Management of Inoculation Injuries Policy User Control Panel

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Last Review Date             New policy to Doncaster PCT
                             Community Infection Prevention and
Approving Body               Control Group

Date of Approval

Date of Implementation

Next Review Date
                             Wendy Feirn
Review Responsibility
                             Head of Infection Prevention and

Version                      1

   Directorate signature   Director of Quality & Clinical

                           Name: Julie Bolus

                           Signature: …………………….

                           Date: …………………………..
                     Doncaster Primary Care Trust
                Management of Inoculation Injuries Policy


                                     Title                        Page
Section A - Definitions                                           3
Section B - Policy                                                3
1.0          Introduction                                         3
2.0          Legislation and Guidance                             3
3.0          Policy Statement                                     4
4.0          Scope                                                4
5.0          Aims and Objectives                                  4
6.0          Accountability and Responsibilities                  5
7.0          Training                                             5
8.0          Record Keeping (Clinical Policies only)              6
8.0          Policy Review and Dissemination                      6
9.0          References (if applicable)                           6
Section C – Procedure

             General Advice for Inoculation, bite, scratch and
             contamination of conjunctiva or mucous membrane

             Management of Inoculation injuries involving staff   9 - 10

             Individuals Exposed To Blood Borne Viruses in
             Health Care Settings

             Management of Inoculation incidents involving the
             General public

Inoculation injuries are defined as follows:

    (a) Needle-stick or Sharps injury: These may be caused by needles,
        scalpels, razor blades, broken glass or any sharp instrument. Sharp
        tissues such as pieces of bone or teeth may also pose a risk. Glass
        items such as ampoules, capillary tubes, and glass slides must be
        treated as sharps and disposed of accordingly. If there is any doubt
        about whether an item should be treated as a sharp, it must be treated
        as one.

    (b) Human bites and scratches which break the skin and involve visible

    (c) Contamination or splashing of the mucous membrane (eyes, nose,
        mouth) or conjunctiva with blood or body fluids

    (d) Contamination or splashing of any open wound or skin lesion e.g.
        eczema with blood or body fluids.

Blood Borne Viruses

Blood borne viruses (BBV) are viruses that some people carry in their blood
and which may cause severe disease in certain people and few or no
symptoms in others. The virus can spread to another person, whether the
carrier of the virus is ill or not.

These viruses can also be found in body fluids other than blood, for example,
semen, vaginal secretions and breast milk. Other body fluids or materials such
as urine, faeces, saliva, sputum, sweat, tears and vomit carry a minimal risk of
BBV infection, unless they are contaminated with blood. Care should still be
taken as the presence of blood is not always obvious.
Health and Safety
Major blood-borne pathogens associated with inoculation injuries are hepatitis
B, hepatitis C and HIV.

Hepatitis B is a blood-borne viral infection that can be prevented through
vaccination. The hepatitis B virus (HBV) causes hepatitis (inflammation of the
liver) and can also cause long-term liver damage.

Hepatitis C infection (also known as Hep C or HCV) is another virus that can
cause long-lasting infection and can lead to liver disease. There is no
vaccination to prevent HCV.

Human immunodeficiency virus (HIV) causes Acquired Immune Deficiency
Syndrome (AIDS). HIV destroys the body's ability to fight infection by
attacking the immune system. This results in infected individuals becoming
susceptible to opportunistic infections.



At times healthcare staff are injured by sharp objects (especially needles)
which are contaminated with a patient’s blood or body fluids. Healthcare staff
may also receive bites or scratches or their mucous membranes or broken
skin may be splashed with blood or blood-stained body fluids.
This inoculation policy applies to all such situations.
In office hours such injuries should immediately be reported to the
Occupational Health Department.

In circumstances where the injury has occurred out of hours the injured
person should attend the A & E Department. The incident should then be
reported to Occupational Health on the next working day.

On occasions members of the public or workers in the community will also
sustain needlestick injuries e.g. children playing with discarded syringes or
police officers arresting violent drug users. Such patients should attend A & E

This policy aims to prevent and reduce the acquisition of blood-borne viruses
from inoculation injuries, both to members of staff and the general public.


