Hepatitis B Policy

Hepatitis B Immunisation Policy

Introduction

The University is aware that some of its staff might be exposed to the Hepatitis B virus as a consequence of their employment. Good working practices should minimise the risk of occupationally acquired Hepatitis B, but as an additional measure, these are to be augmented by Hepatitis B immunisation policy. This will apply to all work activities involving actual or potential handling of blood or other body fluids and tissues.

Clinical personnel who have contracts with the University and Sheffield Teaching Hospitals NHS Foundation Trust (STHFT) will be governed by the STHFT Hepatitis B policy and the Occupational Blood and Body Fluid Exposure policy document in the case of contamination injury.

Legislation

Health and Safety at Work Act, 1974

Management of Health and Safety at Work Regulations, 1999

Specific Legislation

Control of Substances Hazardous to Health Regulations, 2002 (COSHH)

What is Hepatitis B?

• Who requires vaccination?

Hepatitis B is a serious viral infection causing inflammation of the liver which is spread by contact with blood or body fluids (through vaginal / anal intercourse, blood to blood contact e.g. sharing needles – intravenous drug users, `needlestick´ injuries) from an infected person. The virus can infect without causing symptoms but some suffer an acute disease with flu-like symptoms. If the infection persists it becomes chronic and the infected person may go on to develop cirrhosis or liver cancer (WHO, 2000).

Transmission rates from infected persons are variable depending upon the degree of risk and the individual´s immune status.

Who requires vaccination?

• To include all employees who have direct contact with blood, blood-stained body fluids or human tissue samples.
• Employees who are at risk of injury from blood-stained instruments.

Occupations considered `at risk´

Embalming and Mortuary work
Accommodation Campus Services
Health Care
Laboratory Researchers / Technicians (forensic work etc.)
Maintenance / Refuse disposal / Estates
Medical / Dental Work / Health Care
Staff carrying out research e.g. in human sciences etc.

This list is not intended to be comprehensive.

All departments and sections which have identified a potential for exposure to Blood Borne Viruses (BBV´s) should carry out a local risk assessment, taking into account the general guidance given in this policy.

General Principles

The risk of exposure to blood borne viruses can be significantly reduced by:

• Good hand washing techniques
• Protective clothing, proportionate to the level of risk
• Covering broken skin with plasters and suitable gloves
• No consuming of food or drink in areas where there may be risk of exposure to BBV´s

Gloves and skin protection

Disposable gloves should be worn when handling body fluids / tissue. These should be of a kind suitable for the activity, further guidance can be obtained from http://www.hse.gov.uk/latex/labs.htm (powdered latex (rubber) gloves should not be used because of the high risk of causing allergic reactions).

Nitrile gloves are often a good alternative to latex.

The wearing of gloves does not replace the need for hand washing.

An alcohol-based gel hand rub can be used as an alternative to hand washing where hands are not visibly contaminated e.g. between research subjects and after removing gloves.

Laboratory clothing should be washed at a high temperature, ideally above 60ºC.

Waste disposal and sharps

All sharps (metal & glass, needles, blades, syringe needles, hard plastic pipette tips able to puncture plastic bags, etc.) must be placed in designated sharps containers (Yellow top) the container should not be filled more than 2/3 full, for incineration.

Wastes contaminated with cytotoxic or cytostatic substances may require further segregation into orange or yellow containers with purple lids unless quantities are below specific limits on a weight to weight ratio, based on their toxicity, carcinogenicity, mutagenicity, or toxicity for reproduction. See Laboratory Waste Disposal Matrix, Safety Services.

Risk Assessment

Eligibility for immunisation will be determined by the risk assessment which should be carried out by the prospective employee´s line manager prior to commencement of employment and annotated on the `Designated Activities Checklist´.

All University employees who might be at risk of occupational exposure to Hepatitis B will be categorised into the following groups:

High-Risk - To include individuals who, as part of their normal duties would be expected to experience frequent direct exposure to blood or other potentially contaminated human tissue or fluids; and where an acute contamination incident may not be immediately noticed.

This would include those clinical academic staff involved in invasive or exposure prone procedures, forensic pathologists and dentists. (Exposure prone procedures are those where the worker´s gloved hands may be in contact with sharp instruments, needle tips and sharp tissues inside an open body cavity, wound or confined anatomical space, and where the hands and fingertips are not completely visible at all times.)

Moderate-Risk - Activities where there is a risk of contamination on a regular basis, but safe systems of work (including use of suitable and appropriate personal protective equipment where necessary), should normally provide adequate protection against Hepatitis `B´. Contamination incidents are isolated and recognisable.

Includes academic medical staff not carrying out invasive or exposure prone procedures; laboratory technicians in pathology and haematology departments etc.

Low-Risk - Work where there is occasional risk of exposure, but this is not a regular feature of employment. Potential contamination incidents are isolated and recognisable. Includes security staff, porters, university safety officers and domestic staff in areas where Hepatitis B is a significant hazard.

