In most workplaces, employees are not at risk from transmission of HIV, hepatitis B and hepatitis C. However, in workplaces where employees have contact with blood or body fluids there is a potential for transmission of these viruses.
This code of practice applies to those at highest risk – health care workers, police, prison officers and emergency response workers (firefighters and ambulance officers). It is designed to assist employers of these groups in identifying when the risk of transmission exists in the workplace, and if a risk is identified, in assessing and controlling that risk.
This code of practice should be used to:
- address concerns in the workplace regarding HIV, AIDS, hepatitis B and hepatitis C by providing guidelines for program development;
- assist with the formulation and implementation of workplace procedures and practices in accordance with developed programs;
- control the risk of transmission of HIV, hepatitis B and hepatitis C in the workplace;
- and contribute to a better understanding of the workplace issues associated with HIV, hepatitis B and hepatitis C through the provision of guidelines, resources, information and training by employers.
In this code of practice, the following meanings of terms apply:
- Acquired Immune Deficiency Syndrome (AIDS) is a condition in which the body’s immune system loses its ability to fight off infection and thus becomes vulnerable to opportunistic infections and certain cancers. This condition is caused by infection with HIV.
- Antibody is a protein, produced by the body’s immune system after infection or immunization. The function of an antibody is to adhere to and neutralize foreign substances in the body. It usually provides protection against the infecting organism or agent. This is not the case with the HIV antibody – refer to HIV antibody.
- Anti-viral drug is a substance which blocks or slows down the reproduction of viruses.
- Blood means human blood, human blood components aid products made from human blood.
- Body fluids means cerebrospinal fluid, peritoneal fluid, amniotic fluid, pleural fluid, pericardial fluid, synovial fluid, breast milk, semen, vaginal secretions, unfixed organs and tissues, saliva in association with dentistry and any other body fluids containing visible blood.
- Cleaning is the removal of all visible foreign material from objects, most commonly using water, mechanical action and detergents. Cleaning must precede disinfection and sterilization.
- Client means a member of the public (that is not an employee) who is seeking or receiving a service (including training) from an organisation.
- Contaminated means the presence, or reasonably anticipated presence, of blood or other potentially infectious materials on an item or surface.
- Discrimination means treating someone less favorably because they belong, or are presumed to belong, to a particular group of people.
- Disinfection is a process that eliminates many or all infectious micro-organisms except bacterial and fungal spores.
- Exposure means contact with blood or body fluids which may lead to the transmission of HIV and other blood-borne pathogens. Transmission in the workplace has been reported to have occurred in two major ways:
- when sharps contaminated with infected blood or body fluids penetrate the skin;
- or when infected blood or body fluids splash into the eye or other mucous membranes, onto broken skin or into a cut.
- Health care workers are people who work in health care settings (which includes employees, students, trainees, and voluntary workers) whose activities normally involve client or patient care and/or contact with blood or body fluids.
- Hepatitis is inflammation of the liver which can be caused by viruses, bacteria, chemicals, alcohol, and some medications.
- Hepatitis B is a form of viral hepatitis which can result in chronic hepatitis, cirrhosis of the liver or cancer of the liver, in addition to acute hepatitis. There is a vaccination available for hepatitis B.
- Hepatitis B immunoglobulin (HBIG) is a solution containing antibody from human blood. Hepatitis B immunoglobulin is used as a treatment following exposures to blood or body fluids. Immunoglobulin preparations are free from HIV and other human pathogens.
- Hepatitis C is a form of viral hepatitis which can result in chronic hepatitis, cirrhosis of the liver or cancer of the liver, in addition to acute hepatitis. It was previously known as non-A non-B hepatitis. There is no vaccination at the present time.
- Human Immunodeficiency Virus (HIV – includes HIV1 and HIV2) is the name of the virus that causes AIDS. This virus attacks a certain type of white blood cell that is a vital part of the body’s immune system.
- HIV antibody is the protein produced by the body’s immune system against the HIV virus. It serves as a marker for the presence of the virus and is the basis of the most common test for HIV. People who become infected with HIV usually develop HIV antibodies within 6 to 12 weeks of infection.
- Immunization is the process of providing immunity artificially by administering an immunobiological product.
- Infection is the invasion and multiplication of micro-organisms in body tissues. It may or may not lead to disease, either local or systemic.
- Mucous membrane is the membrane lining body cavities and passages, which are usually moistened with mucus. It is found in the mouth, eye, nose, rectum, vagina and urethra.
- Opportunistic infections are infections caused by a variety of agents that take advantage of the opportunity offered by an impaired immune system. These infections would seldom cause illness in people with normal immune function.
- Other blood-borne pathogens means other hepatitis viruses; bacteria such as tetanus and anthrax; and other blood-borne pathogens such as Creutzfeldt-Jakob disease (CJD).
- Patient includes (but is not limited to) a person who is accessing medical or health services or who is undergoing any medical or health procedure.
- Prophylaxis is treatment given to prevent illness or infection.
- Seroconversion is the new production of antibodies.
