Falkirk Council has a legal responsibility under the general duties of the Health and Safety at Work etc, Act 1974, to as far as is reasonably practicable, safeguard employees against risks to their health, including those risks posed by infectious diseases.

In addition, there are specific regulations relevant to the control of infection including the Management of Health and Safety at Work Regulations 1999 and the Control of Substances Hazardous to Health Regulations 2002 (as amended). These regulations require employers to carry out risk assessments, record any significant findings and provide employees with adequate information, instruction and training on any risks to their health which they may face at work.

Policy statement

Falkirk Council recognises that due to the nature of some of the services provided eg caring for service users, uplift and disposal of household waste, road/sewage operations, the provision of first aid etc, it is possible that employees may, on occasion be exposed to infectious diseases or blood borne viruses (BBVs). These also occur naturally in domestic and social situations out-with work. Falkirk Council will fulfil its duty as an employer to protect employees and will ensure employees are provided with information and training as appropriate on the potential risks posed by infectious diseases and blood borne viruses in the workplace to minimise and control these risks.

Services will undertake risk assessments to identify employees who may be exposed to risk and will develop management procedures to control this risk. Where appropriate, Service Managers will discuss the requirement for a Hepatitis B vaccination programme with the Occupational Health provider in liaison with the Corporate Health, Safety & Care Team.

Scope

This Policy and guidance applies to all Falkirk Council employees and Contractors working on behalf of the Council. This policy complements the Health, Safety & Care Policy, Risk Management by Risk Assessment policy, the Accident /Incident Reporting policy and the Needle-Stick Policy. Although the prevention and management of infectious diseases is particularly relevant to Social Work Services Home Care, the term 'service user' can apply to school pupils, nursery schoolchildren, users of residential homes/hostels and homeless transit accommodation, etc. This guidance complements current guidance which is held in these Services.

All trained First Aiders or Appointed Persons are required to adhere to guidance received during training when administering first aid treatment.

Infectious diseases

Infections are caused by a person being exposed to either bacteria or viruses.

Bacteria

Bacteria exist everywhere and many are harmless or even useful. Some bacteria though can cause disease, either by invading the body, or by ending up in an area of the body where they should not be. Bacteria are made up of only one cell, too tiny to be seen. They are able to divide themselves and can spread very quickly.

Viruses

Viruses are also too small to be seen. They are not able to multiply on their own and rely on latching onto cells or getting inside them. They can then take over the cells ‘machinery' and make more virus particles. The cells making up our respiratory system are particularly open to viruses, as they are not covered by protective skin.

Employees can be exposed to infection in the workplace from four main sources:

• Blood and other body fluids eg saliva and sources of blood/body fluids such as human bodies, animal carcasses and raw meat
• Human or animal waste products such as faeces, urine and vomit
• Respiratory discharges such as coughs and sneezes
• Skin - as a result of direct contact.

Out-with work, employees can become infected if they eat or drink contaminated food or water, or through sexual intercourse. This policy does not cover those areas and information on these can be obtained from agencies such as Environmental Health and the National Health Service.

The Guide to infectious diseases provides general advice on the most common infectious diseases including symptoms, incubation period and treatment.

Infection transmission

To become infected, a micro-organism has to get from its source into a host by some means. Most micro-organisms usually have a particular route of entry, but in some cases infection can occur via more than one route.

Infection at work can occur as a result of:

• Putting contaminated hands, fingers or pens etc into the mouth, nose or eyes
• Breathing in infectious airborne contaminants from the air eg respiratory discharges such as coughs and sneezes, contaminated dust or spray from a cooling tower
• Splashes of blood or other body fluids into the eye or other mucous membranes such as the nose and mouth
• Broken skin if it comes into direct contact with the micro-organism, or something contaminated by micro-organisms
• A skin-penetrating injury eg via a contaminated needle or other sharp object or through a bite by an infected person, animal or insect.

Managing the risk

The process for assessing the risk of work place infection is the same as any other risk assessment. Managers should, in liaison with employees:

• Identify the hazards - where infection/BBVs may be present
• Decide who may be harmed and how - which employees and others may be exposed to infections/BBVs and how this might happen, for example through dealing with accidents or handling contaminated items for cleaning or disposal
• Assess the risk - how likely it is that infection/BBV's could cause ill-health and decide if existing risk control measures are adequate or whether more should be done
• Action - Ensure that procedures and safe systems of work are developed and implemented following the undertaking of risk assessments.

