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Hepatitis and HIV

Blood-borne viruses

Hepatitis B and hepatitis C, together with HIV (human immunodeficiency virus) are the most common blood-borne viruses found in the workplace. The risk of transmission of these viruses is low although the consequences can be serious. Some people show few or no symptoms whilst others become seriously ill.

Each of the following blood-borne viruses are unique in the way they are transmitted, treated, prevented, the symptoms that they present, disease progression and the impact on a person’s health. There are a number of steps you can take to prevent transmission.

Hepatitis B

Hepatitis B (HBV) is a virus that infects the liver. HBV is spread by blood and sexual fluids and is generally transmitted:

  • by needlestick injuries among health and community workers
  • by injecting drugs with a contaminated needle
  • through sexual contact
  • by transferring infected blood on razors, toothbrushes and other personal items
  • from splashes of blood and/or sexual fluids to the mouth, nose, eyes or broken skin
  • from mother to child during pregnancy or childbirth
  • by any other blood-to-blood contact.

HBV is not transmitted by saliva, sweat, urine or faeces. You can’t get HBV from kissing, touching someone who has HBV, swimming pools or from sharing cutlery or crockery with someone with HBV.

The incubation period for HBV is about 60-90 days. HBV can remain infectious in blood and body fluids outside the body for several weeks. HBV can cause a range of illnesses from inflammation of the liver to chronic liver disease and liver tumours. Most adults don’t suffer seriously - some only develop jaundice but others never recover and become long-term carriers. Those infected at birth are more likely to be carriers.

Infectiousness varies from one person to another – it may also be different for the same person at different times. If left unmanaged and untreated, long-term carriers risk developing serious liver damage such as liver cirrhosis – degeneration, inflammation and fibrous thickening of liver tissue and liver cancer. There is no cure for chronic HBV but the virus can be easily managed.

A vaccine is available for HBV – it is a protective measure and should not be relied upon to prevent exposure. A universal HBV vaccination program for infants and young adults is available in Australia but not everyone has been vaccinated. If you get exposed to hepatitis B and aren’t vaccinated, you can access a shot of immunoglobulin within 72 hours. Immunoglobulin reduces your chance of getting a HBV infection.

If your business includes any of the high-risk occupations listed in the table below, you should include a HBV vaccination protocol in your workplace policy. Talk to a medical practitioner. Workers should not be charged for their vaccinations, and they must be made aware of its advantages, disadvantages and limitations. They should also have access to their medical records on request.

Immunisation may take up to six months. In high-risk occupations, immunity should be checked at least four weeks after vaccination.

You can find more information about Hepatitis B at Hepatitis NSW or by calling the Hepatitis Infoline on 1800 803 990.

Hepatitis C

Hepatitis C (HCV) is a virus that infects the liver the same way as HBV. HCV is transmitted through blood-to-blood contact only – this means that HCV can only be transmitted when blood containing the HCV enters the blood stream of someone else. HCV can be spread by:

  • needlestick injuries among health and community workers
  • injecting drugs with shared needles
  • tattooing and body-piercing with contaminated equipment
  • sharing razors, toothbrushes and other personal hygiene items
  • from mother to child during pregnancy or childbirth
  • any other blood-to-blood contact.

The incubation period for HCV ranges from 40-60 days. The acute phase shows no symptoms but at least 75 per cent of infected people develop a chronic infection with symptoms ranging from mild to severe nausea, aches and pains and loss of appetite. If left untreated, HCV can lead to serious liver damage, liver cancer or even liver failure. Damage to the liver progresses slowly and the degree of damage varies.

There is no vaccination for HCV although treatment is available. Treatment is not the same for everyone – there are different types of HCV and therefore different drug treatments.

You can find more information about Hepatitis B at Hepatitis NSW or by calling the Hepatitis Infoline on 1800 803 990.

Human immunodeficiency virus

Human immunodeficiency virus (HIV) damages the immune system, making it unable to fight off infection. It is the cause of acquired immune deficiency syndrome (AIDS).

