Policy ICP6 Inoculation Injuries Policy by hkksew3563rd

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									                                      Policy ICP6


                       Inoculation Injuries Policy




Version:                                           ICP6 13 November ‘08
Ratified by:                                       Executive Directors
Date ratified:                                     April 2008
Title of originator/author:                        Associate Director of Patient Safety
Title of responsible Director                      Executive Director of High Secure
                                                   Services and Nursing
Date issued:                                       November 2008
Review date:                                       November 2010
Target audience:                                   All staff Trust wide




        West London Mental Health NHS Trust____________________________________________________
      Policy I8 First Date of Issue: April 2008               This is current version November 08 1
                                                                                                      I


       POLICY TITLE                                    Inoculation Injuries


    POLICY REFERENCE                                           ICP6
         NUMBER


         DATE OF                                          October 2007
     IMPLEMENTATION


       DEVELOPED/                                            Nursing
       REVIEWED BY


       REVIEW DATE                                      November 2010


       RESPONSIBLE                     Executive Director of High Secure Services
        DIRECTOR                                      and Nursing


   DISCLOSURE STATUS                     (B) Can be disclosed to patients and the
                                                          public


                              Equality & Diversity statement

The Trust aims to design and implement services, policies and measures that meet
the diverse needs of its services, population and workforce, ensuring that none are
placed at a disadvantage over others

The development/review of this policy has undergone an Equality Impact
Assessment [EIA], as per the guidance in the Trust Policy Development
Monitoring & Review [P3].




        West London Mental Health NHS Trust____________________________________________________
      Policy I8 First Date of Issue: April 2008               This is current version November 08 2
ICP6
Inoculation Injuries
Version Control Sheet

Version     Date       Title of Author                     Status                     Comment
ICP6/01   13/11/08 Alan Stewart            Head of Standards and Compliance
ICP6/02   13/11/08 Alan Stewart            Head of Standards and Compliance




        West London Mental Health NHS Trust____________________________________________________
      Policy I8 First Date of Issue: April 2008               This is current version November 08 3
Trust aspiration
The Trust aspires to:

“Ensure the health and wellbeing of those we serve and be a leader in the development of
mental health care and treatment”




West London Mental Health NHS Trust______________________________________________________ 4
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
ICP6       Inoculation Injuries Policy


INDEX

1      Introduction

2      Definition

3      Prevention

4      Risk of Acquiring Blood Borne Viruses

5      Course of Action following Accidental Inoculation – Advice to Staff

6      Action of Occupation Health or Accident & Emergency

7      Post Exposure Prophylaxis

8      Monitoring and Training

9      References


Appendix

1      Inoculation Injury or Other Significant Body Fluids Exposure

2      Guidelines for the Management of Human Bites

3      Statutory and Mandatory Training Updates and Refresher Training




West London Mental Health NHS Trust______________________________________________________ 5
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
ICP6Inoculation Injuries Policy

1.     Introduction

1.1    Accidental inoculation with infected blood or body fluids presents a real risk to health
       care workers. Inoculation injuries constitute a major means of contracting occupationally
       acquired infections such as Hepatitis B, C and HIV.


2.     Definition

2.1    Skin prick with contaminated sharp.

2.2    Contamination of a break in the skin caused by abrasion, burn, eczema, etc.

2.3    Spillage into eyes or mouth.

2.4    Human bites where skin is broken.


3.     Prevention

3.1    Extreme care must be taken to ensure that needles and other sharp instruments are
       handled safely to prevent inoculation injury:

       •   The same person using the sharp instruments should dispose of them safely into a
           sharps bin which must be within arms length.
       •   NO attempt should be made to re-sheath needles before discarding them.
       •   Sharps boxes must not be overfilled.
       •   Broken skin e.g. cuts, abrasions, lesions must be covered with a waterproof dressing
           before commencing duty.
       •   Splashing of blood or body fluids on the face must be avoided. Goggles and masks
           or visors are provided for procedures anticipating splashes.


4.     Risk of Acquiring Blood Borne Viruses

4.1    The risk of acquiring Hepatitis C Virus infection following an inoculation injury with
       contaminated blood is 1 in 30 (3%).

