body fluids

LOUGHBOROUGH UNIVERSITY

CODE OF PRACTICE
FOR PERSONS HAVING CONTACT WITH HUMAN BODY FLUIDS

Introduction		Sterlisation Procedure
Procedures		Spillages
	Blood Sampling	Disposal
	Faeces	First Aid
	Urine	Needlestick injuries
	Saliva	Hepatitis B immunisation
	Thermometers	General
	Skin surface electrodes	Persons trained to perform venous blood sampling
	Skin needle electrodes
	Spirometry

INTRODUCTION

This Code of Practice is concerned with the range of potential hazards that exist within the University's activities from Hepatitis 'B' and the Human Immunodeficiency Virus (HIV) (or Lymphadenopathy-Associated Virus (LAV)/Human T Cell Lymphotropic Virus Type III (HTLV III) virus) which is responsible for AIDS.

HIV can be transmitted by blood, blood products, semen, vaginal secretions and possibly other bodily fluids containing visible blood - the virus has also been isolated from saliva, tears, urine, breast milk and brain tissue. However, it must be stressed that HIV is not readily transmissible, the main risk to workers in this University being through accidental percutaneous inoculation from infected blood by contaminated needles and sharps of all descriptions. There is good evidence that infection from such accidents in laboratories and in hospitals treating AIDS patients is extremely rare.

PROCEDURES

The following identifies areas of potential risks and describes universal precautions and procedures to be followed by all personnel whose work brings them into contact with human body fluids both inside and outside of the University. The training and the handling procedures to be adopted by students and research staff will be the responsibility of the member of the academic staff concerned with the work.

Laboratory coats or side-fastening gowns must be worn at all times. Disposable gloves must be worn by staff and students when handling body fluids or materials which may have been contaminated with body fluids. Particular care should be taken to cover any cuts on the hands. Use waterproof dressings (available in all laboratory First-Aid kits).

NB protective eye wear should always be worn during procedures that are likely to generate splashes of any body fluids containing visible blood.

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Blood sampling (High risk area).
Never re-sheath needles. Never re-use needles or cannulae. When handling blood samples always wear gloves.

Venepuncture and intravenous cannulation to be carried out only by staff trained for these procedures. The list of trained persons is held by the University Ethical Advisory Committee

Finger Prick sampling may be carried out by other laboratory users after instruction from staff in charge of the laboratory and only with continuing supervision. Never re-use autolets or lances. Never carry out pipetting by mouth. If containers/phials become externally contaminated, clean immediately with 5% soluble sodium hypochlorite.

Faeces (Low risk area, although haemorrhoidal blood could be a hazard)
Wear gloves.

Urine (Low risk area, although menstrual blood could be a hazard)+
Wear gloves.

Saliva (Low risk area, although bleeding gums and mouth sores could be a hazard from participants using mouthpieces)

In other cases wear gloves when handling used mouthpieces. After use participants undertake their own cleansing procedure (see "Sterilisation" below).

Thermometers glass (Low risk area)
Allocate 1 thermometer per person. Do not use for more than one person without sterilisation. After use clean and sterilise. See "Sterilisation" below.

Thermometers - plastic-coated rectal probes (Low risk area)
After use participants first wipe clean and wash with soap and water. Place to soak and sterilise (as for sterilisation procedure). See disposal for any cloths, swabs or paper towels used.

Skin surface electrodes: ecg, eeg, emg (Low risk area)
Source of risk - exudates, capillary haemorrhage from skin abrading. If abrading wear gloves. Equipment hazards: disposable electrodes, electrode swabs, orange sticks, tape, paper bench-cloths. Dispose of these immediately after first use. Never share. Use once only. Dispose of razors, needles, in designated sharps container. Remaining material - see "Disposal" below.

Sterilise non-disposable electrodes after every single use. Each participant must remove his/her own electrodes, immediately wash them - in the approved manner - and then place them in the prepared disinfectant, as directed by the staff. Then follow "Sterilisation" procedure (below).

Skin needle electrodes (High risk area)
To be carried out only by suitably qualified staff. In normal circumstances these are banned from use in this University. An application for use may be made only through the University Ethical Advisory Committee.

Spirometry (Low risk area)
The only recommendation at present is that the water in water-trap spirometers is drained immediately after use and the spirometer left to dry. Valves and mouthpieces - after use see "Sterilisation" (below).

