Blood-Borne Viruses Guidance

Blood-borne viruses (BBVs) may cause severe disease in some people and few or no symptoms in others. The virus can spread to another person, whether or not the infected person has symptoms. The main blood-borne viruses of concern are:

  • Hepatitis B and Hepatitis C which cause Hepatitis, a disease of the liver
  • Human Immunodeficiency Virus (HIV), which causes acquired Immune Deficiency Syndrome (AIDS)

These viruses are carried in the blood of infected people (who may not know they are infected). They can also be found in other body fluids, for example, semen, vaginal secretions and breast milk. Body fluids such as urine, faeces, saliva and vomit may contain the virus but are unlikely to carry an infection risk unless they are contaminated with blood. However, care should still be taken, as the blood may not be visible.

It is important to remember that the precautions referred to in this document need to be applied in proportion to the risk experienced by staff. As with all health and safety requirements, staff / employees includes those such as agency and voluntary workers.

Acquired Immune Deficiency Syndrome (AIDS) is a term that is used to describe the late stage of HIV. This is when the immune system has stopped working and the person develops a life-threatening condition, such as pneumonia (infection of the lungs). The term AIDS was first used by doctors when the exact nature of HIV was not fully understood. However, the term is no longer widely used because it is too general to describe the many different conditions that can affect somebody with HIV. Specialists now prefer to use the terms of advanced or late-stage HIV infection.

HIV is not passed on easily from one person to another, especially compared to other viruses. That’s because HIV is present in body fluids. So for HIV to be passed on, the body fluids of someone who is already infected have to get into an uninfected person’s body and then into their bloodstream.

The body fluids that contain enough HIV to infect someone are:

  • Seminal fluid
  • Vaginal fluids, including menstrual fluids
  • Breast milk
  • Blood
  • The mucous found in the rectum
  • Pre-cum (the fluid that the penis produces for lubrication before ejaculation)

Other body fluids, like saliva, sweat or urine, do not contain enough of the virus to infect another person.

So the main ways that HIV can be transmitted are:

  • Through sexual intercourse and other sexual activities
  • From mother to baby
  • From blood to blood

The most common way to become infected with HIV is through sexual contact. HIV is not passed on through normal social contact, including:

  • Through unbroken, healthy skin
  • Kissing
  • Sharing cups, plates, cutlery or linen, such as towels
  • Using the same toilets and swimming pools.

Caring for someone living with HIV or AIDS does not put you at risk, and neither does mouth-to-mouth resuscitation. You cannot breathe it in or get infected by mosquitoes or other animals.

There is, therefore, a virtually insignificant risk of contract HIV at work, even in what may be through of as higher risk areas.

Scope

Most staff and service users will only be exposed to common airborne infections such as colds and influenza. However, some staff may be at risk of exposure to BBVs, such as:

  • Health care workers and those delivering personal care
  • Staff of special schools/residential accommodation for those with challenging behaviours e.g. human biting resulting in breaking the skin and drawing blood.
  • Staff exposed to violence resulting in skin breakage
  • Staff at risk from sharps injury (skin puncture), by coming into contact with things such as used hypodermic needles, broken contaminated glass or contaminated machinery/motor vehicles.
  • Staff regularly exposed to bodily fluids as part of their normal duties, including handling of clinical waste, contaminated laundry, waste/refuse of unknown origin, sewage e.g. refuse workers, house clearance workers.
  • First Aiders / Appointed Persons.
  • Staff who work with people who have severe learning disabilities or known drug offenders.

NB: Of course some first aiders and carers will feel vulnerable to the potential risk of exposure to BBVs. However if universal precautions are taken, which should always be the case, the risk is significantly reduced to an acceptable level. Examples of universal precautions include:
  • Good hand washing and care of the hands.
  • Ensuring cuts and breaks in the skin on the first aiders hands and arms are covered with a waterproof dressing.
  • Using protective clothing i.e., disposable gloves. Minor wounds should be cleaned and dried using clean water and disposable paper towels or tissues. A first aid plaster or dressing (individually wrapped) can be applied if desired. Larger wounds should be washed with water; a suitable dressing or pressure pad can be applied if needed. Disposable gloves should be worn where possible, but in an emergency first aid care should not be withheld because gloves are not available.

This list corresponds with the groups included in Health and Safety Executive guidance and the Immunisation Against Infectious Disease 2006 document from the Department of Health. However, this list is not intended to be comprehensive. In order to determine staff at risk of exposure to Hepatitis B specifically, a risk assessment should be completed.

KCC is committed to the health, safety and welfare of its employees and recognises the duty of care owed to others not in its employment. In turn it also recognises the duty of care owed by others to our employees and volunteers while working on our premises.

The why, what and how

Urine, faeces, saliva, sputum, tears and vomit carry a minimal risk of BBV infection, unless they are contaminated with blood. Care should always be taken however, as the presence of blood is not always obvious. BBVs can also remain infectious in dried blood and liquid for several weeks.

