Blood-borne diseases - Infection risk

It has been estimated that more than 18 500 needle-stick injuries occur in Australian hospitals each year (Murphy, 2008).  These injuries present a risk of transmission of blood-borne diseases such as HIV, Hepatitis B and Hepatitis C. Health care workers who are regularly exposed to blood and body fluids are most at risk. They include but are not limited to surgeons, doctors, dentists, dental assistants, nurses, operating theatre staff, laboratory staff, orderlies, ambulance officers and trainee health care workers.

Other groups of workers who may be exposed to an infection risk include prison officers, police officers, funeral workers, sex industry workers and some waste industry workers. 

The Occupational Safety and Health Act places a 'general duty of care' on employers, to provide (as far as practicable) a workplace and systems of work where employees are not exposed to hazards. Employees must take reasonable care of their own safety and health and that of others affected by their work.

Further information on reducing the risks of blood-borne viruses, including standard precautions, is available in the National Code of Practice for the Control of Work-related Exposure to Hepatitis and HIV (Blood-borne) Viruses [NOHSC:2010 (2003)] Copies of this code can be downloaded from the Safe Work Australia website.

‘Universal Precautions’ is the international term used by the medical industry to describe the set of measures introduced to allow medical staff to safely handle material that may carry blood or body fluids infected with diseases. The National Health and Medical Research Council (NHMRC) has recommended the term 'universal precautions' be substituted with 'standard precautions' as the basic risk minimisation strategy.

Health care workers should presume that the blood and body fluids of all persons being treated could potentially be a source of infection. Additional precautions may be required in areas of high risk.

Standard precautions are designed to prevent infection from inoculation, contact with mucous membranes such as the mouth or eye, or through skin damage such as cuts.

The main principles of standard precautions are washing hands, care of intact skin, protection of damaged skin, proper handling and disposal of sharp objects, good hygiene practices, and careful handling of all blood and body fluids.

Personal protection must be provided and available in all areas where blood and body fluids may come into contact with personnel. Gloves, waterproof aprons or gowns, and masks or protective eye wear must be worn where appropriate. Workers with cuts or abrasions on exposed body parts must cover these with waterproof dressings. Double gloving has been shown to further reduce risks in those who perform exposure prone procedures (Yang, 2011).

Workplaces should develop safe work procedures using standard precautions adequate to protect employees in the course of their work. Areas of concentrated risk such as emergency departments may require special work systems to ensure that employees remain adequately protected.

Safety engineered devices have been shown to reduce the rate of sharps injuries among healthcare workers (Jagger, 2008) and should be used where practicable. 

Workers should be provided with information, education and training in relation to disease risks and control measures. This has been shown to reduce injury risks (Yang, 2011).

• Jagger, J. 2008. The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: The critical role of safety-engineered devices. Journal of Infection and Public Health. 2008;1(2):62-71
• Murphy, C. 2008. Improved surveillance and mandated use of sharps with engineered sharp injury protections: a national call to action. Healthcare Infection 2008; 13: 33-37 
• Yang, L. and Mullan, B. Reducing needle stick injuries in healthcare occupations: An integrative review of the literature. International Scholarly Research Network, 2011.