             Department of Health - Standards for Better Health (2004).
             Department of Health - Health Act (2006).
             Department of Health - Essential steps to safe, clean care
             Department of Health - Management of Healthcare Waste
             Guidance for Clinical Healthcare workers: Protection against
              infection with Blood borne Viruses HSC 1998/063
             HIV Post exposure prophylaxis: Guidance from the Chief
              Medical Officer Expert Advisory group on AIDS DOH 2004
             The Control of Substances Hazardous to Health (COSHH)
              regulations 4th Ed 2002
             Health and Safety at Work Act (1974)


3.1   The Trust will ensure that injury or contamination to staff, patients and
      others is reduced to the lowest level of risk possible by following the
      guidance contained within this Management of Inoculation Injuries
      document. To achieve this Trust accepts that a management of
      inoculation injuries Policy requires a high level of management

3.2   This policy and procedural document is the PCT's response to confirm
      that it will fulfil its statutory obligation with the help and support of staff.

4.0   SCOPE

4.1   This policy applies to those members of staff that are directly employed
      by Doncaster PCT and for whom the PCT has legal responsibility. For
      those staff covered by a letter of authority/honorary contract or work
      experience this policy is also applicable whilst undertaking duties on
      behalf of the PCT or working on PCT premises and forms part of their
      arrangements with the PCT. The PCT recognises that primary care
      practitioners are also part of the organisation and as such offers this
      policy for use by them to adapt to their own practices and organisations
      as appropriate. The contact for the policy (see front page) is available
      to offer help and support to primary care practitioners who wish to use
      and implement this policy. As part of good employment practice,
      agency workers are also asked to abide by the PCT policies and
      procedures, as appropriate, to ensure their health, safety and welfare
      whilst undertaking work for the PCT.


5.1   This policy has been developed in order to:

            Prevent the acquisition of blood borne viruses from inoculation
             injuries, both to staff and the general public
            Ensure all staff employed or working for the PCT are aware of
             their responsible for reporting any occurrence of inoculation
             injury to their line manager.
            Direct staff on the management of inoculation injuries to both
             staff and the general public
            Ensure infection prevention and control training is provided for
             all healthcare staff.


       The Chief Executive has overall responsibility for the implementation of
       this policy and procedure.        The Chief Executive delegates this
       responsibility to the Director of Quality and Clinical Assurance as the
       Director for Infection Prevention and Control.
       The Director of Quality and Clinical Assurance has the responsibility as
       Director for Infection Prevention and Control to ensure that adequate
       resources are available to manage infection control within the PCT.

       The Head of Infection Prevention and Control is responsible for working
       with the Director of Quality and Clinical Assurance, Assistant Director
       of Strategic Support and Heads of Services to co-ordinate the provision
       of Infection Prevention and Control services within the PCT.

       It is the responsibility of all staff to act in the best interests of the patient
       and adhere to the principles and practices of standard infection
       prevention and control procedures.

       It is the responsibility of all staff to ensure regular attendance at
       Infection Prevention and Control educational programmes, inclusive of
       management of inoculation injuries.


7.1     Staff will receive instruction and direction regarding infection
        prevention and control practice and information from a number of
        sources: -
             PCT Policies and Procedure Manuals
             Line Manager
             Training- at Induction and annual Infection Prevention and
              Control Workshops
             Infection Prevention and Control Team
             PCT extranet


8.1.1 Staff are required to ensure adequate records are maintained at all
      times in accordance with PCT policy and guidelines from professional
8.1.2 All staff are required to report the inoculation injury immediately to their
      line manager.
8.1.3 An incident form must be completed by the injured staff member.


9.1.1 This Management of Inoculation Policy will be reviewed biannually, and
      in accordance with the following on an as and when required basis: -

                Legislative changes
                Good Practice Guidance
                Case Law
                All Inoculation injury Incidents reported
                Changes to organisational infrastructure

9.2        The Management of Inoculation Injury Policy is located in the Clinical
           Policy Manual. A set of policy manuals is available at all staff base
           points and all staff policies/strategies are available via the PCT

9.3        Staff will be made aware of policy reviews as they occur via team
           briefs and team meetings.

9.4        Related Policies/strategies/Organisational Functions

9.4.1      A number of other policies/strategies in the Clinical Policy Manual
           are related to this Inoculation policy and all employees should
           be aware of the full range including the Trust’s Antibiotic Policy.

9.5        Equality Impact Assessment

           As part of its development, this policy and its impact on equality
           have been reviewed in line with NHS Doncaster’s Equality Scheme
           and Equal Opportunities Policy. The purpose of the assessment is to
           minimise and if possible remove any disproportionate impact on
           employees on the grounds of race, sex, disability, age, sexual
           orientation or religious belief.