STERILISATION PROCEDURE
Participants first wash their own equipment with soap and water. Next use freshly activated 2% glutaraldehyde or 2% phenolic disinfectant or sodium hypochlorite (10,000 ppm available chlorine). The preparation of disinfectant solutions should be undertaken wearing gloves and eye protection near to a sink. Particularly in the case of fresh glutaraldehyde solution, care is necessary to minimise exposure to glutaraldehyde vapour during the preparation, use and disposal of used solutions. If possible the preparation and disposal should be done in a fume cupboard and the container of the solution used for the disinfection of rectal probes should be a narrow necked vessel, e.g. a stable measuring cylinder or jar. Soak for 1 hour. Clean with a detergent and then soak for a further 3 hours in a fresh solution of glutaraldehyde or other (as specified above). Re-wash, rinse and air dry. See section below on disposal for any cloths, swabs or paper towels used. Possible alternative chemical disinfecting agents are ethyl and isopropyl alcohols.

SPILLAGES
If any body fluid is spilt clean down using sodium hypochlorite or disodium dichloroisocyanurate powder (10,000 ppm available chlorine, equivalent to household bleach 1 part to 10 parts water) and disposable paper towels or IJI cloths (see disposal below) - wear gloves and eye protection. Contact with mucous membranes - wash freely in running water and have eye wash bottles available (these should be proprietary sterilised and sealed eye wash bottles that will only need to be changed after use, i.e. if the seal has been broken).

DISPOSAL
All sharps must be placed in a designated plastic puncture-proof sharps container and will be collected by technical staff for disposal by incineration via the University system for clinical waste disposal. Syringe packaging should not be placed in these sharps boxes but needles should not be removed from the syringe or re-sheathed before disposal into sharps boxes.

All contaminated material, i.e. cloths, swabs and paper towels containing blood, other body fluids and faeces, should be put into plastic yellow bags, and will be transferred on a regular basis to large yellow plastic bags. After double bagging and sealing these large bags (marked Loughborough University via Leicestershire County Council) will, after temporary secure storage, be collected by technical services for disposal by incineration using the University system for disposal of clinical waste.

FIRST-AID
Accidents where blood is present, e.g. cuts - wash under running water with soap or an antiseptic suitable for skin. Encourage bleeding. Clean surfaces, where contaminated with blood - deal with as for spillages. All staff and technicians should read the DHSS booklet "Aids and Employment" which has specific reference to dealing with bleeding (copies will be available in each Department).

All accidents involving inoculation or cuts and possible contamination from body fluids must be reported by the individual concerned to the academic member of staff with overall responsibility for the work as well as to the nearest first aider.

Accidents of this nature must be recorded in the Departmental Accident Book. See a first aider or the Departmental Safety Officer.

Additional advice, where necessary, will be available from the Health and Safety Office, Occupational Nurse or the Medical Centre. The members of staff will be responsible for ensuring that accidents are reported to the Departmental Safety Officer who will ensure the appropriate form is completed and submitted to the University Health and Safety Officer as soon as possible.

Needlestick injuries
All inoculation-type injuries should be reported immediately to the responsible member of the academic staff and should be recorded in the Accident Book B1 150. The injured individual should initially encourage bleeding by squeezing the area under running water before going to the Medical Centre for assessment and possibly further treatment.

If at all possible, a sample of the "donor" blood should be obtained for testing as soon as possible; donor consent is necessary before this can be carried out. Subsequent management depends on these results and the state of hepatitis immunity of the injured individual which should be held in an accessible record.

In the event of the donor being found to be HIV positive, urgent consultation with the doctor at the Medical Centre is essential for discussion on further management.

Hepatitis B immunisation
Hepatitis B immunisation is advisable for all staff who regularly carry out venepuncture/cannulation as, although the donor group would be deemed to be low risk in the circumstances of work in this University, the frequency with which each operator performs the techniques may be high. Immunisation is also advisable for staff or research students who regularly handle blood samples.

The simplest means of obtaining the vaccine is through general practitioners and the cost would be for a single prescription charge only. Three injections are given, the second after four weeks, the third at six months. It is essential that post-immunisation sampling is carried out to confirm seroconversion has taken place and certificates to this effect should be obtained from each operator and placed with their records in the department. These should be accessible for checking in the event of a needle-stick injury. Some individuals, particularly in the over-40 age group do not respond to the vaccine and they should have a note to this effect in their record.

GENERAL

1. General information will be made available in the laboratories and other areas drawing attention to the availability of information, such as the report of The Advisory Committee on Dangerous Pathogens, on the hazards of dealing with human body fluids (previously referred to) and to the availability of expert advice. This information may be obtained from the Departmental Safety Officer or the University Health and Safety office.