4.2    The risk of acquiring Hepatitis B Virus infection following an inoculation injury with
       contaminated blood is 1 in 3 (30%).

4.3    The risk of acquiring HIV infection following an inoculation injury with contaminated
       blood is 1 in 300 (0.3%). (CDR 1998).

       For more information on HIV, Hepatitis B and C please refer to the Blood Borne Virus
       Policy.


West London Mental Health NHS Trust______________________________________________________ 6
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
5.      Course of Action following Accidental Inoculation – Advice to Staff

        The staff should carry out the following six point procedure (appendix 1): -

5.1     Needle pricks, cuts, human bites (Appendix 2)

5.1.1   Encourage bleeding by squeezing. Do not suck injury.

5.1.2   Wash thoroughly with soap and water.

5.1.3   Cover with waterproof dressing.

5.2     Splashes to mouth or eyes

5.2.1   Rinse thoroughly with plenty of running water.

5.3     Inform your Manager or the person in charge immediately

5.4     Report to or contact your nearest Occupational Health Department as soon as
        possible within the hour:

           West Middlesex Hospital occupational Health Department (0208 565 5044)
           8.30am – 4.30pm
           St Bernard’s Wing Uxbridge Road Occupational Health Department (020 8354 8919)
           8.30am – 4.30pm or
           Charing Cross Hospital Occupational Health Department (020 8846 1134)
           8.30am – 4.30 pm or
           Broadmoor Hospital Occupational Health Department (01344 754310)
           8.30am – 4.30pm.
           For the Cassell Hospital consider Kingston Hospital A&E Department.

        Whichever you can get to within one hour.

           Wilmot Ward at Ealing Hospital can also be contacted for advice on 020 8534 5465.

5.5     When the Occupational Health Department is Closed

5.5.1   Attend or contact your nearest A & E Department for further advice:

               Heatherwood Hospital (01344 623333)
               Ealing Hospital (020-8967-5613)
               Charing Cross Hospital (0208-8846-1006)
               Kingston Hospital (0208-546-7711 ext. 2181)
               Frimley Park Hospital (01276 604604)

        Please attend your Occupational Health Department the next working day.

5.6     Incident Reporting

5.6.1   Complete the Incident form on the exchange system in line with the Trust Incident
        Reporting Policy. Include the name of the patient from which the sharp/body fluid came.

5.6.2   It is the responsibility of the staff and his/her Manager to see that the above procedures
        are carried out.

West London Mental Health NHS Trust______________________________________________________ 7
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
5.6.3   The Manager must investigate the cause of the accident and take appropriate action.


6.      Action of Occupational Health or Accident & Emergency

6.1     The Occupational Health Department or Accident & Emergency Department will
        undertake an assessment to identify the risk of transmission of any of the viruses.

6.1.1   In addition to reporting immediately to Occupational Health or Accident and Emergency,
        the incident must be reported to the relevant Line Manager, in accordance with the
        Trust’s Incident Reporting procedure (I8).

6.1.2   To assist the risk assessment process, the clinician (Doctor) in charge of the source
        patient (if known) should undertake a risk assessment of that source. This may include
        obtaining a blood sample from that patient, with their informed consent (see Blood Borne
        Virus Policy).

6.1.3   If it is not possible to obtain a blood sample, then the risk should be assessed according
        to the available information. This information may assist in the initial assessment and
        can also be used to inform decisions at the follow-up stage. This information must be
        communicated to the Occupational Health or Accident and Emergency Department as
        soon as possible.

6.2     The following steps may be undertaken following risk assessment:

        •   If the risk is assessed as low (for BBV transmission), the Occupational Health
            Department or A&E staff will provide advice and reassurance, which will include a
            review of previous immunizations.