Factors to consider when undertaking a risk assessment include:

• The frequency and scale of contact with blood or other body fluids
• The volume and variety of different persons' blood/body fluids with which contact is made
• Any existing information on injuries/infections/conditions reported in the workplace
• The quality of control measures used
• Recording of findings/incidents
• Regular monitoring and review of risk assessment (at least annually) and re-assessment where necessary, eg an increase in incidents or a change in working practices/circumstances.

Where a risk assessment indicates that an employee is likely to be exposed to blood or body fluids and control measures may not provide sufficient reduction of potential risk, vaccinations eg for Hepatitis B, should be offered to employees. Line Managers should liaise with the Corporate Health, Safety & Care Team to discuss arrangements for the Occupational Health provider to arrange this. There may be a charge for this service. Examples of this may include employees exposed to biting incidents from pupils or service users, or where there is a high risk of accidental injury from discarded needle-sticks or sharps. To assist managers to undertake risk assessments and implement adequate control measures, an example generic risk assessment can be found below:

Downloads

Risk assessment (example)

DOCX file, 45.3 KB

To ensure that control measures are effective, managers must ensure employees are advised of the risks that have been identified relating to their job and of the measures that are in place to control exposure to risk. Employees need to know and understand when and how to apply the control measures, which may include the use of personal protective equipment (PPE), and what to do in an emergency.

Further guidance for employees who are carers is contained at Guidance for employees who are carers (how to avoid infection).

Rules/further guidance for catering staff is contained at Guidance for food handlers and kitchen staff.

General advice

Where employees are provided with a uniform, eg boiler suit, or overall, this is classed as personal protective equipment and it is important that it is cleaned regularly by the employee. This should be done by washing it at the highest temperature possible and separately from other uncontaminated clothing.

Most micro-organisms will be physically removed and/or killed if work surfaces/areas are cleaned with hot water and detergent. If a disinfectant is used, it is necessary to make sure that it kills the micro-organism and that it doesn't damage your work/surface areas – or cause any health problems for employees. It is also important to ensure that the process of cleaning doesn't create any risk, eg use low pressure hosing for cleaning large areas to avoid creating infectious aerosols/spores.

Where employees don't have access to soap and hot running water to wash their hands, eg because they aren't based at any one location, it may be possible to provide hand washing facilities on board a vehicle they are using. Alternatively, suitable alternatives such as antiseptic wipes, hygienic hand rub, or anti-bacterial gels can be useful for peripatetic employees eg home care employees.

Blood spillage

Spillages of blood and other body fluids/substances, (eg faeces, vomit, urine, pus), could contain pathogenic micro-organisms and may present a risk to any individual coming into contact with them. Managers in higher risk environments such as residential homes, hostels and the Joint Loan Equipment Service should consider having spillage kits available as these can help ensure the correct action in the event of a spillage. Spillage kits may contain, for example:

• disposable gloves (NOT latex)
• a disposable apron
• a clinical waste sack
• paper towels
• disposable cloths
• disinfectant
• tongs and sharps box for disposing of discarded needle-sticks or sharps.

Contact with blood or body fluids

The following precautions must be taken when there is any contact with blood or body fluids:

• Disposable vinyl or nitrile gloves should be worn when dealing with any blood or body spillages. A disposable apron should also be worn where appropriate.
• Any cuts or abrasions to the hands should be kept covered by a waterproof dressing (not fabric dressing).
• Splashes of blood or body fluids to the skin should be washed off immediately using soapy water.
• Splashes of blood or body fluids to the eyes or mouth should be rinsed immediately with copious amounts of water.
• Where there is the need for mouth-to-mouth resuscitation, a resuscitation aid or mask should be used.
• Spillages should be cleaned up immediately according to local procedures if applicable, using an appropriate disinfectant eg Milton, Presept or Vircon, and disposable cloths or paper towels.
• Contaminated gloves, dressings, wipes etc should be disposed of carefully in a plastic bag and disposed of according to local procedures if appropriate.
• First aid box contents should be replenished as soon as possible.
• Larger spillages can be contracted to agencies such as Rentokil. Using contracted cleaning providers will, however, incur a charge by the Service.

