always ensure that any abrasions or cuts are covered immediately with a
suitable and waterproof dressing;
o Any employee who has a skin condition on the hands, arms, or face, e.g.
Eczema, psoriasis or dermatitis should avoid contact with bodily fluids;
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o If your gloves or apron become cut or torn, dispose of them safely and put on
new ones at the earliest opportunity. If you are in the middle of clearing up a
spillage, STOP, wash and dry your hands before putting on a new pair of
gloves;
o First aiders carrying out any procedures involving wound cleaning or cleaning
blood spillages should follow the above guidelines and infection control
procedures taught on the first aid course;
o If clothing becomes contaminated with blood or other bodily fluids, it should be
sponged with cold water, and then laundered separately in a hot wash - the
sponge should be disposed of as infected waste.
First Aid arrangements in the event of an incident
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If an injury occurs during cleaning of bodily fluids - encourage all wounds to bleed,
wash with running water where possible, cover with waterproof dressing;
If a scratch or bite is received from a member of an “at risk" group, or splashes of
body fluids into the eyes, mouth or open wound:
o
o
o
o
o
o
o
o
o
Encourage the wound to bleed but do not suck it.
Wash it well under cold running water with soap if available.
Cover with a dry, waterproof dressing.
Employees should seek medical help as soon as possible from either their own
GP or, if unavailable, from the Accident & Emergency Department of a local
hospital, and, if applicable, take the "sharp" which caused the injury with them
in a suitable container so as to prevent further injury;
Record the incident and action taken on the accident report form;
If applicable, the manager should notify the Health & Safety Executive under
Reporting of Injuries, Diseases Dangerous Occurrence Regulations .See
details on the Health & Safety site on Intranet or Schools portal;
Manager to investigate and review risk assessment;
Attend the nearest Accident & Emergency department within 2 hours of the
incident occurring for assessment of risk/possible treatment & blood sampling;
If you are worried about any risks following an accident which involves an injury
or the possibility of infection, then you should contact the Occupational Health
Service on Tel: 01772 532199 for further advice.
Colour coded cleaning system
RED - used in high-sanitary (high risk of spreading infection) applications or in restroom
cleaning, such as with toilets and also for cleaning of contaminated bodily fluids. Urinals
BLUE - General areas including public areas, offices, corridors
GREEN – Catering, kitchen and general food preparation areas
YELLOW – Isolation/high risk areas
http://www.coshh-essentials.org.uk/assets/live/sr04.pdf
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Disposal of waste involving bodily fluids including nappies
If only small quantities of offensive/clinical waste are being produced (one bag or less of
approximately 7kg in each collection interval) the waste can be disposed of with the general
waste. Establishments should check whether their normal waste management contractor is
able to accept this waste and if not, find an appropriate specialist service.
Please also see the guidance on disposal of Offensive / Hygiene Waste on the Premises
Management Guidance on the LCC Health & Safety site at Intranet or Schools portal
Further advice and guidance
Further advice and guidance can be obtained from the following sources
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LCC Occupational Health Service on Tel: 01772 532199
Corporate Health, Safety & Wellbeing team. Contact details: Intranet or Schools
portal
LCC COSHH website Control of Substances Hazardous To Health Regulations 2002
Information On Risk From Biological Agents
HSE Guidance on Blood-borne viruses in the workplace
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Disposal of Clinical Waste Guidance
Clinical Waste is divided into five categories (see table below). The category determines the
packaging and labelling requirements. If a risk assessment shows that sanitary towels,
tampons, nappies, stoma bags, incontinence pads and other similar wastes (providing they
do not contain sharps) do not present a significant risk of infection, they need not be
classified as clinical waste. However, the offensiveness of non-infectious waste needs to be
taken into account when deciding how to package the waste for disposal.
1. Waste Groups
Waste Group
Type of Clinical Waste
Group A
Identifiable human tissue, blood, soiled surgical dressings,
swabs and other similar soiled waste. Other waste
materials, e.g. from infection disease cases, excluding any
in groups B-E.
Discarded syringe needles, cartridges, broken glass and
any other contaminated disposable sharp instruments or
items.
Microbiological cultures and potentially infected waste
from pathology departments and other clinical or research
laboratories.
Drugs or other pharmaceutical products.
Items used to dispose of urine, faeces and other bodily
secretions or excretions that do not fall within Group A.
This includes the use of disposable bedpans or bed liners,
incontinence pads, stoma bags and urine containers*.
Group B
Group C
Group D
Group E
* Where the risk assessment shows there is no infection risk, Group E waste is not clinical
waste as defined.
It is generally expected that the types of clinical waste commonly dealt with are Groups A, B,
D and E.