        •   If the risk is assessed as high or significant, the Occupational Health Department or
            A&E Department may provide/recommend some treatment as well as advice. This
            will almost certainly include taking some blood, which will be stored and potentially
            tested at a later stage (with informed consent), dependant upon the outcome of the
            risk assessment.

        a) Hepatitis B: The staff member’s immunization history will be reviewed. If there is
           evidence that the staff member has adequate immunity, reassurance will be provided
           and blood may be taken for future testing. If evidence is unavailable or immunity is
           not adequate, a booster vaccination or immunoglobulin may be offered, dependant
           upon the staff member’s immune status and the risk. For immunoglobulin to be
           effective, it should be administered within 48 hours of the incident.

        b) HIV: The risk of HIV transmission is low (see section 4 above). However, post-
           exposure prophylaxis (PEP) can be administered to reduce the risk of sero-
           conversion. A sample of blood can be taken from the staff member for HIV serology
           if indicated by the risk assessment. If there is an assessed risk of HIV transmission,
           urgent advice should be obtained, in order to consider post exposure prophylaxis
           (see section 7 below). PEP should be commenced within one hour of the incident.

        c) Hepatitis C: There is no vaccination or post exposure prophylaxis for Hepatitis C.
           Blood will be taken and stored. If the source is assessed as high risk or known to be
           Hepatitis C positive, further blood will be taken after 3 and 6 months and tested. If
           either test is positive, the initial sample will then be tested to ascertain whether or not
           transmission has occurred because of the inoculation injury. If transmission of the
           virus has occurred, relevant treatment can then be commenced.

West London Mental Health NHS Trust______________________________________________________ 8
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
6.3    Follow-up

       •   Following initial treatment and advice, the staff member will be followed-up by the
           Occupational Health Department. If the incident occurred out of hours, the staff
           member must report to Occupational Health on the next working day.

       •   Referral for specialist advice/counselling if required for the staff member can be
           arranged.

       •   Further blood tests and counselling can be arranged as necessary for the staff
           member.


7.     Post Exposure Prophylaxis

7.1    It has been suggested that following an inoculation injury, risk of HIV can be reduced
       with the use of Post Exposure Prophylaxis (PEP). Antiretroviral drug combinations are
       now used in HIV infected persons to suppress viral replication. The risk of
       seroconversion can be reduced using a recommended drug provided it is taken shortly
       after the occupational exposure.

7.2    Firstly, the incident must be reported to the appropriate persons.

7.3    A risk assessment will then be carried out. The Nurse in the Occupational Health
       Department or the Doctor in the Accident & Emergency Department will carry this out.

7.4    The Consultant and the exposed member of staff will make the choice of regimen.

       The following factors will also be considered: -

       •   Allergies.
       •   Pregnancy.
       •   Interactions with other medications.
       •   Resistance.

       Side effects may occur but are reversible.

7.5    Packs of drugs are available on Wilmot ward at Ealing Hospital, and the Accident &
       Emergency Departments at Charing Cross Hospital, Frimley Park Hospital,
       Heatherwood Hospital and Kingston Hospital.

7.6    Follow up and counselling will be arranged.


8.     Monitoring and Training

8.1    All staff attend infection control training on the Trust Mandatory Induction programme.
       This includes inoculation injury awareness.

8.2    Update training will be delivered as per mandatory training matrix

8.3    Mandatory training attendance is monitored monthly by Learning and Development.

8.4    Non-compliance of attendance at mandatory training will be followed up by Local

West London Mental Health NHS Trust______________________________________________________ 9
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
       Managers through supervision and annual appraisal.


9.     REFERENCES

9.1.   CDR Vol. 8 (no 20) 15th May 1998 175
9.2.   Department of Health. HIV Post Exposure Prophylaxis: Guidance from the UK Chief
       Medical Officers Expert Advisory Group on AIDS. UK Health Departments. July 2000.

Policy Reviewed by:                  Infection Control Team




West London Mental Health NHS Trust______________________________________________________ 10
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
                                                                                                 Appendix 1




             INOCULATION INJURY OR OTHER SIGNIFICANT
                    BODY FLUIDS EXPOSURE
                             Needle sticks,              Splashes into eyes,
                             cuts & bites                   mouth, cuts,
                                                             abrasions

                                    FIRST AID MEASURES
              Squeeze to make bleed                      Irrigate with copious
             Wash under running water                      amounts of water
               Cover with dressing

                                   REPORT THE INCIDENT

                                Seek immediate advice/treatment at




          Occupational Health Dept.                       Accident & Emergency Depts.
           (normal working hours)                        (outside normal working hours)
                                                                        at
                        at                        OR         Frimley Park Hospital
                                                             Heatherwood Hospital
          Broadmoor (01344 754310)                                      or
                                                           the nearest A&E dept. to
                   or contact                                     your location