Several different conditions occur before AIDS develops. In the first few weeks, there are symptoms similar to those of glandular fever. Antibodies usually form at this time, within three months of infection occurring.

After the first few weeks, there is a long period with few or no symptoms, but HIV is detectable. Some develop a long-lasting enlargement of the lymph glands due to antibodies in the blood. This can last three to eight years.

As the virus begins to destroy the immune system, weight loss, fever, night sweats, diarrhoea and swollen lymph glands may commence. This usually progresses to full-blown AIDS – over several years – and develops when the immune system is severely damaged. HIV/AIDS is treatable, but related infections, cancers and neurological disorders can lead to death.

HIV is not as infectious as HBV or HCV, and is not usually transmitted non-sexually. However, it can be transmitted if infected blood or body fluids come in contact with broken skin or mucous membranes – eg in the eyes, nose or mouth. Sharing toothbrushes and razors also increases the risk of transmission.

HIV can remain infectious in blood and body fluids outside the body for several weeks.

There is no vaccine for HIV.

High-risk occupations

In addition to high-risk health care workers (doctors, dentists, surgeons and operating staff, nursing staff, ambulance and paramedic staff, etc) there are many other occupations where workers can be exposed to a BBV, including:

  • acupuncturists,  tattooists and body piercers
  • care  workers
  • crash site investigators
  • cleaners
  • council workers
  • correctional centre workers, prison guards, etc
  • emergency workers – police, fire brigade, SES, lifesavers, etc
  • first-aid providers
  • funeral workers, post-mortem technicians and other mortuary staff
  • hospitality staff – bars, cinemas, restaurants, etc
  • housekeeping staff – hotels, motels and caravan parks
  • laboratory and pathology workers
  • laundry workers
  • plumbers and other maintenance staff
  • postal workers
  • sanitation, garbage, recycling and sewerage workers
  • security guards
  • sex workers
  • taxi drivers
  • teachers
  • upholsterers
  • vehicle recovery, repair and service workers.

Control exposure risks

Identify hazards

Effective control starts with recognising potential sources.

Identify workplace activities that may put someone at risk of exposure. Talk with all of your workers about anything that could result in them being exposed to a blood-borne virus.  Analyse workplace incident reports. Check audits of the workplace layout and work practices.

Consider who is at risk. Do you have first-aid personnel? Are your workers exposed to violence and assaults? Do they clean toilets? Do they collect laundry? Do they handle rubbish?

Sources of a blood-borne virus include:

  • infected patients, clients and public – a virus is unlikely to be transmitted during everyday workplace contact; but it is more likely to occur if cut by a contaminated sharp object.
  • infected deceased bodies – don’t embalm infected bodies, they pose a significant risk of exposure.
  • contaminated items – includes anything contaminated with the blood or body fluids of an infected person, such as sharps, dressings, clothing, linen and furnishings.
  • equipment, including medical devices – sterilise everything before it is reused, even if blood isn’t visible.
  • motor vehicles – vehicles involved in traffic accidents are often contaminated with blood; be wary of sharp metal, broken glass and needles (vehicle service and repair workers should also be wary of sharp items found in upholstery and gloveboxes).
  • accident sites – including workplaces, playgrounds, roads.

Assess risks

To assess the risks of exposure to a blood-borne virus, take into account:

  • type and frequency of exposure – What factors could contribute to exposure? Poor lighting? Crevices that conceal used needles?
  • access to emergency and medical services
  • knowledge and training of workers
  • availability and use of personal protective equipment (PPE)
  • suitability of equipment  used for the task
  • individual risk factors for each at-risk worker, such as broken skin, dermatitis and eczema
  • availability of vaccines and post-exposure treatment
  • effectiveness of current risk control strategies.

Control risks

To control the risks, follow the hierarchy of controls as much as possible. Use higher level controls first. Only use administrative controls and PPE to supplement the higher controls you’ve implemented. A combination of controls can be used.

Eliminate the hazard

  • Have well-designed work premises, work processes and equipment, automated where possible.
  • Where practicable, don’t use sharps, needles, glass or metal.
  • Use standard precautions, such as washing hands with warm running water, liquid handwash and disposable paper towels.
  • Implement cleaning procedures for spills, contaminated equipment and the like.

