Universal Precautions

The risk of exposure to infections, particularly blood-borne viruses (BBVs), can be minimized by adopting measures that are considered good practice in the United Kingdom, the United States, and Australia (1-3).

Forensic physicians or other health care professionals should wash their hands before and after contact with each detainee or victim. Police officers should be encouraged to wash their hands after exposure to body fluids or excreta. All staff should wear gloves when exposure to body fluids, mucous membranes, or nonintact skin is likely. Gloves should also be worn when cleaning up body fluids or handling clinical waste, including contaminated laundry. Single-use gloves should only be used and must conform to the requirements of European Standard 455 or equivalent (1-3). A synthetic alternative conforming to the same standards should also be available for those who are allergic to latex.

All staff should cover any fresh wounds (<24 hours old), open skin lesions, or breaks in exposed skin with a waterproof dressing. Gloves cannot prevent percutaneous injury but may reduce the chance of acquiring a blood-borne viral infection by limiting the volume of blood inoculated. Gloves should only be worn when taking blood, providing this does not reduce manual dexterity and therefore increase the risk of accidental percutaneous injury.

Ideally, a designated person should be allocated to ensure that the clinical room is kept clean and that Sharps containers and clinical waste bags are removed regularly. Clinical waste must be disposed of in hazard bags and should never be overfilled. After use, the clinical waste should be double-bagged and sealed with hazard tape. The bags should be placed in a designated waste disposal (preferably outside the building) and removed by a professional company.

When cells are contaminated with body fluids, a professional cleaning company should be called to attend as soon as possible. Until such time, the cell should be deemed "out of action."

2.1. Sharps Awareness

There is a legal requirement in the United Kingdom under the Environmental Protection Act (1990) and the Control of Substances Hazardous to Health Regulations 1994 to dispose of sharps in an approved container. In the United States, the Division of Health Care Quality Promotion on the Centers for Disease Control and Prevention (CDC) Web site provides similar guidance. In custody, where Sharps containers are transported off site, they must be of an approved type. In the United Kingdom, such a requirement is contained within the Carriage of Dangerous Goods (Classification, Packaging and Labelling) and Use of Transportable Pressure Receptacles Regulations 1996. These measures help to minimize the risk of accidental injury. Further precautions include wearing gloves when handling Sharps and never bending, breaking, or resheathing needles before disposal. Sharps bins should never be overfilled, left on the floor, or placed above the eye level of the smallest member of staff.

2.2. Contaminated Bedding

Any bedding that is visibly stained with body fluids should be handled with gloves. There are only three acceptable ways of dealing with contaminated bedding:

1. Laundering with a detergent at a minimum temperature of 71 °C (160° F) or at a lower temperature (22-50°C) with water containing detergent and 50-150 ppm of chlorine bleach.

2. Dry cleaning at elevated temperatures/dry cleaning at cold temperatures followed by steam pressing.

3. Incineration.

It is not considered acceptable practice for detainees to share bedding.

2.3. Other Measures

It is not necessary for staff to wear masks or protective eyewear in the custodial setting because the risk of infection is low. However, single-use eye wash should be available in the clinical room or contained in other first aid kits located within the police station in case of accidental exposure. Contact lenses should be removed before eye washing.

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