Health Clearance for Tuberculosis, Hepatitis B, Hepatitis C and HIV for New Healthcare Workers with Direct Clinical Contact with Patient

SUMMARY

Standard Health Clearance

1. This guidance recommends that all new healthcare workers, including students, who will have direct clinical contact with patients (as opposed to casual or social contact):

• have checks for tuberculosis disease/immunity;
• are offered hepatitis B immunisation, with post-immunisation testing of response; and
• are offered tests for hepatitis C and HIV.

2. To be clear, in the case of hepatitis B the only requirement is the offer of immunisation and testing; although health care workers should be encouraged to commence immunisation and testing there is no requirement for them to do so. Likewise in the case of hepatitis C and HIV the only requirement is that health care workers be offered tests. Health care workers are not required to undertake such tests.

3. These standard health clearance checks should be completed pre-appointment before clinical duties commence. All checks for TB disease/immunity must be completed before clinical duties commence.

Additional Health Clearance

4. For new healthcare workers, including students, who will perform exposure-prone procedures ( EPPs), additional health clearance will also be needed. Additional health clearance means being non-infectious for:

• HIV (antibody negative),
• hepatitis B (surface antigen negative or, if positive, e-antigen negative with a viral load of 10 ³ genome equivalents/ml or less); and
• hepatitis C (antibody negative or, if positive, negative for hepatitis C RNA).

5. Additional health clearance checks must be completed before confirmation of an appointment to an EPP post, as the healthcare worker will be ineligible for appointment if found to be infectious.

Definition of New Health Care Workers

6. For the purposes of this guidance, a new healthcare worker includes:

• healthcare workers new to the NHS (see para 17);
• healthcare workers moving to post or training that involves EPPs for the first time in their career (see para 17 and 39); and
• returning healthcare workers, depending on what activities they have engaged in whilst away from the health service (see paragraphs 40 -41).

7. The guidance is not intended to prevent those infected with blood-borne viruses from working in the NHS, but rather to restrict them from working in those clinical areas where their infection may pose a risk to patients in their care. This is consistent with existing policy, which imposes restrictions on the working practises of those healthcare workers known to be infectious carriers of HIV, hepatitis B and hepatitis C.

Existing guidance

8. This health clearance guidance is additional to existing guidance on healthcare workers and bloodborne viruses and is intended to reinforce and extend existing measures to reduce the risk of healthcare worker to patient transmission of BBVs and TB.

Timing

9. The measures proposed in this guidance should be implemented and in place as soon as is reasonably practicable but by no later than 1 August 2008.