Group A waste should be disposed of into appropriately labelled yellow, plastic bags
and placed into a clinical waste bin awaiting collection by the County Council
Contractors - PHS (Tel: 01204 704633) (www.phs.co.uk) This service is available upon
request.

Group B waste should be disposed of into sharps containers or other appropriate
containers, if a sharps container is not available (see section 4).

Group D wastes are unused drugs or other pharmaceutical products and should be
returned to a GP surgery or pharmacy for disposal.

Group E waste should be assessed for level of risk :-
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o If there is no infection risk, clinical waste may be disposed of to a foul drain if
possible i.e. flushed down a toilet. In situations where this is not possible, the
waste material should be adequately wrapped in plastic bags, etc., and disposed of
with standard domestic waste.
o If a risk of infection is identified or cannot be adequately determined, Group E
waste must be disposed of into appropriately labelled yellow, plastic bags and
placed into a clinical waste bin. Arrangements for collection are available on
request and should be made from PHS (Tel: 01204 704633) (www.phs.co.uk).
2. Colour coding for clinical waste
A widely used system of colour coding is as follows:
Yellow – Group A clinical waste for incineration or other suitable means of disposal.

Yellow with black stripes – non-infectious waste, e.g. Group E and sanpro (sanitary
towels, tampons, nappies, stoma bags, incontinence pads.) Waste suitable for landfill
or other means of disposal.

Black – non-clinical or household waste.
3. Body Fluid Disposal Kits
Establishments that deal with clinical waste on a daily basis should already be aware of the
County Council Contract for disposal and will already have suitable Personal Protective
Equipment (PPE), clothing and cleaning products, etc., for dealing with spillages or waste.
This may include gloves, aprons, goggles, paper towels, cleaning granules, scoops, tongs,
disinfectant, disposal bags, etc.
However, for establishments where clinical waste is not a common occurrence, 'Body Fluid
Disposal Kits’ can be purchased .These provide sufficient equipment and cleaning materials
for dealing with 5 incidents. Replacement items must be funded from individual
establishment budgets and can be purchased from the Careshop (Tel: 01204 384858).
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Hand Washing Technique
Remember to….always wet your hands before applying soap and dry them
thoroughly afterwards!
Advice on the use of soap:
Blocks of soap can harbour bacteria from previous users and therefore should be
changed frequently. The use of foam or liquid soap is recommended in preference to
using blocks of soap. If foam or liquid soap is used it should be stored in a wall
mounted dispenser that takes refill sachets/cartridges, rather than being stored in a
refillable dispenser.
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USE OF LATEX GLOVES
1. Introduction
This document provides guidance on the use of latex gloves by employees of Lancashire
County Council, who are either required or have occasion to, use gloves during the course of
their employment.
Managers should use the guidance to develop procedures within their own establishments to
ensure the health, safety and wellbeing of employees and users of the service whilst
undertaking personal care tasks.
2. Problems Associated with the Use of Latex Gloves
Certain individuals are sensitive to the natural proteins or the chemical additives found in
latex gloves, this can result in a wide range of allergic reactions varying from contact
dermatitis to anaphylactic shock.
3. Types of Reaction to Latex
Due to potential prolonged and close contact, all latex gloves can present a particular risk of
skin sensitisation. There are three recognised types of reactions:
Irritation – This is not an allergic reaction and the effects are usually reversible
once contact with the latex product is discontinued. Symptoms include; redness,
soreness, dryness or cracking of the skin in areas exposed to latex. Irritation
caused by latex can be associated with a history of hand eczema
It is important to note that a wide range of substances including skin cleansing and
disinfectant products may also cause skin irritation. In all cases medical advice should be
sought as to the possible cause and treatment in addition to advising the line manager.

