About the research

Our research team explored the way that BBV risk is managed in different organisations’ health and safety measures, identifying areas for improvement, and supporting updates with clear guidance. In the health and safety materials of the five different organisations that were audited, we identified examples of some good and some well-intentioned practice, but it was even more common to see BBV risk management procedures that were ineffective, costly and scientifically outdated.

Our analysis highlights 4 key areas in need of special attention during health and safety reviews, and is highly relevant for all organisations interested in:

• Improving the effectiveness of their health and safety policy and practices;
• Reducing unwarranted fear of blood borne infection;
• Ensuring more inclusive encounters for people with lived experience of BBVs; and
• Enabling people living with disabilities to be treated fairly and equally, as stipulated by the  2010 Equality Act 

Key findings

Clarifying Different Types Of Exposure Risk 

In our sample, only one organisation (Avon and Somerset Constabulary) provided health and safety document that conveyed an understanding that BBV type, and the context of exposure, each carry different transmission risks. In addition, this was the only one of the five participating organisations that adequately cited and applied existing guidance from England’s Health and Safety Executive and from Public Health England on the different likelihoods of infection based on exposure context for each BBV; and how to best manage relative risk depending on the setting. 

In body fluid exposure situations identified by the organisations we audited, such as: high-contact sports, laboratory staff handling biological samples, and cleaning out rooms in a homeless hostel – vital information about different viruses, and the different levels of infection risk associated with different types of exposure was missing, but could have been highly beneficial.  

Universal Precautions

We found there were missed opportunities for the use of universal precautions among several of the organisations taking part in the audit. For instance, more organisations could have uniformly advised use of latex gloves (and in some specific scenarios, sharps resistant gloves or visors) in situations that carry a medium to high likelihood of biological material exposure.

Health and safety training could benefit by focussing on the multitudes of infections avoided annually through universal precautions alongside basic and extended safety measures, including:

• Regular stock checks of first aid kits and PPE such as gloves
• Emphasising the effectiveness of soap and disinfectants to reduce viral and bacterial exposure and transmission
• Ensuring workers with a high risk of sharps or needlestick injury have free and supported access to Hepatitis B vaccination

Sharps Management

Among the audited organisations where BBV exposure risk through needlestick was medium to high, the availability and reliability of information about managing sharps was generally quite poor. Two organisations (the Avon and Somerset Constabulary and the high-contact sports team) did include clear and reliable information regarding use of and access to sharps containers; however the sports team had no written health and safety document, making it unclear how this practice was disseminated and assured. 

Despite the research laboratory training repeatedly raising concerns about BBV risk, routine practices to manage sharps disposal did not feature. Instead it was stated that lab supervisors would discuss workplace equipment and safety provisions. Furthermore, the provider of crisis housing provided erroneous information about how to manage and transport sharps. 

Health and safety documents in all settings with medium/high likelihood of needlestick and other puncture injuries should clearly provide information about the supply and use of sharps containers (see this Health and Safety Executive resource) alongside appropriate waste disposal and cleaning procedures for bodily fluid spills. 

Handling Of Exposure Incidents

Only two of the four organisations that identified a medium to high risk of BBV exposure offered details about what actions to take immediately following an exposure incident. Where this information was provided, one was complete and up to date, but another contained outdated contact details. 
Situations involving confirmed HIV or Hepatitis B exposure require immediate preventive treatment to avoid onward infection, making it vital that timely information and clear routes to support are easy to access. The Health and Safety Executive (HSE) encourages health and safety leads to communicate the best sources for timely and accurate emergency advice following a potential BBV exposure event, typically involving: 

• Seeking immediate advice from a local authority Health Protection team,
• Getting advice from Occupational Health (for those in larger organisations), or
• Visiting Accident and Emergency.

Template decision-trees based on diverse and institution-specific scenarios could be successfully adapted and added to HSE resources on incident-response, and disseminated by local Health Protection Teams as well as Public Health and Licencing teams. 

Recommendations: How To Improve Workplace Health And Safety Procedures Regarding BBVs 

1. Review your documents for up to date BBV risk and safety information using our accompanying resource guide
2. During your document review ask:
   1. Have we clarified relative risk between BBVs and in different scenarios?
   2. Are we making the use of universal precautions easy and building trust in them?
   3. Does our policy make it clear how to handle any dangerous sharps (where relevant to your setting)?
   4. Do our people know what steps to take in case of an exposure incident? Is the contact information we have provided still current?
3. Seek out updated BBV safety resources from the Health and Safety Executive and other expert organisations such as National AIDS Trust and Hep C Trust as well as your local health protection team
4. Become familiar with your organisation’s responsibilities under the Equality Act 2010:
   1. The Equality Act covers discrimination in private services, public services and in employment.  Workplaces have responsibilities under the Equality Act to prevent discrimination and harassment against anyone in a protected category.
   2. A person living with HIV is explicitly classified under the Equality Act 2010 as having a ‘disability’, in Schedule 1 and people living with other BBVs such as Hepatitis B and Hepatitis C can be protected where their infection is disabling. 
   3. The most effective way to avoid inadvertent discrimination is to recommend and support the use of universal precautions where there is a risk of bodily fluid exposure.
   4. If you are unsure whether your practices are compliant with the Equality Act 2010, please contact National AIDS Trust for advice.