The Department of Health is currently consulting on the above draft guidance, which is available on their website at http//:www.doh.gov.uk/healthclear. Hard copies may be requested from the NHS Responseline 08701555455. The consultation is open until the end of April.
The summary states
"Ministers set up an expert group in 2001 to assess the potential health risks posed to patients from health care workers new to the NHS infected with serious communicable diseases, in particular HIV, hepatitis B, hepatitis C and TB, and to report on options to minimise these risks. The measures proposed in this consultation document are based on the expert group’s recommendations, which ministers have accepted.
All new health care workers will need to have a standard health clearance for serious communicable diseases. Additional health clearance for blood-borne viruses will be needed for all new health care workers who will perform exposure prone procedures.
The new proposals are not intended to prevent those infected with blood-borne viruses from working in the NHS, but to restrict them from working in those clinical areas where their infection may pose a risk to patents in their care. This is consistent with existing policy, which imposes restrictions on the working practices of those health care workers known to be infectious carriers of HIV, Hepatitis B and hepatitis C."
Main Points:
All NHS Trusts and Primary Care Trusts must ensure that arrangements to implement the proposals are in place 4 months from the issue of the final version of the guidance.
All new health care workers must have a standard health check for serious communicable diseases. This includes:
Checks for TB disease / immunity;
Offer of hepatitis B immunisation, with post-immunisation testing of response;
In the context of reminding them of their professional responsibilities in relation to serious communicable diseases, the offer of testing for hepatitis C and HIV.
Additional health checks for serious communicable diseases must be provided for all new health care workers who will perform exposure prone procedures;
In addition to the above checks this will also include health checks to establish that they are not chronically infected with hepatitis B, hepatitis C or HIV.
New health care workers will include those returning to work in the NHS.
Exposure prone procedures are those invasive procedures where there is a risk that injury to the worker may result in the exposure of the patient’s open tissue to the blood of the worker.
Procedures where the hands and fingertips of the worker are visible and outside the patient’s body at all times, and internal examinations or procedures that do not involve possible injury to the worker’s gloved hands from sharp instruments and/or tissues are considered not to be exposure prone procedures, provided routine infection control procedures are adhered to.
Examples of procedures that are not exposure prone include;
Taking blood
Minor surface suturing
Incision of external abscesses
Routine vaginal or rectal examinations
Simple endoscopic procedures
Setting up / maintaining IV/ central lines. Providing any skin tunnelling procedure used is performed in a non-exposure prone manner.
Additional health clearance for serious communicable diseases is not required for nursing students.
It is required for midwifery training and those qualified nurses moving into training or posts in operating theatres and A&E.
Additional health clearance is also required for all dental students, including dental nurses / hygienists / therapists, paramedics, ambulance technicians and podiatrists.