Delayed Hypersensitivity – This condition is predominantly caused by residues
of the agents used in the manufacturing process of gloves. Delayed
hypersensitivity is also known as allergic contact dermatitis, the severity of which
varies greatly. Symptoms include; a red rash on the back of the hands and
between the fingers. Also, the skin may become leathery and express papules or
blisters.
The reaction is delayed, usually occurring several hours after contact, usually reaching a
peak after 24 - 48 hours, before subsiding. Repeated exposure may cause the skin condition
to extend to other parts of the body beyond the area of contact with the gloves. The amount
of latex required to cause sensitivity is unknown. If employees display any of the above
symptoms medical advice should be sought and their line manager should be informed.

Immediate Hypersensitivity – This allergy is a response to the natural protein
residue found in natural rubber latex. It generally produces a reaction within 5-30
minutes of latex exposure, this usually diminishes rapidly once contact with the
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latex has ceased. The reaction may take the form of conjunctivitis, asthma or
other respiratory difficulties in addition to the rashes mentioned previously.
4. Use of Powdered Gloves
The risk of a latex allergy is exacerbated by the use of powdered gloves. The powder in the
glove itself is not an allergen. However, proteins in latex gloves leach into the powder and
become airborne once gloves are removed. Inhaling the powder may lead to respiratory
sensitisation. Powdered gloves pose an additional risk, not only to the user but also to
sensitised people in the area.
5. Avoidance of Latex
In the majority of cases, non-powdered latex gloves which have low extractable protein levels
are suitable to protect individuals against the risk of cross infection and the risk of allergy.
Any employees who demonstrate signs of an allergy to latex should monitor their symptoms
with their line manager.
If the use of powder free gloves is not effective in controlling the symptoms, switching to nonlatex gloves is recommended. In such cases appropriate alternatives should be sourced via
the Corporate Procurement
6. Action Required
Under the Control of Substances Hazardous to Health Regulations (2002) employers must
protect both employees and anyone else who may be exposed to potential risks, in this case,
an allergic reaction to latex gloves. County Council guidance is that all offices and
establishments should cease to use powdered latex gloves and purchase non-powdered
gloves as an alternative.
If any employees exhibit signs of a latex allergy, they must bring this to the attention of their
line manager immediately. They should be advised to contact their own GP with a view to
ascertaining whether the reaction is attributable to the use of latex gloves and any advice
given should be followed so far as is reasonably practicable.
Employees who exhibit minor reactions may find that these subside with the use of a nonlatex glove between the skin and the glove. Alternatively, managers, officers in charge, etc.,
may wish to change to the use of non-latex gloves for all personal care tasks.
It should be borne in mind that users of the service may also suffer from latex allergies. Any
allergic reactions should be monitored closely and if necessary, discussed with an
appropriate parent, guardian or carer or referred to their GP for further investigation.
Remedial action such as ceasing the use of latex gloves with or in the vicinity of a particular
user of the service may be required whilst awaiting the outcome of further investigation.
7. Other Recommendations:

Good hygiene practices should be followed in conjunction with glove use, such as
washing hands after removing gloves e.g. using a ph balanced agent and not drying
hands with an abrasive material.
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

Employees who may wear gloves as part of their duties should be informed of the
possible reaction to latex.
Latex gloves should not be worn for long periods of time i.e. do not allow hands enough
time to sweat.
For further guidance on the selection of gloves please refer to the HSE website HSE & latex
If exposure to latex results in occupational dermatitis or asthma then this is reportable to the
Health and Safety Executive under the RIDDOR Regulations.
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Corporate H&S Guidance on dealing with Sharps and Needle-stick Injuries
This guidance deals with the risks arising from the careless or malicious disposal of needles/sharps
that may be discovered by County Council employees in the course of their work.
What does this guidance cover?
•
•
•
•

Identifying the hazards
Introducing preventative measures
Actions if needle stick injury occurs
Further information
Dealing with Sharps and Needle stick Injuries Flowchart
Identifying the hazards