         St. Bernard’s (020 8354 8919)                     Inform A&E staff that you are a
                                                            WLMHT employee and your
                                                               reason for attendance




     Risk                       Risk assessment                         Risk assessment
     assessment
     of source
     by clinical             Low risk – advice,                          High risk – initial
     team                      no treatment                            advice and treatment


                               Follow-up and                           Attend Occupational
                              appropriate referral                   Health next working day
                                                                     (if not attended already)




West London Mental Health NHS Trust______________________________________________________ 11
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
                                                                                    Appendix 2

       Guidelines for the Management of Human Bites

       These guidelines are intended for use by staff of the Trust in the event of a human bite
       injury to a member of staff or patient. A bite injury may occur in the form of a puncture
       wound, a scratch, or a laceration. In view of the infectious complications that may
       present following a human bite injury, it is essential that any human bite that breaks the
       surface of the skin at any point must be reported and treated in accordance with this
       guidance.

       Human Bites

       Both patients and staff may be at risk of sustaining human bites. It is well known that
       human bites have a higher complication and infection rate than animal bites (Mandell et
       al, 1995). Patients, including people who may bite themselves, are at less risk of
       infection as they will directly inoculate their own flora. Other than basic wound cleansing
       and application of a dressing if required, self-inflicted bite injuries will not normally
       require further action unless the wound deteriorates or becomes infected.

       The incidence of contracting HIV, Hepatitis B or C is considerably small from a bite or
       scratch, even if bleeding occurs. However it remains extremely important for all
       members of staff to ensure that they are inoculated covered with Hepatitis B vaccine.
       This vaccine does not boost the immune system against HIV and Hepatitis C.

       Action to be taken if a patient sustains a human bite from another patient:

       Where a patient sustains a human bite from another patient or visitor the following action
       should be taken:

       First aid should be administered immediately to the wound, which may include
       encouraging bleeding to remove any surface contamination, providing the wound is not
       bleeding spontaneously. Referral to a local A&E Department may be required if severe
       injury is sustained. Cleansing and covering the wound with a waterproof dressing if
       required.

       Consideration must be given to photographing the wound at an appropriate time in the
       event of legal action; this must be discussed with the Ward / Unit manager. Patient’s
       consent must be considered and in the case of a child, parents must be approached.

       In view of the need for early commencement of treatment, at weekends or out of normal
       working hours, the Infection Control Team should be contacted via the switchboard
       following a bite injury to a patient.

       Depending on the extent of the injury the affected patient may need to commence on a
       course of antibiotic therapy in accordance with Trust antibiotic policy.

       The affected patient should have bloods taken for storage: if the affected patient
       requests an HIV or blood test immediately following injury, the patient should be
       reviewed by the medical team and if necessary offered pre and post test counselling.

       A history of tetanus status should be taken from the affected patient and a booster
       considered: further advice may be sought from the Infection Control Doctor. Please note
       that Tetanus is no longer available as a separate vaccination and advice can be sought
       from the pharmacist.
West London Mental Health NHS Trust______________________________________________________ 12
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
       An accelerated course of Hepatitis B immunisation must be considered following risk
       assessment of the injury and in consultation with the Infection Control Doctor or
       Consultant in Communicable Disease Control.

       The patient who caused the injury may have bloods taken for HIV and Hepatitis B and C,
       if their status is unknown. This is carried out only after a discussion between the Multi-
       disciplinary Team and the Infection Control Team and in accordance with the Blood
       Borne Virus Policy. If the patient refuses to undertake these tests then a sample cannot
       be obtained. The Trust cannot authorise the test to be taken without the patient’s
       consent. If a child is involved, the parent’s consent will be required.

       If the patient who caused the injury is known to have caused similar injuries to other staff
       or patients, a risk assessment must be made by the Multi-disciplinary team to establish
       the suitability of care placement.

       An accident form must be completed and forwarded in the usual way following injury to a
       patient, even though the affected patient may request that no further action is required.