Waste disposal

Clinical waste by definition, means, any waste which consists wholly or partly of:

• Human or animal tissue
• Blood or other body fluids
• Excretions
• Drugs or other pharmaceutical products
• Swabs or dressings
• Syringes, needles or other sharp instruments which unless rendered safe may prove hazardous to any person coming into contact with it.

In practice, arrangements for managing clinical waste are based on categorisation of the waste into groups which present different hazards.

Some waste from human hygiene may carry micro-organisms. Examples include:

• Sanitary towels/tampons
• nappies
• stoma bags
• incontinence pads and
• other similar wastes, provided that they do not contain sharps.

When such wastes are generated in the home, they are generally healthy, and the waste is not considered to be either infectious or clinical waste. The house-holder may put it into the domestic waste, provided it is adequately wrapped and free of excess liquid. In the working environment, if there is no specific risk associated with a service user, then such wastes are not clinical waste, since they do not present a significant risk, either to employees or others. Nursery schools, day centres, residential homes etc should develop their own waste management policy to manage and control waste products. Risk assessment will identify that waste falls into two groups:

• those items or categories of items, that represent a significant risk of infection and
• those that do not.

Those in the first group are clinical waste and should be treated as such, while those in the second group may be treated as domestic waste. However, the offensiveness of substantial quantities of non-infectious waste needs to be taken into account when deciding on how to package the waste. If the risk assessment shows that waste cannot be disposed of through a purpose-built disposal unit then a system of colour coding can assist the process of waste segregation.

The following system is widely used for waste containers:

• Yellow - Group A clinical waste which will be incinerated in a clinical waste incinerator, or otherwise disposed of
• Yellow with black stripes - non-infectious waste, eg Group E which is suitable for landfill or other means of disposal
• Light blue or transparent with blue lettering - waste for autoclaving (pressurised heat treatment) or equivalent to eliminate contamination before disposal
• Black - treated clinical waste, non-clinical waste or household waste

In addition to colour-coding, the containers need to be of the correct standard for the waste they are to store. Service specific waste management policies should identify arrangements for the uplift, transport and disposal of clinical waste in line with the Council's waste management strategies.

Universal control precautions

Universal Control Precautions were developed and agreed by the World Health Organisation (WHO). The precautions were introduced to encourage global participation in reducing the risk of infection involved in health care and the caring professions and consist of basic procedures to ensure that carers have clean hands. The WHO leaflet: Hand Hygiene - When and How provides details of how to wash hands thoroughly.

It is not always possible to readily identify who could spread infection or to be aware of an infection being present when engaging with clients. Consequently, employees who are carers or who are involved in other areas of work that could present a risk of infection eg waste disposal, must assume that they are exposed to risk of infection and exercise the Universal Control Precautions on Hand Hygiene at all times.

All blood and body fluids are potentially infectious and precautions are necessary to prevent exposure to them. This involves avoiding injury by sharp objects and needle-sticks and avoiding contact with body fluids by use of Personal Protective Equipment (PPE).

Every employee is responsible for his/her actions and must ensure that they follow procedures, safe working practices as per risk assessments developed by their Service.

Roles and responsibilities

Service Directors

Service Directors are responsible for ensuring the effective operation of the Policy for the Prevention and Management of Infectious Diseases within their Service. They are also responsible for ensuring that adequate resources are made available to implement appropriate protective measures where risk assessments have indicated that these will be required.

Heads of Service and Head Teachers

Heads of Service and Head Teachers are responsible, so far as is reasonably practicable, for ensuring the health, safety & care at work of all employees and others in their respective services. Heads of Service and Head Teachers must ensure that in accordance with this policy:

• They implement management arrangements, within their Service through which the Policy on Prevention and Management of Infectious Diseases and Service based Risk Assessments, procedures and safe systems of work are communicated and implemented.
• Risk Assessments for the prevention and management of infectious diseases specific to their Service are developed, implemented and regularly reviewed. This includes the identification of groups of employees who work in higher risk areas and the implementation of a vaccination programme for those employees where a risk assessment indicates that this would be an effective control measure.
• Written procedures and safe systems of work based on these risk assessments are developed and implemented and that employees receive training on these procedures, safe systems of work and supporting risk assessments, as appropriate.
• All employees are made aware of the Policy for Prevention and Management of Infectious Diseases and Service based procedures safe systems of work and risk assessments.