Preventing needle stick and sharps injuries and the related prevention of infection is a
health and safety management issue;
Hypodermic needles/syringes and other similar instruments are commonly known as
"SHARPS" and can be harmful if handled incorrectly. The main risks from accidental
skin puncture wounds are from hepatitis B and C and HIV viruses;
Hepatitis B and C, and HIV (Human Immunodeficiency Virus) are blood-borne
diseases and are spread by "sharps" that have been contaminated with blood or
blood-stained body fluids such as vomit or urine; The actual risk of infection depends
upon certain factors, namely;
o Whether the needle was used by a person infected with Hepatitis or HIV
o How long it has been since the needle was used, both viruses can survive for
relatively long periods of time, particularly if the needle has not dried out.
o How much material enters the bloodstream, (a needle attached to a syringe
containing blood will pose a greater risk than a detached needle)
o For Hepatitis B, the risk also depends upon whether or not the injured person
has been vaccinated
The attached Dealing with Sharps and Needle stick Injuries Flowchart also makes reference
to ‘splash injuries’ but this guidance does not expand on this issue further. However it should
be noted that anyone with broken skin or a condition such as dermatitis/eczema should seek
advice as a priority to prevent infection.
"Sharps" are often found in a number of common areas as noted in the illustrative list below:
Examples of some areas / places / sources
where there may be a risk
Toilets (including waste bins) Refuse
sacks, litter bins
Temporary accommodation e.g. in settees,
vacuum cleaners, mattresses, household
rubbish
Issue No: 7
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Examples of some categories of people
who may be at risk
Cleaners, waste handlers, site supervisors,
Cleansing workers, plumbers
Care workers, Social workers, other
service users, visitors
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Disused/vacated buildings
Lift Shafts
Sewers, gullies
School Playing areas
Bedding, clothing
Concealed on person
Beaches and open areas
Public playgrounds
Building or cleansing workers, gardeners,
children, members of the public
Maintenance engineers, fire service
(potentially)
Sewerage and cleansing workers
Pupils, teachers, site supervisors & others
e.g. visitors
Laundry/dry cleaners, care workers
Care workers members of the public, social
workers, other service users
Members of the public
Children, grounds maintenance workers,
visitors. Some of the needles found in
children's playgrounds are known to have
been deliberately wedged in slides or
buried in sand
This list of potential places and vulnerable groups is not intended to be fully comprehensive
For instance some LCC employees, services users, members of the public and also
contractors working within or on behalf of LCC, may be at risk by exposure to persons or
objects carrying infections and also from cuts, bites, nips and scratches, etc., sustained at
work.
Introducing preventative measures
The following matters are suggested as a guide as to the areas that should be considered
when preparing a safe system of work:




Employees working in at risk areas should be alert to foreign objects in the work area
before carrying out work activities;
Under no circumstances should an employee put their unprotected hands where they
cannot see, such as into soil, drains, u -bends, inside bins etc.;
Where a task involves kneeling, consideration should be given to additional protection;
Where there is any risk of coming into contact with syringes or other sharps:
o tongs or tools should be used wherever possible;
o appropriately fitted personal protective equipment should be provided and used in
accordance with the PPE Regulations;
o If a sharp is found, and where possible, ensure that is effectively guarded until it
can be safely removed;
o Use "remote" methods when picking up needles/syringes/ sharps, e.g. spade,
brush and shovel, rake, litter picker, piece of wood etc.;
o It is not necessary to use reinforced gloves as long as the "sharp" is not touched
by bare hands/ skin;
o Where remote methods are not available and removal is imperative, the item
should be picked up by the handle or plunger end NOT the needle end;
o No attempt must be made to remove a needle-stick where the employee does not
feel confident to do so. In such situations, the area where the needle-stick is
located should be secured and the line manager should be contacted for advice.
o Place the sharp in a sharps disposal container, if available, needle end down and
replace the lid firmly.
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o If there is no sharps container available, place in a suitable temporary container
(e.g. a tin with a lid, plastic or cardboard) until it can be taken to a sharps disposal
container.
o Arrangements should then be made to take the container to an *establishment,
which is known to have a disposal box where it can be disposed of properly.
o Alternatively, or where there is not a suitable establishment locally, schools and
establishments can contact LCC Building Cleaning & Grounds Maintenance in
Property Group on (01772) 537689 or at
[email protected] who will arrange for a contractor to
pick it up and dispose of it safely. There may be a charge for this service if the
contractor is not in the area at the time and there will be a charge if the contractor
has to retrieve the needle from the location where is has been found.
* Sharps bins can be found at many Children & Young People and Adult and Community
establishments who should be willing to help in the disposal of a used needle-stick.
If the Manager of an establishment, etc., assesses that there is a requirement for a ‘sharps
disposal box’ they can contact PHS Group on Tel: 029 2085 1000 or at [email protected]
or source their own alternative supplier.
Employees finding sharps should report the incident to their line manager who should follow
it up and review the risk assessment for the task and complete an incident / near miss report.
If working at a manned location / establishment, the establishment head or other responsible
person should also be informed of the incident.
Actions if needle stick injury occurs
"Needle stick"/"sharps" injuries are skin punctures caused by hypodermic needles, or
lacerations caused by other sharps. In the event of such an injury, the following action should
be taken without delay:






