Healthcare workers can be exposed to high levels of dangerous pathogens during their day-to-day tasks. Infection control techniques are in place to provide as much protection as possible, and everyone is aware of how important it is that such procedures are adhered to religiously.
However, it is also prudent to offer staff and patients another level of protection from potential infection, the maintenance of clinical staff's personal health.
On employment, it is the responsibility of management to ensure that all staff receive full health checks to ensure they are immunised according to current national guidelines, and do not carry any blood-borne viruses (BBVs).
The current policy for new entrants into the NHS is a full health screening test. The test looks for evidence of tuberculosis and the offer of hepatitis B immunisation. The individual is also offered testing for hepatitis C and HIV, which although not mandatory is offered within the context of their professional duties.
All clinical staff should also receive vaccinations against hepatitis B, rubella, tetanus, polio, tuberculosis, and, if not already immune, varicella (chicken pox). It is recommended a vaccination against seasonal influenza is also considered, due to the proximity of staff to potentially infected patients.
Hepatitis B is one of the most important vaccinations to consider. All staff who are likely to come into contact with blood/bodily fluids, clinical waste and sharps during the course of their duties should be fully immunised against this virus. Following the initial immunisation, antibody responses should be measured one to two months hence, in order to ensure the team member has developed an adequate antibody response. Poor responders should be offered an additional booster injection. There is a small percentage of people who may not respond at all to the vaccine. In this situation, additional care must be taken when working with sharps or needlesticks, and should this occur the individual should be referred to the nearest accident and emergency department for assessment and treatment if required.
These immunisations and medical tests are important throughout the healthcare sector, but particularly important in the field of dentistry. This is because staff in dental practices are one of the few groups in the medical community that regularly perform Exposure Prone Procedures.
EPPs are those where there is a risk that injury to the worker may result in the exposure of the patient's open tissues to the blood of the healthcare professional. There are many occasions where a worker's gloved hand may come into contact with a sharp instrument, needlestick or fragment of bone or tooth whilst inside a patient's mouth, this may result in infected fluids passing from a patient to the professional, or vice versa.
It is obvious that specific care must be taken when performing EPPs, but nobody is infallible and mistakes can be made; this is why it is so important, for the professional and the patient, that proper steps are taken to immunise against BBVs where possible. Any professional who proves to be positive for hepatitis B, hepatitis C or HIV will not be allowed to perform EPPs.
Any dental professional currently registered with the General Dental Council who believes they may have been exposed to blood borne viruses such as HIV, hepatitis B or hepatitis C are under a legal, professional and ethical obligation to promptly seek and follow confidential advice on testing for BBV and national guidelines on practising restrictions. Failure to do so could breach the healthcare workers' duty of care to patients, as detailed in the Health and Safety at Work Act, and the Control of Substances Hazardous to Health regulations.
Confidential documentary evidence should be kept by management of all immunisations that staff receive, including the completion date of immunisations and boosters, post vaccination antibody levels, and dates on which any further booster injections are required. It is advisable a member of the management team is nominated to co-ordinate staff health records. Many PCTs ensure occupational health departments receive funding for work with dental practices to ensure all staff are given the necessary vaccinations, advice and follow-up.
Many healthcare workers neglect to consider themselves when considering infection control. It is important procedures are maintained within the practice at all times for the patients' sakes, however it is also important to remember the health of healthcare staff. Education within this area is important, and many healthcare workers are not aware of the legal requirements surrounding their own health.