{{org_field_logo}}

{{org_field_name}}

---

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 its service users 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 its service users who suffer from TSE are not discriminated against and are treated with dignity and fairness at all times.

The organisation understands that the provision of effective care is a legal requirement under Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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 vCJD 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.

Procedure

1. {{org_field_name}} will work closely with the service user 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 service users.
3. The same high standards of infection control precautions should apply to service users with CJD as for any other service user and no additional or special precautions will be deemed necessary. This should include:
   a. effective hand washing between providing care for every service user 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. washing and drying used or fouled bed linen in the usual way and in accordance with home policies
   e. disposing of all clinical waste materials by incineration, double-bagged
   f. storing and transporting routine clinical specimens according to the local infection control policy
   g. applying all aspects of the organisation’s decontamination of surgical instruments policy and use of single-use instruments policy.
4. Isolation of residents with TSE/CJD is not necessary unless recommended by expert infection control sources as a specific response to other infectious disease outbreaks  in the home, 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 service user 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 Service Users

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 1995 (RIDDOR) to report all occupationally acquired needlestick injuries involving significant exposure to infectious material to the Health and Safety Executive.

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.

---

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

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

Copyright ©2024 {{org_field_name}}. All rights reserved