Encourage the wound to bleed but do not suck it;
Wash it well under cold running water with soap if available;
Cover with a dry, waterproof dressing;
Employees should seek medical help as soon as possible from either their own GP
or, if unavailable, from the Accident & Emergency Department of a local hospital, and,
if it is safe to do so (see preventative methods above), take the "sharp" which caused
the injury with them in a suitable container, so as to prevent further injury and for
analysis purposes;
Employees and managers can access immediate telephone advice or further
information by contacting the LCC Occupational Health Helpdesk on Tel: 0845 130
9490 or the Infection Prevention and Control Team on Tel: 01772 539911;
Following the employee seeking initial urgent medical assistance, where appropriate,
the manager should make arrangements for the employee to be referred to the County
Council's Occupational Health Service using the on-line referral system, Cosmas Vista
– see details at OHU on 'How to make a referral'. The manager may wish to consider
if a bespoke service such as counselling, or the on-going support with any treatment is
appropriate should the employee require this. The manager can make this request in
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


their initial referral to the Occupational Health Service, or they may wish to discuss the
options first with a clinician on the Occupational Health Helpline Tel: 0845 130 9490.
Record the incident and action taken on the County Council accident report form on
the Oracle system;
Manager to notify the Health & Safety Executive under Reporting of Injuries, Diseases
Dangerous Occurrence Regulations if applicable;
Manager to investigate and review risk assessment;
Further information
Further advice or information can be obtained from:





Lancashire County Council Occupational Health Service Tel: 0845 130 9490
Lancashire County Council Infection Control guidance at Intranet or Schools Portal
HSE Guidance : Blood-borne viruses in the workplace
NHS Hepatitis information
NHS HIV Information
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Dealing with Sharps and Needle-stick Injuries Flow Chart
What should you do if you suffer a sharps injury, human bite or scratch or have
been contaminated by body fluids?
If you suspect that body fluids from an infected person/source may have entered your body via:
 any open wounds, abrasions, broken skin
 your eyes or mouth
 an accidental puncture wound through a needle stick injury
Operational Risks




needle stick/sharps injury puncturing skin
human bite piercing skin
any area of broken skin in contact with body fluids
splashes of body fluids into eyes or mouth
Additional Information
Blood borne infections include: Hepatitis ‘B’, Hepatitis
‘C’ & HIV. Immunisation is only available for Hep. ‘B’,
this is a course of 3 vaccinations, a blood test to check
immunity & 5 year booster. See Vaccinations advice in
Infection Control guidance.
The risk of infection from exposure to blood is greater
than for other body fluids.
Where required / appropriate the Occupational Health
Service will be able to give immediate telephone
advice.
How to protect yourself








ensure a risk assessment been completed
is the safe procedure known and understood
wear waterproof gloves when handling body
fluids/contaminated objects
cover all cuts/abrasions with waterproof dressing
use eye protection if necessary
safe handling and disposal of all contaminated
materials i.e. discarded needles into sharps
container; gloves etc. into yellow bio hazard bag;
wash hands thoroughly
consider vaccination against Hepatitis ‘B’
First Aid


Encourage all wounds to bleed, wash with running
water where possible. Cover with waterproof
dressing;
Irrigate eyes/mouth with plenty of water if
contaminated with body fluids;
Further action required following
body fluid contamination
Further advice
For further advice or information contact the LCC
Occupational Health Service, the Health and Safety
Team or the Community Infection Control Nurse





Attend nearest Accident & Emergency Dept.,
within 2 hours of incident for assessment of risk /
possibly treatment & blood sampling for storage
Complete the LCC Accident Report Form on
Oracle
Manager to report to HSE under RIDDOR if
appropriate
Manager to investigate & review risk assessment
Manager to refer employee to OHU if appropriate
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Guidance on Vaccinations against blood borne viruses and other infections
As part of the risk assessment process, managers/headteachers will need to consider
whether or not staff in their area are likely to be at risk of infection either from needle-stick
injuries, contact with items of clinical waste, infections that people using the service may
have, or bites, nips and scratches sustained from people using the service who they come
into contact with. If a risk is identified, employees should be encouraged to visit their GP to
discuss the issue and have vaccinations where appropriate.
The need for vaccination will depend upon a number of factors, particularly the type of work
involved and the likelihood of being exposed to needle-sticks or bodily fluids etc.
Examples of occupations, which may be considered to be at increased risk of exposure to a
communicable disease and therefore may benefit from vaccination, are;

