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Health clearance for serious communicable diseases: report from the Ad hoc Risk Assessment Expert Group

Document type:

Guidance
Author:

Department of Health
Published date:

18 December 2002
Primary audience:

Professionals
Publication format:

Electronic only
Gateway reference:

2002
Pages:

17
Copyright holder:

Crown copyright

The Ad hoc risk assessment expert group was set up at the request of CMO and Ministers to consider the risk posed to patients by health care workers infected with serious communicable diseases (HIV, hepatitis B, hepatitis C and tuberculosis [TB]) who were new to the NHS.

Considerations for existing staff were specifically excluded. During the course of their deliberations the expert group reviewed:

National and global prevalence information for the infections under consideration and used this to carry out a risk assessment;
Current UK policy on screening for and restriction of health care workers infected with blood-borne viruses (BBVs);
Whether qualification/professional registration required performance of those clinical procedures which pose a risk of transmission of blood-borne viruses;
Legal issues with a potential bearing on any new policy; and
The issues around TB and the strengthening of occupational health monitoring.

1.2 Using the best available evidence on the current prevalence and transmission rates in the UK it was estimated that, for the four infections combined, around 30 or fewer transmissions per year might be expected from infected health care workers to patients. In terms of the relative risk of transmission to patients, both TB and hepatitis B are on equal footing, with hepatitis C next and HIV posing the least risk.

1.3 The Group agreed the following framework as the basis of their recommendations:

All new entrants to the NHS should be treated equally regardless of their ethnic origin, geographic origin, nationality, or sexual orientation.
The definition of 'new entrants' should include not only students and those from overseas but also re-entrants.
Screening requirements for blood-borne viruses (BBVs) and TB must be assessed separately because of fundamental differences in the nature of the risk and the route of transmission.
Where screening/immunisation is deemed necessary, those who decline will be treated as if infected and their practice restricted accordingly.
Health checks include elements of protecting the health of the individualhealth care worker as well as the public.

1.4 The Group recommends that health clearance for serious communicable diseases should include:

pre-appointment/pre-admission health checks for serious communicable diseases for ALL new entrants to the NHS including NHS-related education and training
- checks for TB disease/immunity and hepatitis B immunity (with immunisation if needed)
- the offer of testing for hepatitis C and HIV.
health clearance for blood-borne viruses (i.e. proof that not infectious for hepatitis B and C and HIV negative) will be required for posts or careers involving exposure-prone procedures (EPPs).

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