9.6       The Equality Impact Assessment has been completed and has
          identified possible adverse impact on one or more of the equality
          strands. Conclusions and recommendations have resulted in an
          action plan to be implemented by the Directorate.

9.7       The EIA has been forwarded to the Equality and Diversity Manager
          for audit and publication purposes.

9.8       The code to evidence the completed EIA is... EIA071.... The EIA will
          be reviewed and amended in line with legislative changes when
          appropriate or in line with the review date of this policy.


      1. Guidance for Clinical Healthcare Workers: Protection against infection
         with Blood borne Viruses HSC 1998/063

   2. Department of Health (2004) HIV Post exposure Prophylaxis: Guidance
      from the Chief Medical Officer expert advisory Group on AIDS

   3. Department of Health (2004) Standards for Better Health. London

   4. Department of Health (2005).A Health Technical Memorandum: Safe
      Management of Healthcare Waste. London. Crown Copyright.

   5. Department of Health (2006). The Health Act: a code of practice for the
      reduction of healthcare associated infections. London. Crown

   6. HM Government. Health and Safety at Work Act 1974. London: HMSO;
      1974; 2(1).


General Advice for Inoculation, bite, scratch and contamination of
conjunctiva or mucous membrane Injuries

The following actions must be taken immediately

A) Sharps and Needlestick injury

      Encourage Bleeding

      Do not suck , scrub or rub the injury

      Wash the injured area with soap and water

      Cover with a waterproof dressing

B) If bitten or scratched, or if skin lesions or wounds become contaminated
   with blood or body fluids

      Wash the injured area with soap and water
      Cover with a waterproof dressing

C) If contamination of the conjunctiva or mucous membrane occurs ( eyes,
   mouth, nose)

      Irrigate the eye thoroughly with copious amounts of water or normal saline
       before and after removal of contact lenses.
      Irrigate the mouth thoroughly with drinking water without swallowing the

Management of Inoculation injuries involving Staff:

This guidance must be used in conjunction with the Safe Use and Disposal of
Sharps Policy

These principles apply whether the injured staff member is managed in:
      the Occupational Health Department ( office hours 8.00 am – 4 pm) or
       A & E department ( out of hours)
      If the incident is managed by A & E, it is essential that the Occupational
       Health department is informed as soon as possible to ensure the incident
       is documented.

   1) The incident must immediately be reported to the staff member’s line

   2) The injured staff member must complete an incident form.

   3) The injured staff member should contact the Occupational Health
      Department or A&E (if out of hours). The details of the injury should be
      recorded, including the type, time and likely volume of inoculation.

   4) A 5 ml clotted blood sample (1 x gold top) is required from both patient
      and staff member involved

   5) Informed consent must be obtained

   6) The sample must not be taken if informed consent is not obtained.

   7) If consent is refused or unobtainable guidance must be discussed with
      the Occupational Health Department , Consultant in genitourinary

      medicine and /or Consultant Medical Microbiologist in all cases

   8) If the patient is on the ward ask a doctor to take the sample and record
      the name of the doctor or senior nurse involved

   9) If the patient is at home informed consent and blood sample must be
      obtained as soon as practicable.

   10) The injured staff member should not take the blood sample themselves

The Staff member’s sample ( recipient)

This sample will be saved in the microbiology department in case, during
subsequent months, the staff member develops problems related to the
inoculation incident. This sample then acts as a baseline.
If the staff member has been immunised against Hepatitis B within the last 1 –
4 months but has not had their antibody level checked then this can be done
using the baseline sample at the time of the incident. The sample will be saved
for possible future reference.

The patient’s sample (source of injury)
This sample will be either saved or tested for the presence of blood-borne
viruses e.g. hepatitis B, C or HIV. Under no circumstances should testing be
carried out without a patient’s informed consent.
A careful risk assessment should be carried out on the patient to determine if
any of these tests are required and, if so, how urgently. Advice can be obtained
during office hours from the Occupational Health Department and out of hours
from the Consultant Microbiologist.
An “Inoculation Injury Procedure” form will be completed by Occupational Health
or by A&E.

The patient’s blood should be tested as soon as possible following the incident.
If the patient is in a high risk group then they may require urgent testing.
This must be discussed with the microbiologist

Provision of Information

If Hepatitis B, C or HIV testing is necessary consent must be obtained from the
patient. A provision of information leaflet (appendix one) should be given to the
patient by the person taking the blood sample. Further guidance can be
obtained from the Consultant in genitourinary medicine or Consultant

In all other circumstances the person taking the samples should explain that the
sample will be saved only, and that no further tests will be carried out on the
sample without the patient’s prior consent.