Isolate the hazard

  • Isolate risky work processes, to reduce the number of people exposed.
  • Use a biological safety cabinet when handling blood products in the laboratory.
  • Use biological waste disposal systems.

Engineering controls

  • Use devices that incorporate safety features – eg safe needle devices and blunt-end scissors.

Administrative controls

  • Collect, store and dispose of contaminated waste safely.
  • Don’t eat, drink, smoke or apply cosmetics in areas where there is a risk of contamination.
  • Cover all cuts and abrasions with waterproof dressings and use suitable gloves.
  • Implement post-injury testing, counselling and follow-up processes.
  • Have a HBV immunisation program – including boosters – for all at-risk workers, including first-aid personnel.
  • Buy equipment that minimises the risk of exposures.
  • Good housekeeping.
  • Regular supervision.
  • Train workers in risk control measures.

Personal protective equipment

  • Ensure appropriate PPE is available, and used.
  • Wear rubber boots or plastic disposable overshoes if the floor is likely to be contaminated.
  • Provide non-porous waterproof dressings to workers with broken skin.
  • Provide water-resistant clothing – eg plastic aprons, overalls.
  • Provide a range of waterproof gloves, such as sterile and non-sterile, powder-free latex and vinyl, neoprene and nitrile.
  • Don’t use standard food-handling gloves, as they are permeable and easily damaged.
  • Provide fluid-resistant masks and masks with filters for mouth-to-mouth resuscitation.
  • Keep contaminated PPE separate.
  • Dispose of single-use PPE safely.
  • Launder contaminated PPE, such as coats, overalls and aprons.

You must also have a first-aid kit. See our code of practice for first aid in the workplace.

Sharp objects

Sharps injuries are a common cause of getting infected by a blood-borne virus.

Basic rules should apply if sharps are used (or found) in the workplace, including the following:

  • whoever uses the sharp, disposes of it
  • don’t pass sharps by hand, use tongs
  • use disposable sharps
  • don’t put a used needle back in its cover, put it in a sharps container
  • don’t separate a needle from a syringe
  • don’t break, burn or manipulate a sharp
  • don’t clean re-usable sharps by hand, use a long-handled brush and tongs or, better still, a machine
  • don’t keep potentially contaminated sharp objects for laboratory testing
  • don’t put hands or fingers into garbage bags, laundry bags, crevices and the like – use tongs
  • don’t manually compress garbage bags – use the tie-straps to lift and carry the bag

Sharps disposal containers should be sealable, rigid-walled and puncture-resistant. See AS 4031: Non-reusable containers for the collection of sharp medical items used in health care areas.

Contact the local council or health service for information about collection and disposal. Sharps should be appropriately stored until decontaminated or disposed of.

Don’t use drinks cans, bottles or cardboard boxes to dispose of sharps – they may find their way into domestic waste and present a hazard to council workers and the public.

Sharps containers should be installed in toilets, between hip and shoulder height level, but noteasily accessible to children. For example, they are best placed at shoulder height on the back of a toilet door, so children can’t access them – even if standing on a toilet seat.

Never try to retrieve anything from a sharps container, nor press down on the contents to make more room. Containers must be signposted and regularly emptied.

Spills

Clean-up spills of blood and body fluids immediately – and treat all waste products as contaminated.

For drops of blood and other small spills, wipe-up the spill with a paper towel, then clean with warm water, detergent and a standard disinfectant.

For larger spills (the width of your hand), use a spill kit that contains:

  • plastic disposal bags
  • sachets of granular disinfectant (to absorb the spill and minimise aerosols)
  • disposable PPE – eg: gloves, apron, mask, overshoes – and a respiratory device
  • a disposable scraper and pan

All disposable items in the spill kit should be replaced immediately after each use of the kit.

For large spills in outdoor workplaces, playgrounds and on roadways, hose down the contaminated area thoroughly, and contact the local council or the Environment Protection Authority (EPA) to find out what to do with any waste products.