BBVs cannot be spread in swimming pools, sharing toilets, crockery, or by daily workplace activities, such as shaking hands or working with others. Accidents with blood-contaminated needles in healthcare workers are probably the most common method of occupational transmission of BBV.

Contraction of BBV can be prevented by safe working practices. For most people, simple measures such as being careful when cleaning up spilt blood and keeping wounds covered are all that are required. However, any incident in which blood from one person may have penetrated the skin of another person (e.g. by biting or from a contaminated needle), or as a result of contamination of the mucous membranes (eyes, nose and mouth), should be reported to the officer in charge or the headteacher.

Hepatitis B, Hepatitis C and HIV can be spread through:

  • Unprotected sexual contact with an infected person.
  • The injection of infected blood into an uninfected person’s bloodstream (e.g. drug users sharing needles, needlestick injuries, contaminated needles used for tattooing and ear piercing).
  • Contamination of open wounds and biting.
  • A mother to her unborn child.

An accident form HS157 must be completed to record the incident and first aid action taken as described in part 5 of this document.

Hepatitis

There are several types of Hepatitis, but Hepatitis B and C are blood-borne viruses.

Not all those with acute Hepatitis will have symptoms. Depending on the type, a certain number will go on to develop chronic infection but even then some may experience only mild symptoms or no symptoms at all. After the virus enters the body, the incubation period is one to six months. Many people have their virus in their bodies for a long time (sometimes for life) and never have any symptoms. These people are carriers and may be unaware that they carry the virus. Most carriers are infectious, whereas some get rid of the virus after several years. About 25% of carriers develop serious liver disease.

Hepatitis B, sometimes called Hep B or HBV, is a liver disease. The virus circulates in the blood stream and causes inflammation of the liver, possibly leading to jaundice in rare cases. A sudden inflammation of the liver is known as acute Hepatitis. Where inflammation of the liver lasts longer than six months the condition is known as chronic Hepatitis. Cirrhosis of the liver can also occur if the liver is damaged long-term, which in turn can develop into liver cancer in some people.

There is a vaccine that can protect people from Hepatitis B. It is suitable for protecting the small number of people at greatest risk of contracting the disease.

Hepatitis C, sometimes called Hep C or HCV, is also a liver disease. The effects vary from one individual to another. While many people will remain symptom free, some will develop cirrhosis and a few will develop liver cancer. Hepatitis C is spread in the same way as Hepatitis B. Unlike Hepatitis B, there is no available vaccine for Hepatitis C, so universal infection control measures should be followed at all times.

Hepatitis C can now be treated and around 55% of those individuals are cured.

Acquired Immune Deficiency Syndrome (AIDS)

A great deal of information has been issued by central government on the subject of AIDS. The disease is principally transmitted either sexually or by the injection of contaminated blood. In the normal working environment, the risk of AIDS being transmitted is very small. Even for staff caring for children or adults who carry the antibodies of these diseases, who could therefore be infectious, the risks are extremely small provided simple routine hygiene precautions are taken.

AIDS is caused by the virus HIV which attacks the body’s immune system. This can leave the body open to a wide variety of infections and can lead to death. However, many people who carry the virus (and are therefore HIV Positive) remain entirely healthy.

Information and Training

Heads of establishments and other managers are responsible for seeing that full information about the nature of these diseases and the measures necessary to control them are made available to all staff, and that staff receive appropriate training via a competent person. Heads of establishments and other managers are responsible for seeing that good hygiene practices are regularly followed in all KCC premises, and that staff are allowed adequate time for carrying out the recommended procedures.

Employees need to know:

  • If they could be exposed to blood-borne viruses and how;
  • The risks posed by this exposure;
  • The main findings of the risk assessment;
  • The precautions they should take to protect themselves and other employees, contract staff, volunteers or visitors; and
  • What procedures to follow in the event of an emergency.

Risk assessment for Blood-Borne Viruses

Managers should firstly consider if their team are exposed to blood-borne viruses through their work activities, remembering to consider volunteer activities. A list of occupational staff groups at possible risk of contraction has been produced for that purpose (Appendix 2). The list is designed to identify KCC staff members who are at greater risk than others within the organisation. If your team is not covered by this list and you believe them to be at risk, please contact either Staff Care Services (Occupational Health) or the Health and Safety Advice Line for further information and guidance. No KCC employee would be classed as being at ‘high risk’ on a national scale, as those most at risk are emergency staff, hospital staff, dentists and similar occupations.

For teams identified on the list, a risk assessment should be completed. A generic risk assessment form has been created to identify further procedures (Appendix 3).

When completing the risk assessment, the following factors should be considered:

Where the infection is likely to be present e.g., needles, waste?
Ways in which employees/volunteers may be exposed e.g., first aid, handling contaminated items?
What information is given to employees/volunteers about BBVs?
Estimate the level of exposure considering:
  • How often staff/volunteers are likely to come into contact with blood?
  • How many different peoples’ blood are they likely to come into contact with?
  • How good are existing measures e.g., universal hygiene precautions?