If consent is refused or unobtainable guidance must be discussed with the

Occupational Health Department, Consultant in genitourinary medicine and /or
Consultant Medical Microbiologist in all cases

If the source patient belongs to a high risk group (e.g. intravenous drug user
(IVDU), homosexual, originates from high-risk country) then consideration
needs to be given to testing for blood-borne viruses, such as Hepatitis B, C and
HIV, as prophylactic antiviral therapy may be of benefit.


Source Patient’s laboratory form
On the source patient’s laboratory form write in the clinical details section
“Inoculation injury to (Name of Staff Member) on (Date, Time)”.

Staff member laboratory form
On the staff member’s form, write in the clinical details section “Inoculation
injury. Source of injury is (Name, Location)”. Write down whether the member of
staff has had a course of hepatitis B vaccine and the result of antibody test if

Individuals Exposed To Blood Borne Viruses in Health Care Settings

Any person exposed to the risk of blood borne viruses in any healthcare
setting (including a domiciliary care situation) should be assessed and
managed according to the principles laid out in the guidance provided by
Occupational Health or A & E department at Doncaster Royal Infirmary.

Support will be available to the individual during and after the incident. This
support can be accessed through several sources including line management,
Human Resources or Occupational Health.

Management of Inoculation incidents involving the general public

All inoculation injuries involving the general public must be referred to the
Accident and Emergency department at Doncaster Royal Infirmary

                                     Appendix One

         Doncaster and Bassetlaw Hospitals NHS Foundation Trust

    Patient information following staff exposure to your blood or
                             body fluids.

Testing information for patients

A member of staff has been accidentally exposed to your blood or body fluids
during the course of their work. We are requesting to test your blood in order
to assist the member of staff. Three specific viruses are covered in this
information sheet. All three viruses can be present in your body without your
knowledge. We ask every patient in this situation if we can test him or her for:

    HIV (Human Immunodeficiency Virus): A virus that can be transmitted
     through blood, body fluids, and sexual exposure. Examples include
     sharing needles, syringes or equipment for drugs, tattoos, body piercing,
     through unscreened blood transfusions, and from mother to baby.
    Hepatitis B: A virus that affects the liver and is passed on in the same
     way as HIV.
    Hepatitis C: A virus that affects the liver and is usually passed on through
     blood or sharing needles or other equipment during recreational drug
     injecting. Other examples include tattoos, body piercing, and unscreened
     blood transfusions.

Frequently Asked Questions:

What does the test involve?

A 5 ml sample of blood will be taken from your arm. If any of the results are
positive, the test will be repeated to confirm the result.

Who will know my test result?

The result will be given to you in confidence and your own doctor will be
informed. The doctor looking after the member of staff affected will be
informed, unless you request otherwise.

What if I am found to have one of these viruses?

If the test shows that you have one of these viruses, you will be offered care,
support, and treatment.

What are the benefits of having these tests now?

You can have these viruses with or without any symptoms. If you have
Hepatitis B or Hepatitis C virus, treatment can often help to cure you and
reduce the damage to your liver. New treatments are available for individuals
with HIV. The treatment for HIV may be more effective if it is given before any
serious illness develops

How can this help the member of staff who has been exposed to my

If you are carrying a blood borne virus the member of staff affected can be
followed up to see if the virus has been transmitted to them and treated if

Will having the HIV test affect my chances of getting life insurance?

Doctors do not need to report negative HIV tests when writing insurance
reports. Insurance companies should no longer ask whether you have had an
HIV test, they should only ask whether or not you are HIV positive (As agreed
by the Association of British Insurers 1994).

What are the drawbacks of having the HIV test?

If you do have HIV, the benefits of knowing usually outweigh the
disadvantages, which may include difficulties in relationships with family and
friends or, for some, employment issues. Travel to some countries is currently
restricted for people who know they have HIV.

If you have any further questions, please do not hesitate to ask a member of
staff. When you have read this information sheet and asked any questions
please sign below. You may have a copy of this information sheet.


I fully understand the information given to me and have had the opportunity to
ask questions regarding the tests.

I agree/do not agree to have my blood tested for HIV, Hepatitis B, and
Hepatitis C.

Signed…………………………………………………                              Date…………………….

Print name…………………………………………………..


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