- Sharps means needles, cannulas, scalpels or blades, ends of dental wires, edged instruments, broken glassware, bone fragments or any other item that might penetrate the skin or mucous membranes.
- Sharps injury is an injury which occurs when a sharp penetrates the skin or mucous membranes. The most common form of sharps injury is a needle stick injury. Sharps injuries may lead to transmission of HIV and other blood-borne pathogens only if the sharp is contaminated with infected blood or body fluids.
- Source individual means any individual living or dead whose blood or body fluids are the source of exposure to HIV, hepatitis B or hepatitis C.
- Sterilization is a process which kills micro organisms, including bacterial and fungal spores.
- Transmission means the spread of infectious viruses, bacteria, and so forth from an infected person to another person.
- Universal precautions involves the routine use of safe work practices and protective barriers to minimize the spread of infectious diseases. It is a strategy which assumes that all blood and body fluids are potential sources of infection. This is consistent with the approach taken by the National Health and Medical Research Council and the Australian National Council on AIDS.
- Unsafe sex is any form of sex in which HIV (and other infectious diseases) passes from the blood, semen or vaginal fluids of one person directly into the bloodstream of another person.
- Vaccine is a biological substance administered into the body to induce immunity and thereby prevent infectious disease.
- Window period is a term used to describe the period of time from infection to a positive test for infection, it is called the window period because the person may be negative when tested, but may be infectious. The window period after HIV infection is usually 6 to 12 weeks.
Employers should develop a control program to prevent transmission of HIV and other blood-borne pathogens in the workplace. The program involves the development of procedures to prevent transmission of HIV and other blood-borne pathogens, and to monitor and evaluate these procedures.
The purpose of risk control is to minimize employee exposures to blood or body fluids in the workplace. Risk control should be achieved by applying the risk control hierarchy outlined below.
Elimination: Work practices associated with exposures to blood or body fluids, which have been assessed as not being necessary, should be eliminated.
Substitution: Where elimination is not practicable, the employer should substitute the work practices with suitable practices which present a lesser risk of exposure to blood or body fluids.
Engineering controls: Engineering controls are designed to prevent occupational disease and injury by management of the work environment. These controls may include the isolation of the process, material or worker; enclosure of the process; ventilation of the process or work environment; the use of mechanical equipment or automation; and modification of tools and equipment.
Employers should ensure that the workplace, and equipment used in the workplace, is designed to minimize exposures to blood or body fluids. This should include consideration of:
- ergonomic factors such as lighting, workplace maintenance and work station layout;
- new technology which may become available to improve employee safety by eliminating or substituting unsafe procedures (for example, protective guards designed for the purpose of re-sheathing needles);
- the instruments and equipment used in the workplace;
- and the development of procedures to ensure that instruments and equipment are checked regularly, and repaired or replaced as appropriate, to ensure their effectiveness.
Safe work practices: The fundamentals of minimizing the risk of transmission of HIV aid other blood-borne pathogens in the workplace are: personal hygiene, universal precautions and an infection control program.
Employers should ensure safe work practices are in place to minimize exposures to blood or body fluids. Employers should establish a procedure for safe first aid, to cover the eventuality of accidents occurring in the workplace.
If exposures to blood or body fluids do occur in the workplace, employers should have a procedure in place to manage such exposures. Any identified unsafe work practices should be modified after the consideration of elimination, substitution aid engineering controls.
Personal hygiene: Hand washing and hand care are important measures in infection control. Employers should ensure that hand washing facilities are provided at clearly identified sites in the workplace.
Hand washing facilities should be equipped with adequate supplies of running water, soap and single-use paper towels or hot-air drying machines. When it is not possible for employees to wash their hands in running water, alternative methods for hand cleaning should be made available.
Employees should wash and dry their hands: (a) after contact with blood or body fluids; and (b) immediately after removing gloves. Employees should check for cuts or abrasions on exposed parts of the body. Cuts or abrasions should be covered with waterproof dressings.
Employees should maintain a high standard of personal hygiene, (for example, hands should be washed at the beginning and end of each shift and before and after eating, drinking, smoking and going to the toilet).
Universal precautions: The use of universal precautions will minimize the risk of transmission of HIV and other blood-borne pathogens from client to employee, from employee to client, and from employee to employee.
Universal precautions are intended to minimize transmission from infected blood or body fluids splashing into the eye or other mucous membranes, onto broken skin or into a cut.
Universal precautions should be applied in all situations in which employees have contact with blood or body fluids. Although the adoption of universal precautions will minimize contact with blood and body fluids, it cannot prevent sharps injuries.
Immunization for hepatitis B: Employers should offer to provide a course of hepatitis B immunization to all employees who may be exposed to blood or body fluids.
A full course of hepatitis B vaccine should be given; this consists of three doses – given at zero, one and six months. The full course must be given before protection will be adequate. The frequency of seroconversion increases from 35 percent after one injection to over 90 percent after the third injection.
Employees should be screened for seroconversion one to three months after the third injection. Those who do not seroconvert should be offered a fourth dose of vaccine and they should be re-screened for seroconversion.