2. An adequate supply of equipment, materials, sterilising and disinfecting agents and double plastic bags will always be available. Responsibility for this will be in the hands of the laboratory technicians within each Department concerned.

3. It is the responsibility of the Departmental Safety Officer (in conjunction with the University Safety Officer) to ensure that adequate and safe facilities are available for the disposal of waste including disposable protection equipment, sharps, faeces and urine and other contaminated substances and materials.

4. Specific training of students and research staff will be arranged by members of academic staff concerned.

5. Where students and staff are undertaking work outside the University's premises, it shall be the responsibility of the member of academic staff concerned to ensure that they and the students are aware of all potential hazards from hepatitis and HIV and that adequate precautions are being taken.

6. This document will be distributed to all academic staff in Departments where work may give rise to risks described herein. Each Departmental Safety Officer will ensure that existing and future members of the Department whose work may bring them into contact with human body fluids sign a declaration confirming that they have read and will abide by the contents of the document. Copies of this document should be displayed in laboratories of the departments concerned.

7. Periodic monitoring procedure should be undertaken in each Department to check that these guidelines are being adhered to. This should be the duty of the Departmental Safety Officer and, where appropriate, the Chair of the Departmental Ethical Advisory Committee who will report to the Departmental Safety Committee.

8. The University Ethical Advisory Committee will keep this Code of Practice under review, taking advice from the University Health and Safety Officer and the University Occupational Health Physician as appropriate.

Loughborough University Ethical Advisory Committee

Persons trained to perform venous blood sampling.

Venepuncture

Professor Emeritus AE Hardman (SSES)
Dr R Hooper (HS)
Professor Emeritus PRM Jones (HS)
Dr H K Lakomy (SSES)

Dr S S Mastana (HS)
Dr M E Nevill (SSES)
Dr C Nicholas (SSES)
Mrs ML Nute (SSES)

Venous cannulation

Professor Emeritus AE Hardman (SSES)
Professor Emeritus PRM Jones (HS)
Dr ME Nevill (SSES)

Dr C Nicholas (SSES)
Dr D Stensel (SSES)
Professor C Williams (SSES)

Withdrawal of blood samples through a venous cannula

Those listed above to carry out venous cannulation plus the following: (all SSES)

A Ali
D Bailey
M Bruce
P Cherry
G Falero

C Koutsari
S Newport
ML Nute
M Peyrebrune
K Stokes

C Sunderland
A Tsampoukos
C L Wu

03.05.2000
Robin Hooper
Chair University Ethical Advisory Committee

Return to Ethical Advisory Committee Home Page

1.	General information will be made available in the laboratories and other areas drawing attention to the availability of information, such as the report of The Advisory Committee on Dangerous Pathogens, on the hazards of dealing with human body fluids (previously referred to) and to the availability of expert advice. This information may be obtained from the Departmental Safety Officer or the University Health and Safety office.
2.	An adequate supply of equipment, materials, sterilising and disinfecting agents and double plastic bags will always be available. Responsibility for this will be in the hands of the laboratory technicians within each Department concerned.
3.	It is the responsibility of the Departmental Safety Officer (in conjunction with the University Safety Officer) to ensure that adequate and safe facilities are available for the disposal of waste including disposable protection equipment, sharps, faeces and urine and other contaminated substances and materials.
4.	Specific training of students and research staff will be arranged by members of academic staff concerned.
5.	Where students and staff are undertaking work outside the University's premises, it shall be the responsibility of the member of academic staff concerned to ensure that they and the students are aware of all potential hazards from hepatitis and HIV and that adequate precautions are being taken.
6.	This document will be distributed to all academic staff in Departments where work may give rise to risks described herein. Each Departmental Safety Officer will ensure that existing and future members of the Department whose work may bring them into contact with human body fluids sign a declaration confirming that they have read and will abide by the contents of the document. Copies of this document should be displayed in laboratories of the departments concerned.
7.	Periodic monitoring procedure should be undertaken in each Department to check that these guidelines are being adhered to. This should be the duty of the Departmental Safety Officer and, where appropriate, the Chair of the Departmental Ethical Advisory Committee who will report to the Departmental Safety Committee.
8.	The University Ethical Advisory Committee will keep this Code of Practice under review, taking advice from the University Health and Safety Officer and the University Occupational Health Physician as appropriate.