       Action to be taken if a member of staff sustains a bite from a patient:

       First Aid should be administered immediately to the wound, which may include
       encouraging bleeding to remove any surface contamination, providing the wound is not
       bleeding spontaneously. Arrest any profuse bleeding. Referral to a local A&E
       Department may be required if severe injury is sustained. Cleansing and covering the
       wound with a waterproof dressing if required.

       The injured member of staff must be referred to the Occupational Health Department,
       who will:

       Assess the Hepatitis B status of the injured member of staff and provide vaccination if
       necessary

       Take blood from the member of staff for storage

       Assess the need for a tetanus booster

       Offer advice and support to the injured person

       Out of hours advice can be obtained from the local A&E Department.

       Where appropriate and in accordance with the Trust Blood Borne Virus Policy, the
       Clinical Team of the source will risk assess and decide whether blood should be taken
       for Hepatitis B and C. This should be discussed fullest with the source.

       An accident form must be completed and the Line Manager informed.




West London Mental Health NHS Trust______________________________________________________ 13
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients
                     Statutory and Mandatory Training Updates and Refresher Training                                                                                                                                                                                                                                                                                                                                                    Appendix 3
                                                                                   PMVA Courses




                                                                                                                                                                              (Including Fire Awareness)
                                                                                                                                                                              Fire Marshall Training

                                                                                                                                                                                                           Basic Fire Awareness


                                                                                                                                                                                                                                    Moving and Handling

                                                                                                                                                                                                                                                          (Risk Management)
                                                                                                                                                                                                                                                          Health & Safety Update

                                                                                                                                                                                                                                                                                   Equality & Diversity

                                                                                                                                                                                                                                                                                                          Confidentiality
                                                                                                                                                                                                                                                                                                          Information Security and


                                                                                                                                                                                                                                                                                                                                       Safeguarding Children (Basic)
                                                                                                                                                                                                                                                                                                                                                                       (Community or In patient)
                                                                                                                                                                                                                                                                                                                                                                       Maintaining Patient Safety
                                                                                                                                                                                                                                                                                                                                                                       Clinical Risk Day
                                                                                                                                                                                                                                                                                                                                                                                                    Life Support)
                                                                                                                                                                                                                                                                                                                                                                                                    Defibrillation) (includes Basic
                                                                                                                                                                                                                                                                                                                                                                                                    Automated External


                                                                                                                                                                                                                                                                                                                                                                                                                                      Medical Emergencies

                                                                                                                                                                                                                                                                                                                                                                                                                                                            Infection Control -update

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Food Hygiene

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Mental Health Law Update

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Staff Only)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Security –update (Broadmoor

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Searching (Forensic)
    Staff Group




                           Lone Worker

                                         includes PSTS Theory
                                                                CAMHS, OPS,
                                                                              Specific (In Date)
                                                                              Teamwork Refresher Site


                                                                                                         Teamwork 5 Day Course

                                                                                                                                 Safety)
                                                                                                                                 Breakaway (Personal

                                                                                                                                                       Therapeutic Services
                                                                                                                                                       Promoting Safer and
     Frequency in years
                          1.5                                       1.5                                 1.5                        1.5                  1.5                              3                 1                      1-3*                             1               3                              3                   2                                             3                              1                  3                     3                             3            2                                     1                   2
      Length of course
         D =Days          2D                              Up to                                         5D                          1D                    1D                         1D                    1H                     Up                        0.5D                   1D                         2H                     Up to                                       1D                         0.5D                      1D                    1D                          1D             Up                                1D                     0.5
         H = Hours                                        3D                                                                                                                                                                      to                                                                                                  1D                                                                                                                                                               to
                                                                                                                                                                                                                                  1D                                                                                                                                                                                                                                                                   1D

    Clinical 1


    Clinical 2


    Non-clinical 1

    Non-clinical 2

    No Direct Contact 1


    No Direct Contact 2

       Teamwork Refresher for High Secure Services is 1 Day and does not include PSTS Theory
       Dependent on job role, location and Personal Development Plan.
   For other training courses specific to particular roles ie, Leave of Absence, First Aid training, Personal Protective Equipment etc, please see Mandatory
   Training Section on the Development Matters page of the Exchange.
West London Mental Health NHS Trust______________________________________________________ 14
Policy: ICP6 Date of issue: March 2005                            May be disclosed to patients

								
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