Service Unit Managers

All managers who have operational responsibility for employees and for implementing systems and procedures of work will be specifically responsible for ensuring that:

• The Policy on Prevention and Management of Infectious Diseases is effectively implemented, monitored and reviewed in the area/activities under their supervision.
• All employees are made aware of and understand the content of the Policy on Prevention and Management of Infectious Diseases.
• Procedures, safe systems of work and risk assessments are developed and implemented relevant to the varying working environments and that all working procedures and practices are properly documented and adhered to.
• Appropriate safety equipment, including personal protective equipment (PPE), is supplied, properly maintained and used at all times by employees.
• Relevant health, safety & care training is provided to all employees to enable them to carry out their duties in a competent manner.
• All necessary arrangements are made and maintained in respect of accident/incident reporting, first aid provision, access to vaccination programmes and counselling if appropriate.

First Line Managers, Team Leaders, Supervisors and charge-hands

These employees have responsibility for implementing, monitoring and reviewing systems of work and risk assessments to achieve the aims of the corporate Policy on Prevention and Management of Infectious Diseases and Service based Health & Safety Policies. They are responsible for ensuring that:

• Employees within their area of control are made aware of the Policy on Prevention and Management of Infectious Diseases, Service based Health, Safety & Care Policies, Service vaccination procedure for employees working in higher risk areas, other relevant health, safety & care policies, risk assessments, procedures and safe systems of work.
• Employees adhere to procedures, safe systems of work, risk assessments and prescribed standards, including using specified equipment and wearing protective personal equipment (PPE).
• The Council's Accident/Incident Procedure is adhered to, including the reporting and investigation of accident/incidents, and that remedial action is taken, where appropriate
• All new employees undergo appropriate induction training which includes advice on the prevention and management of infectious diseases where applicable.
• Employees working in higher risk areas receive a copy of the Needle-stick information leaflet.

Employees

All employees of Falkirk Council must contribute positively to ensure the successful management of health, safety & care. To ensure the effective implementation of this policy, employees must:

• Safeguard their health and safety, and that of others, by following procedures and operating safe systems of work in accordance with the Policy on Prevention and Management of Infectious Diseases and other Falkirk Council corporate and Service based Health & Safety Policies, procedures and risk assessments
• Wear/use P.P.E. as instructed by their manager
• Alert line managers to unsafe practices, conditions or areas of concern
• Attend relevant training as instructed by their manager.

Head of Human Resources

The Head of Human Resources, in conjunction with Service Directors and Trade Unions, will monitor and review this policy as required.

A guide to infectious diseases

Guidance for employees who are carers (how to avoid infection)

Service users being provided with care pose significant risk relating to the development of health care associated infection, eg invasive devices and wounds. In addition, facilities within a client's home can sometimes make infection control measures problematic as there may be a lack of suitable hand-washing facilities, a lack of hygiene supplies, and difficulties in cleaning and decontaminating equipment. Despite this, the risks presented by providing care in a client's home are likely to be less than those presented in hospital.

Hand washing

Washing hands thoroughly and regularly is the single most effective way of avoiding infection. Artificial nails and nail polish should not be worn, as research has shown that they harbour bacteria and discourage people from washing hands properly. Hands must be thoroughly washed before and after:

• Attending the physical care of a client
• Handling items of clothing, bedding or laundry
• Dealing with pets/animal waste
• The use of disposable gloves and apron
• Using toilet facilities
• Eating and drinking
• Food preparation.

Refer to the World Health Organisation leaflet: Hand Hygiene - When and How.

Body fluids

When handling body fluids, disposable gloves and apron must be worn. Immediately after use, all disposable items should be placed in a plastic bag, and then into the bin liner for normal waste uplift. Employees have a responsibility to ensure the effective cleaning of each piece of equipment that is kept and used in a service user's home. This will reduce the risk of infection to anyone coming into contact with the piece of equipment.