No Normal Risk - No potential for contamination in normal course of employment would include administrative, clerical and kitchen staff, most non-clinical academics.

Risk Management

Under normal circumstances the risk assessment will be undertaken within each Department. Each department will submit details of the individuals who fall into risk categories to the Staff Occupational Health Service (SOHS). In addition, the SOHS should be informed of any re-classification of employees as a result of changes in their working practice. In the case of new employees, the relevant information should be provided through the Pre-Employment Health Questionnaire. This will enable the SOHS to maintain an accurate register of all "At Risk" personnel.

For those employees in the High Risk category, unless there are medical reasons to the contrary, the University will normally require evidence of immunity to Hepatitis B. For those falling into the moderate and low risk groups immunisation will be recommended, whilst for anyone considered to be at no normal risk, immunisation would not be advised.

(For those employees who also hold Honorary NHS contracts, that aspect of their employment will continue to be determined by the Hepatitis B policy of the NHS Trust concerned).

Implementation of Policy

High-Risk - The SOHS will contact all employees in the High Risk category, either directly or via their department. Those who do not have evidence of current immunity against Hepatitis B will be referred by the SOHS to the University Health Service (UHS). The UHS will then undertake to vaccinate and/or arrange serology testing as appropriate. The SOHS will maintain a record of this, and will notify individuals if any subsequent booster doses of Hepatitis B are required.

NB. It is anticipated that the majority of individuals in this group will already have been vaccinated – especially those with Honorary NHS contracts (who should continue to liaise with the Trust´s Occupational Health provider).

Immunisation

Immunisation is by intramuscular injection of a Hepatitis B surface antigen (HBsAg) containing vaccine; this vaccine cannot cause the disease against which it protects.

There are several regimes available for the administration of Hepatitis B; the SOHS/UHS will assess the risk to the employee from information given in the `designated activities checklist´ and job description and select the most appropriate: generally at 0,1,6 months with serology being performed 2 months after the 3rd injection.

The vaccination is given by intramuscular injection into the deltoid muscle; there can be some local inflammation / soreness around the site of the injection and occasionally generalised malaise, headache, flu-like symptoms.

A recommended level of Anti-Hepatitis B antibody for those in `high-risk´ (moderate risk categories for those with Sheffield Teaching Hospital NHS contracts) occupations is >100 IU/ml with a booster dose given after 5 years or following a contamination injury. For those in `moderate – low risk occupations a level of >10 IU/ml is considered adequate protection. A booster dose at 5 years will be offered to those in moderate risk categories.

The UHS will brief all recipients of the Hepatitis B vaccine prior to its administration according to their protocol.

Management of Non-Responders to Hepatitis `B´ Vaccine

Existing Staff

The University recognises that a proportion of recipients fail to develop an adequate immune response after a primary course of Hepatitis `B´ vaccine. It is recommended that a further booster dose be given, followed by further antibody testing. This may be extended into a second complete course if there is still an inadequate response. Despite this, there will remain a cohort of "non-responders". It is proposed that such individuals are seen at the SOHS for a detailed review of their working practice to assess the potential for modification of those practices to reduce the risk of Hepatitis B transmission as far as this is reasonably practicable. Should this prove impossible, the employee will be fully counselled by the SOHS (including discussions of the procedure to be followed in the event of a potential contamination episode where post exposure vaccination might be appropriate). If the SOHS is then satisfied that the employee is fully aware of the degree of risk involved, it is expected that he/she will confirm in writing that he/she understands and accepts that risk. The SOHS will then inform the University Human Resources (HR) Department of this decision.

(Any employee who refuses immunisation and/or subsequent monitoring will also be asked to attend for interview at the SOHS. If, despite being fully informed of the risk involved he/she still declines it will be necessary for a signed disclaimer to be forwarded to the HR Department, similar to the procedure for "Non-Responders").

New Staff

High-Risk

It should be noted that all successful applicants to posts designated High Risk would normally be required to demonstrate adequate immunity to Hepatitis B, as a condition of employment.

Moderate & Low Risk

All employees in these categories will be contacted directly or via their Department. The SOHS will arrange an appointment with the UHS as for the High Risk category. Although strongly advised, vaccination and subsequent antibody testing will not be compulsory in these groups, again those staff with Honorary NHS contacts, (and whose risk of contracting Hepatitis B is a direct consequence of their clinical contact) will continue to be subject to the Trust´s Hepatitis B policy.

The SOHS will maintain a record of an individual's immune status, and document any decision to refuse immunisation.

Any individual in these categories, who is involved in a potential contamination incident, should contact the SOHS as soon as possible so that the possibility of post exposure vaccination can be considered.

No Normal Risk

The University does not consider prophylactic Hepatitis B vaccination necessary in this group.

Contamination Injury

In the event of an incident exposing the individual to Hepatitis B/ Hepatitis C/HIV contaminated material, the SOHS should be contacted and the risk assessed. (See Contamination Injury Policy)