Guidance on completing a risk assessment is available from SafetyNet or contact the Health and Safety Advice Line. It is recommended that staff members who are identified as being in the moderate/high risk categories on the risk assessment be vaccinated against Hepatitis B.

First Aid Treatment

For all BBV contamination accidents / injuries, including:

  • Where a needle or other sharp object punctures the skin.
  • Where BBV contamination of an open wound, eyes, mouth or other mucous membrane has occurred.
  • Where a human bite or scratch puncturing the skin has occurred.

The injured person MUST:-

  • Wash splashes off the skin with soap and running water.
  • If the skin is broken, gently encourage the wound to bleed. Do NOT suck the wound – rinse thoroughly under running water.
  • Wash out splashes in the eyes with plenty of tap water – do not swallow the water.
  • Cover the wound with a waterproof dressing.
  • Seek medical attention as soon as possible e.g. from an A&E department or their own doctor ideally within 1 hour and not more than 48 hours.
  • Inform the manager/team leader/head teacher.
  • Complete an accident/incident form (HS157).
  • Inform the Occupational Health Unit and the Health and Safety Advice Line.

The Manager MUST:-

  • If possible, obtain a blood sample with full consent from the source, where known, of the needlestick.
  • If the service user is known to be Hepatitis B or HIV positive or the injured person (recipient) is a known non-responder to Hepatitis B vaccine (not immune), the recipient must attend the local A&E department or GUM clinic for post exposure prophylaxis treatment – ideally within 1 hour and not more than 48 hours.

Special consideration for first aiders

If you are a first aider in the workplace, the risk of being infected with a BBV while carrying out your duties is small. There has been no recorded case of HIV or Hepatitis B being passed on during mouth-to-mouth resuscitation. The following precautions can be taken to reduce the risk of infection:

  • Cover any cuts or grazes on your skin with a waterproof dressing;
  • Wear suitable disposable gloves when dealing with blood or any other body fluids;
  • Use suitable eye protection and a disposable plastic apron where splashing is possible;
  • Use devices such as face shields when you give mouth-to-mouth resuscitation, but only if you have been trained to use them;
  • Wash your hands after each procedures.

As a first aider it is important to remember that you should not withhold treatment for fear of being infected with a BBV.

Associated procedures and documentation

The documentation below refers to related guidance and legislation.

Related Guidance

  • HSE INDG342 – Blood-borne viruses in the Workplace (
  • SafetyNet guidance:
  • Safe Disposal of Discarded Needles and Syringes
  • Universal Precautions for the Control of Infection
  • Guidance on MRSA
  • First Aid
  • Use of gloves (SC)
  • Infection Control - Prevention of Healthcare-associated Infection in Primary and Community Care (NICE)
  • Infection Control Guidance for Care Homes (Department of Health)
  • Guidance on Communicable Disease and Infection Control in Schools and Nurseries (Kent Health Protection Unit)
  • Guidelines for Infection Prevention and Control in the Community (Kent Health Protection Unit)

Legislation

  • The Health and Safety at Work Act 1974
  • The Management of Health and Safety at Work Regulations 1999
  • The Personal Protective Equipment Regulations 1992
  • The Control of Substances Hazardous to Health Regulations 2002
  • Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 2013
  • The Health & Safety (First-Aid) Regulations 1981

Frequently asked questions

How can I prevent exposure to blood-borne viruses?

Exposure to blood-borne viruses can be prevented by adhering to infection control procedures as outlined in the Universal Precautions for the Control of Infection guidance. Managers must remember that vaccination is not the ultimate protection and the emphasis must be on behaviour.

A safe and effective vaccine for the prevention of Hepatitis B infection is available, that said, immunisation should not be relied upon as a primary control to prevent exposure.

There are currently no vaccines available against Hepatitis C or HIV, although there are measures that can be taken following exposure, which may prevent the development of infection. Studies have indicated, however, that antiviral therapy does not prevent acquisition of infection following Hepatitis C exposure, although there is evidence that therapy given shortly after acquisition is more successful, in terms of a sustained viral response, than therapy given later. Such treatment should be seen as distinct from post-exposure ‘prophylaxis’.

The procedures for management of incidents involving exposure to a blood-borne virus can be found at Appendix 5.

What is the procedure for vaccination against Hepatitis B?

Hepatitis B immunisation is recommended for all employees whose work tasks involve exposure to blood, blood-stained body fluids or tissues and there is a risk of injury e.g. puncturing /breaking of the skin, splashing into the eyes or mouth. Immunisation can also be recommended based on a risk assessment.

Where universal hygiene precautions are deemed to be insufficient to bring the risk of BBV contamination down to an acceptable level, Hepatitis B immunisation is advised. This provides effective protection but should not be regarded as a substitute to safe working practices.