Those staff who are involved in
gardening activities or refuse
collection

Staff who work in residential
establishments,
which are likely to accommodate known
or


Domestic workers
Care workers

possible drug users
Social workers
The most common types of vaccination which may be appropriate for LCC employees are:
1. Hepatitis B Vaccination
This is generally a course of 3 injections followed by a blood test to check if the vaccination
has been effective. A booster maybe required after 5 years, after which time, persons are
considered fully vaccinated against Hepatitis B for life. Blood tests will indicate whether or
not a booster is needed. Full details will be provided by your local GP. (There is no
vaccination for Hepatitis C, E, F or G).
Vaccination against Hepatitis may be considered appropriate for employees who may, at any
time come into contact with blood or other bodily fluids from ‘at risk’ groups such as drug
users, people with learning difficulties, or where there is a risk of contact with discarded
needles which may be infected.
It is important to remember that many people infected with Hepatitis B or C are unaware of
their condition and may lead normal lives without ever finding out. It is for this reason that,
where there is a perceived risk, employees must follow safe systems of work and any
precautionary control measures identified by risk assessments.
2. Tetanus Vaccination
This is generally a full course vaccination followed by a booster every 10 years. It is normally
carried out as part of childhood immunisation. Boosters are usually offered as standard
during visits to the hospital or GP as a result of puncture wounds, animal bites etc. Tetanus
vaccinations/boosters are normally recommended for maintenance workers or employees
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who may work in unhygienic environments, with animals, or where there is an increased risk
of infection through accidents or the general working environment.
3. BCG Vaccination Test (TB vaccination)
There has been a recorded increase of TB in the UK. The TB vaccination may be required in
cases similar to those noted for Hepatitis. This vaccination will usually have been offered
whilst at school and, if so, there is no need to repeat it.
4. Obtaining Vaccinations and Reimbursement
Employees identified as ‘at risk’ or consider themselves to be ‘at risk’, should be advised to
visit their own GP to discuss the issue. If considered necessary, the GP will recommend
vaccination.
If an employee is deemed to be high risk due to their job role there is usually no charge made
by the GP. If a charge is made for the injections or prescriptions then a receipt must be
obtained by the employee and sent to their line manager/headteacher. This should then be
claimed for by the employee through Oracle self-service Mileage/Expense Claims section,
where reimbursement will be made through the employee's salary. Schools who do not have
access to the Oracle HR system will need to follow their own local arrangements for school
employees wishing to claim these reimbursements.
The links below will take you to a flow-chart that provides an overview of LCC's
arrangements for vaccinations and how employees can claim reimbursement for the cost of
these.
LCC flow-chart on vaccinations – Intranet link or Schools Portal link
5. Action required by County Council Managers / Headteachers
Managers and Headteachers must

Assess the potential risks from needle-stick injuries and/or exposure the Hepatitis, HIV
etc. viruses to themselves and their employees, taking into consideration the
information contained within this guidance note and their own knowledge and
experiences.

Consider ways, within their control, of preventing exposure as far as is reasonably
practicable.

If there is a risk that employees may come into contact with needle-sticks and other
clinical waste material, ensure that appropriate safe systems of work are in place to
deal with such situations i.e. provision of suitable PPE, disposal tubes, cleaning
chemicals, etc.

Evaluate and review the risk assessments as appropriate to satisfy themselves that
they continue to be suitable and sufficient.

Ensure that the contents of this guidance note are brought to the attention of all
employees and anyone else as necessary.
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Consider whether or not employees should be advised to visit their GP to obtain advice on
the need for appropriate vaccinations taking into account the information contained within this
guidance note.
6. Other Resources
Please also see the Infection Control guidance on the Health, Safety & Wellbeing web site.
From the Health, Safety & Wellbeing Homepage go into the Health & Safety 'A-Z' and choose
'I' - Infection Control guidance.
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