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Transmissible Spongiform Encephalopathies in Residential Care Policy

The purpose of this policy is to provide a practical working document for care workers who provide care for people with Transmissible Spongiform Encephalopathies (TSEs) such as variant Creutzfeldt-Jakob Disease (vCJD).

This care service is committed to providing high-quality care and to eliminating discrimination in its service delivery. It is also committed to protecting and promoting the health of its employees and of the people who use the services and their relatives and visitors. In this respect it recognises that TSEs represent a health issue that has attracted widespread publicity in the past. The organisation will ensure that its policy challenges erroneous assumptions about such infections and ensures that both its employees and people who use the services who suffer from TSE are not discriminated against and are treated with dignity and fairness at all times.

Background

Bovine spongiform encephalopathy (BSE) is a fatal disease of the nervous system in cattle. In the UK BSE became a major health problem during the 1990s when a link was established between BSE and similar human conditions including CJD. This led to new legislation covering the raising, keeping and slaughtering of cattle and covering the sale of beef.

CJD is a rare human disease causing severe neurological symptoms and eventual death. It affects about one person in a million and like BSE it has a lengthy incubation period. As with BSE the infectious agent has not been identified but cases of CJD have occurred:

1. through eating infected meat, especially brain or spinal cord
2. in people who have received tissue transplants from infected individuals
3. in people where brain electrodes have been used
4. in people receiving corneal grafts
5. in people receiving growth hormone given by injection.

Several different types of CJD have been identified so far. The disease is invariably fatal. The illness usually has a short duration after the onset of progressive symptoms but varies according to the type of CJD.

Because of the rarity of the disease and the lack of a simple diagnostic test it is often difficult to confirm a diagnosis. Older patients with sporadic CJD might initially be given a diagnosis of dementia.

The Advisory Committee on Dangerous Pathogens has published guidance on all aspects of CJD risk control, including precautions for work with human and animal TSEs. Current evidence suggests that normal social or routine clinical contact does not present a risk to health or care workers, families or others and that people with CJD can be nursed or cared for with no special precautions other than the standard good infection control practice.

Special precautions are required only for handling high-risk tissues including central nervous or eye tissue, including cerebrospinal fluid. There is no evidence of infectivity in saliva, body secretions or excreta.

The report confirms that the risk of surgical transmission cannot be ruled out and that the most at-risk procedures are those involving the central nervous system and the back of the eye. Risks of transmission are significantly reduced if instrument decontamination is carried out to the highest standards.

Where nursing care of wounds is concerned the following tissues have been categorised by the Advisory Committee on Dangerous Pathogens according to their CJD/vCJD infectivity.

• High risk: brain, spinal cord, posterior eye.
• Medium risk: anterior eye, lymphoid tissue, olfactory epithelium.
• Low/no detectable risk: other tissues.

The types of wound care performed routinely therefore represent a very low risk of transmission and should be safe as long as standard infection control precautions are taken.

Legal Considerations

This care service will adhere to all relevant legislation, including:

• the Health and Safety at Work, etc Act 1974
• the Public Health Infectious Diseases Regulations 1988
• the Control of Substances Hazardous to Health Regulations 2002 (COSHH).

Under the above legislation, and associated codes of practice, {{org_field_name}} understands its legal and moral duty to ensure the health and safety of both staff and people who use the services and to protect them, wherever practicable, from dangerous substances in the workplace, including the risk of transmission of infections.

In addition to the above, the home must also comply with the Reporting of Incidents, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). These place a duty on the home to report outbreaks of certain diseases as well as accidents such as needlestick accidents.

Guidance

{{org_field_name}} seeks at all times to comply with evidence-based best practice in infection control, particularly with the Health and Social Care Act 2008 Code of Practice on the Prevention and Control of Infection and Related Guidance published by the Department of Health and Social Care (the Hygiene Code). The home understands that in England compliance with this guidance is an effective way to help it to meet its regulatory requirements with the Care Quality Commission under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition, the home will comply with all other relevant best practice infection control guidance.

For instance, applicable guidance from the National Institute for Health and Care Excellence (NICE) includes:

• CG139: Healthcare-associated Infections: Prevention and Control in Primary and Community Care (updated February 2017)
• PH36: Healthcare-associated Infections: Prevention and Control (November 2011).

Guidance is also available from the Department of Health and Social Care (DHSC) and from the Health and Safety Executive (HSE) in the form of:

• Infection Prevention and Control (IPC) resource for Adult Social Care (updated March 2024), DHSC
• Prevention and Control of Infection in Care Homes: An Information Resource (2013), DHSC
• HSG220 Health and Safety in Care Homes (2^nd edition) (2014), HSE.

Specialist advice and support will be obtained from the local public health protection team.

Procedure

1. {{org_field_name}} will work closely with the person receiving care and their GP, specialist/neurologist and family or representatives to supply high-quality care that includes providing them with choice, respect, dignity and freedom from prejudice or discrimination.
2. Care staff should maintain and encourage a positive and understanding attitude towards people with TSE/CJD and actively work to prevent discrimination in any form, ensuring that they are treated with dignity and fairness at all times and in the same way and to the same high standards as are all other people who use the services.
3. The same high standards of infection control precautions should apply to people who use the services with CJD as for any other person receiving care and no additional or special precautions will be deemed necessary. This should include:
   a. effective handwashing between providing care for every person where direct contact is involved, no matter how minor the contact
   b. wearing gloves during any clinical contact and washing and drying hands after use
   c. taking care when dealing with sharps; needles should never be resheathed and all sharps should be disposed of for incineration in purpose-built sharps boxes
   d. in care homes, washing and drying used or fouled bed linen in the usual way and in accordance with home policies
   e. in care homes, disposing of all clinical waste materials by incineration, double-bagged
   f. in care homes, storing and transporting routine clinical specimens according to the local infection control policy
   g. in care homes, applying all aspects of the organisation’s decontamination of surgical instruments policy and use of single-use instruments policy.
4. Isolation of people who use the services with TSE/CJD is not necessary unless recommended by expert infection control sources as a specific response to other infectious disease outbreaks, such as diahorrea and vomiting.
5. {{org_field_name}} will work closely with the local infection control team, who should be contacted for advice or guidance whenever required.
6. Whenever a person with TSE or CJD is transferred to or from {{org_field_name}}, all relevant clinical information will be exchanged with due regard to confidentiality.

Needlestick Injuries Involving CJD-infected People Receiving Care

Any needlestick injury involving blood from a potentially CJD-infected source should be dealt with according to {{org_field_name}}’s policy on needlestick injuries contained within the disposal of sharps policy.

In the event of an injury with a used or potentially contaminated needle, staff should:

1. wash the area immediately and encourage bleeding if the skin is broken
2. apply a dressing
3. report to the manager immediately and fill in an incident form
4. report immediately to a GP, occupational health department or accident and emergency department.

There is a legal requirement under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) to report all occupationally acquired needlestick injuries involving significant exposure to infectious material to the HSE.

Implementation

All staff are responsible for the implementation of this policy. Overall responsibility for ensuring the policy is implemented, monitored and reviewed rests with the infection control lead.

Information on the policy will be:

1. circulated to all staff
2. provided to all new employees
3. included in the infection control policy.

Training

All new staff should be encouraged to read this policy as part of their induction process. Those with specific duties and responsibilities under the policy will be offered additional training.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

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