Cleaning of utensils, equipment & clothing

All cleaning must be conducted thoroughly:

• Toilet facilities, commodes, etc: hot water and detergent should be used and gloves should be worn
• Clothing and bedding should be washed in hot water (over 65 degrees) and with a suitable detergent
• Moving and handling aids and equipment should be washed with hot water and soap/detergent
• Cutlery and crockery should be washed with hot water and suitable detergent

Given that it is not always possible to be aware if a client has, or is carrying any infectious condition, the precautions above must be practised with all service users at all times. However, where the responsibility lies with the service user or the service user's carers, it is important that they receive clear advice with regard to the correct procedure involving the control risk of infection relevant to the service user's condition. The use of household detergent and hot water is normally sufficient for cleaning purposes in a house. However, the manufacturers' instruction must always be consulted.

The frequency of cleaning will depend on the nature of the equipment, eg commode pots should be cleaned each time they are emptied, mattresses on the other hand can be cleaned at greater intervals, depending on the degree of soiling. Cleaning regimes should be incorporated within the service user's care package.

Cuts and wounds

Carers and Service users who have minor cuts or wounds should use waterproof dressings/plasters to ensure that infection is controlled and the cut or wound is kept dry.

Guidance for food handlers and kitchen staff

Rules on hygiene issued to all food handlers and kitchen staff and as displayed in all catering establishments

All catering staff must complete a medical questionnaire and possess a certificate of medical fitness prior to appointment. It is obviously important that in catering high standards of health and hygiene are maintained. When you have taken up your post, you must comply with these standards which are:

When you go to see your own Doctor for any reason you should make sure that he knows that you are a food handler.

From time to time you may suffer from diarrhoea and/or vomiting. If you do you should not be at work. If you are already at work you must see your Supervisor immediately.

You will normally be sent home for examination by your Doctor who may ask you to produce a faecal specimen before returning to work.

If any members of your immediate family have had an attack of vomiting and/or diarrhoea you should let your Supervisor know.

In certain circumstances you may be asked to go off duty until checks have been made. If this happens you should not be alarmed. It is a safeguard to protect your own health and that of the people who eat the food you handle.

If you sustain a cut or injury while at work, you must see the Supervisor and/or the First Aider immediately who will arrange whatever treatment is necessary. In your own interest make sure that an entry is made in the Accident Book and an Accident Report is completed.

Never think that an accident is too trivial to report.

Hands should be frequently washed in hot water with soap. Rinse and dry well. Nails should be kept short and scrubbed with care to avoid damaging the skin. Nail biting and finger licking should be avoided. Nail varnish should not be used. If you notice an infection of your skin, report immediately to your Supervisor.

Always wash your hands:

• Immediately before starting work
• After handling raw fish, poultry or meat
• After cleansing, handling swill or refuse
• After visiting the toilet, or using your handkerchief

Personal protective clothing must always be worn on duty. It should be changed regularly and frequently. Hair should be covered as much as possible and you must avoid touching it while on duty. Your protective clothing should only be worn whilst on duty.

Food handlers must not wear bracelets and necklaces or other such jewellery and, where possible, rings should be removed.

Footwear is very important. Shoes must be comfortable and well fitting. In your own interest, you should always wear strong shoes that are as slip-proof as possible. The following are examples of shoes unsuitable for the situation found in kitchens; sandals, "health" shoes, high heel shoes, plimsoles, trainers, and those without adequate means of fastening.

Smoking is prohibited in all working areas. This includes cooking and preparation rooms, storage areas including vegetable stores areas, trolley loading/storage bays, washing up areas and rooms without adequate ventilation which lead into or onto a food preparation area.

General rules for Personal Cleanliness

As further emphasis to the points listed above you are reminded of the following extracts which are taken from the Hygiene Regulations and can be regarded as 5 basic rules to be observed in order to prevent germs entering food:

1. There is a constant need for cleanliness of hands, face and other parts of the body likely to come into contact with food (e.g the hair and scalp and the forearms, particularly if short sleeves are worn): the need to avoid touching the nose and lips while handling food and to wash the hands frequently.
2. The need to maintain in a clean condition personal and protective clothing.
3. The need to completely cover open cuts and grazes with a detectable waterproof dressing.
4. The avoidance of spitting.
5. The avoidance of smoking, chewing tobacco, using snuff or chewing gum while handling food or while being in a room where food is present.

You must appreciate that these Regulations place a legal obligation on all employees handling food to comply with such rules on personal cleanliness.