Information for Practitioners: Blood-Borne Viruses
When a needle breaks a person’s skin, microbes can get in and blood (possibly containing microbes) can get out.
This information contains guidelines on how to protect yourself and your client from the risk of blood-borne infections.
What is blood-borne infection?
This is any infection which is transferred from the bloodstream of one person to the bloodstream of another. Most infections are caused by viruses, the most significant of which are mentioned below.
How is blood-borne infection spread?
Blood, serum or small fragments of tissue inevitably adhere to the needle or instrument used. These can then be transferred to dyes, operator’s hands or other objects in the room if stringent infection control procedures are not followed. As a result, other instruments, cloth or paper that come into contact with the pierced skin, may also become contaminated.
If instruments or materials are contaminated with infected blood, infection can be spread through:
- An open lesion on the skin or more rarely by blood in the eye or mouth
- By injury with a sharp contaminated object
What causes blood-borne infection?
Hepatitis B
The virus of hepatitis B is very resilient and spreads readily from person to person by contact with very small amounts of infected blood, serum or tissue fluids. It has been known to survive for at least eight years on inanimate surfaces in a laboratory and can also show more resistance to disinfections than HIV.
With tiny abrasions in the skin, or where a procedure involves piercing the skin, even where blood is not normally drawn, the serum that exudes is equally infectious. A person could feel well, (the incubation period is two to six months and the person is infectious), or be a “carrier”, and in these instances there is usually no sign that the person is carrying the infection. The long-term carrier of hepatitis B is usually symptomless.
Early symptoms are fever accompanied by an intense loss of appetite. The skin and eyeballs may go yellow, and the urine can go dark and the stools pale. Patients may feel severely ill for several months. The liver may fail and very occasionally the patient may die (less than 1 in 100). Some (about 1 in 10 of those infected) may not be aware that they have contracted the infection, but can still suffer the long-term complications which include liver disease, liver failure and cancer.
Hepatitis C
This is a virus which usually causes mild or no symptoms on initial infection. However, as with Hepatitis B, patients may go on to develop long-term liver disease and may not be aware that they have contracted the infection. At the present time there is no vaccination available.
HIV
The Human Immunodeficiency Virus (HIV) attacks the body’s immune system and renders it ineffective against many infectious diseases. When initially infected, patients occasionally have mild flu-like symptoms and then usually remain completely well for many years.
Eventually the body’s defences become more and more depressed, other infections and symptoms are seen, including weight-loss, fever and night sweats. The disease progresses until the person suffers from Acquired Immunodeficiency Syndrome (AIDS). AIDS is the result of the depletion of specific immune cells caused by HIV.
How can I prevent the risk of blood-borne infection?
Those with any of the above infections may not show any signs of illness, but can still be infectious to others. As in hospitals, it is sensible to treat blood and articles contaminated with blood from any client as if it were infectious.
Some procedures to protect you and your clients:
- Practice good hand hygiene. Wash and dry hands well before and after any procedure where skin is pierced. Wear single use disposable gloves. Gloves should be made of latex or vinyl.
- Cover all cuts, grazes and rashes with a waterproof plaster.
- Only use sterile single-use, disposable instruments to breach skin.
- Other articles must be sterilised by the appropriate type of autoclave.
- Autoclaves must be regularly maintained, and staff trained in their use.
- Articles soaked in disinfectants are not sterile.
Sterilisation: the complete removal of all microbes
Disinfection: a reduction in numbers of microbes to levels where bacterial infection probably will not occur.
With regard to hepatitis B virus, disinfection of instruments is not adequate, and instruments must be sterilised.
- Blood spillage should be cleaned up using a bleach solution (1 part bleach to 10 parts water) which should be kept in contact with the spill for 2 minutes. Bleach tablets are ideal to ensure an adequate concentration is reached. Always follow the instructions on the product.
- Know what to do if contaminated with a sharp object.
- Sharps must be disposed of in a sharps box, which should be collected and disposed of by a licensed contractor, as with any other contaminated waste.
Risk of infection from equipment
| High | Medium | Low |
|---|---|---|
| Anything that enters a normally sterile body (i.e. below the skin) | Anything in contact with intact mucous membrane | Anything in contact with intact skin |
Decontamination of equipment
| High | Medium | Low |
|---|---|---|
| Sterilised | Sterilised or chemical disinfection | Sterilised, heat or chemical disinfected or cleaned |
Decontamination: Disinfection, Sterilisation
Cleaning is required before the decontamination process of disinfection or sterilisation. Steam sterilisation in an autoclave is preferred but it is essential to maintain equipment and ensure proper use.
Disinfectants are often unstable and generally inactivated by organic contaminants – blood, tissue and other body fluids. Items in close contact with the skin or mucous membranes, or introduced in to a sterile body area (eg instruments, dressings, implants) should be sterilised.
| Instruments | Skin | Worksurfaces, equipment and jewellery | |
|---|---|---|---|
| Bleach | No | No | Yes (hard, man-made work surfaces, but not for jewellery) |
| 70% alcohol | No | Yes | Yes |
| Dettol™ or Dettox™ | No | No | Yes (work surfaces only) |
| Chlorhexidine | No | Yes | No |
| Povidone-iodine preparations | No | Yes | No |
| Glutaraldehyde (e.g. Cidex™, Omnicide™) |
This substance is both an irritant and a potent allergen.
Exposure to it is strictly controlled under COSHH. |
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