APPENDIX 1: THE 5 MOMENTS FOR HAND HYGIENE

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1 APPENDIX 1: THE 5 MOMENTS FOR HAND HYGIENE (WHO 2009) Page 1

2 APPENDIX 2 - HAND WASHING TECHNIQUE WITH SOAP AND WATER Page 2

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4 APPENDIX 3: SKIN CONDITIONS Page 4

5 APPENDIX 4 - GUIDE TO GLOVE SELECTION NB: A risk assessment must always be carried out 5

6 APPENDIX 5 COLOUR CODING OF SHARPS BINS 6

7 APPENDIX 6 - FOUR EASY STEPS TO REMEMBER IN CASE OF NEEDLESTICK INJURY ALLOW IT TO BLEED WASH IT WITH SOAP UNDER RUNNING WATER COVER IT WITH A WATERPROOF DRESSING REPORT IT

8 APPENDIX 7 SHARPS INJURY PROCEDURE 8

9 Occupational Health Services Royal Berkshire Hospital 21 Craven Road Reading RG1 5LE Tel: Fax: Procedure for taking blood from source patient after an Inoculation Injury 1. Please give information for source patient s leaflet for patient to read 2. Take consent, fax it to Occupational Health Department and file it in patients notes 3. Please ensure Path form is completed and signed by a doctor or nurse. 4. Please write patient s consultant s name in requesting location and additional copy to Occupational Health Department 5. Please request for HIV Antibodies, Hep B Surface Antigen and Hep C Antibodies in any other test. 6. Please write SOURCE PATIENT- POST INOCULATION INJURY in clinical information 7. Take blood in red virology bottle and send it to Lab immediately 8. For any queries please ring Occupational Health Department

10 Occupational Health Services CONSENT FOR SCREENING FOR BLOOD BORNE VIRUSES FOLLOWING A BLOOD EXPOSURE INCIDENT TO A HEALTHCARE WORKER. To: (Source Patients Name): Address: (Affix hospital label if available): DoB (dd/mm/yyyy): A healthcare worker involved in your care has sustained an exposure to your blood or body fluids which may put them at risk if you are infected with Hepatitis B, Hepatitis C or HIV. In order to ensure that the healthcare worker receives appropriate treatment, we need to test your blood to find out if you are infected with these viruses. If you have any reason to believe you may be infected with Hepatitis B, Hepatitis C or HIV, or wish to discuss the implication so having your blood tested for these conditions, please discuss with the doctor before signing this form. Please read the Information for Source Patient carefully and discuss in confidence any of the risk factors with the medical staff responsible for your care. The results of these blood tests will be given to you by the team responsible for your care. They will also be given to our Occupational Health Service to help them care for the healthcare worker. The standard of your care will be unaffected whether you agree or refuse to undergo these tests. I understand that I am being asked to undergo blood testing for Hepatitis B, Hepatitis C and HIV. I understand that the results of this test will be given to me. I consent to my blood being tested for Hepatitis B, Hepatitis C and HIV. Signed: Print Name: Date Print name of Doctor/Nurse Manager requesting consent : Signature: Date Please fax this document to Occupational Health Department Fax number after taking consent. 10

11 CG082 Sharps, Inoculation Injury and Needle-stick Policy Appendix J INOCULATION INJURY - Risk Assessment & management Plan Form RISK ASSESSMENT FORM OH Staff received call: Passed to: Initial Assessment By: Date & Time: Occupational Health Department 21 Craven Road, Reading Berkshire RG1 5LE Tel: Fax: INJURED PERSON (RECIPIENT) Name Employer Date of Birth Contact Number Job Ward/Department Date of injury GP Details Time of Injury INJURY & REPORTING How Injured: Needlestick Sharp Item Bite (which breaks the skin) Scratch (which breaks the skin) Splash incident What was involved with: Blood yes no Blood stained Body Fluids yes no Non blood stained Body Fluids yes no no Description of incident Was the injury encouraged to: Bleed Washed Was protective clothing work at the time of the incident Yes Describe No Was it a high risk incident? Yes reason No Reported by (Name of staff member): Date of Incident: Time of Incident: Reported to (Name of OHA) Discussed with OHP: Incident / Datix form completed. Yes / No Name of manager to whom incident was reported- 11

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13 APPENDIX 8 DECONTAMINATION CERTIFICATE DECONTAMINATION CERTIFICATE Before any equipment is sent for repair or servicing to an external body it must be decontaminated (cleaned) and a certificate completed. The certificate must accompany the equipment; the company concerned should ask for evidence of decontamination and failure to supply this may result in return of the equipment. Surgery/Practice: Description of equipment Make Model Serial No. Please select one box and tick accordingly The above piece(s) of equipment has been appropriately decontaminated following patient usage This equipment MAY be contaminated by potentially infected material and has been decontaminated externally as per decontamination policy This equipment MAY be contaminated but could not be decontaminated because, (Please give details) SIGNATURE DATE NAME DESIGNATION 13

14 APPENDIX 9 BLOOD SPILLAGE GUIDANCE 14

15 GENERAL INFECTION PREVENTION AND CONTROL REFERENCES Care Quality Commission (CQC) Essential standards of quality and safety. Accessed via: _dec_2011_update.pdf Department of Health Health Technical Memorandum 64 Sanitary Assemblies. Accessed via: Department of Health Health and social care act 2012 fact sheets. Accessed via: Department of Health Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance. Accessed via: Department of Health Health Building Note 00-09: Infection control in the built environment. Accessed via: Department of Health Environment and sustainability, health technical memorandum: 07-01: Safe management of healthcare waste. Accessed via: Health and Safety Executive (HSE). (nd.) Carriage of dangerous goods. Accessed via: Hoffman, P., Bradley, C. and Ayliffe, G Disinfection in healthcare. Blackwell Publishing: Oxford. National Institute for Health and Clinical Excellence Infection: prevention and control of healthcare associated infections in primary and community care. Accessed via: 15