If possible, don’t furnish your workplace with carpets, curtains and soft furnishings if it’s an area where blood or body fluid spills could occur. In some environments, such as home-care settings, this is obviously not practical, so contaminated furnishings should be professionally cleaned and laundered – or replaced. Washable chair covers are an option.

Cleaning

Contaminated items should be cleaned with detergent and warm water.

Wash all contaminated items as soon as possible after use, in an automatic machine if possible.

If you must wash contaminated items by hand, wear appropriate PPE, use a scrubbing brush and avoid splashing the water. Dry everything thoroughly before storing it away.

In some workplaces – hospitals, hairdressing salons, beauty parlours, tattoo shops and the like – contaminated items should be sterilised after cleaning, either by using chemicals, heat or ultrasonics.

Contaminated waste

Patients’ samples, cultures and contaminated waste from spills and first-aid – called ‘clinical waste’ – are the most likely things to carry blood-borne viruses.

Clinical waste is classed as dangerous goods. It can only be transported to a disposal site by someone authorised by the EPA. The vehicle must have a weatherproof, lockable compartment with appropriate signage, and a spill kit. The driver must get a signed statement from the producer of the waste and the disposal-site operator (who must also hold EPA authorisation).

Clinical waste should be stored:

  • in a clean, leak-proof, labelled container, suitable for transport to a disposal site
  • in a weatherproof secure location, isolated from other wastes
  • so that it does not represent a risk.

Develop safe work procedures for handling clinical waste that cover collecting, sorting, storing, transporting and disposal.

Laundry services

Clean and contaminated linen should be sorted, transported and stored separately. All used linen is potentially infectious, whether visibly contaminated or not. If visibly contaminated, store it in impermeable bags. Colour-code the bags to distinguish them.

Always wear appropriate PPE, such as leather or puncture-resistant gloves when handling contaminated linen. Make sure sharps containers are available.

The laundry should have hand-washing facilities, hot and cold water, lever taps, liquid soap and disposable paper towels.

Education and training

Let your workers know if they are likely to be exposed to BBV. Make sure everyone, particularly those in high-risk occupations, knows how to protect themselves by using safe work procedures, equipment and PPE correctly.

Training should be part of the induction program for new workers and should include information about first aid, HBV vaccination, counseling and updates about blood-borne viruses.

Emergency plans

Emergency plans must be developed in the event of a spill or other incident that might expose someone to a blood-borne virus. The plan should outline the PPE and other equipment to be used, first-aid procedures, special needs of any disabled workers, roles and responsibilities of relevant staff, and emergency services contacts.

Manage exposure incidents

You must have procedures in place in the event of a spill, splash or sharps injury. The procedures should include:

First-aid advice

  • For puncture wounds, gently encourage the wound to bleed – do not scrub or suck it – then flush under warm water, pat dry, and apply adhesive plaster (a pressure bandage may also be used to stop bleeding)
  • For eyes and mouth, splash with copious amounts of water if they are exposed to blood or body fluids
  • Remove contaminated clothing as soon as possible.

Medical advice

  • Get medical advice as soon as possible after exposure.

Counselling

  • Counselling should be made available to all those exposed.

Testing

  • Counselling and informed consent are required before any testing is undertaken – testing is voluntary and bound by privacy and antidiscrimination legislation.
  • Baseline testing should be conducted within 72 hours of exposure.

Prophylaxis treatment

  • Recommended within 24 hours of being exposed to HBV or HIV – should be given no later than seven days after exposure.

Notify incidents and keep records

You must notify SafeWork NSW and NSW Health of high-risk blood-borne virus exposure incidents.

Keep records for 30 years, which should include  registers of incidents, outcomes and recommendations from workplace investigations and evaluations of the effectiveness of actions taken.

Monitor and evaluate

Regularly monitor and evaluate your work practices to ensure they are effective. Involve your workers. Look at the equipment you use, compliance with policies and procedures, your training and vaccination programs, the sources and causes of exposures to blood and body fluids, and the effectiveness of post-exposure follow-up.

More information