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

SUMMARY OF ACTION

21. The health checks recommended in this guidance for new healthcare workers as defined in paragraphs 16 and 17 are presented in two sections:

• the standard health checks recommended for all new healthcare workers;
• the additional health checks required for healthcare workers who will perform EPPs for the first time in their career (para 39).

Standard Health Checks

22. It is recommended that Chief Executives of NHS Boards, Principals in the General Medical and Dental Services and Principals in the Personal Medical and Dental Services ensure that the following arrangements are in place as soon as is reasonably practicable:

• To provide pre-appointment standard health checks for all new healthcare workers (as defined in paras 16 and 17 above and further clarified in paras 31- 45 below). These should be completed before clinical duties commence and should include:
  • checks for TB disease/immunity;
  • the offer of hepatitis B immunisation, with post-immunisation testing of response (with no requirement for such immunisation to be undertaken);
  • the offer of testing for hepatitis C and HIV, in the context of reminding healthcare workers of their professional responsibilities in relation to serious communicable diseases (with no requirement for such testing to be undertaken).
• 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.
• Students should be subject to these same standard health checks when they commence their courses.

23. Details of standard health checks are given in paras 46 - 55

24. All new healthcare workers need to have standard health clearance before they have clinical contact with patients, i.e. be free from TB disease, with immunisation where appropriate, and to be offered immunisation against hepatitis B.

Additional Health Checks

25. It is also recommended that Chief Executives of NHS Boards, Principals in the General Medical and Dental Services and Principals in the Personal Medical and Dental Services ensure that the following arrangements are in place as soon as is reasonably practicable:

• To provide the following additional health checks for all new healthcare workers (as defined in paras 16 and 17 above, and further clarified in section 31- 45 below) who will perform EPPs for the first time:
  • health checks to establish that they are not infected with hepatitis B, hepatitis C or HIV.

26. Details of additional health checks are given in paras 56 - 65.

27. For new healthcare workers whose post or training requires performance of EPPs for the first time in their careers, appointment or admission to training should be conditional on satisfactory completion of standard and additional health clearance checks. New healthcare workers performing EPPs should be free from infection with hepatitis B, hepatitis C and HIV as well as TB. It is therefore recommended that these checks be carried out early in the appointments/admissions process. (see paras 32-38 below for students; para 39 below for healthcare workers who are performing EPPs for the first time; para 40-41 for those returning to the NHS; para 42-44 for locum and recruitment agencies; and para 45 for the independent healthcare sector).

Timing of health checks

28. The timing of any tests taken should, taking account of guidance below, take account of the natural history of the infections (i.e. 'window period'). Guidance on the risk factors for hepatitis C and HIV is provided in paragraphs 51, 52 and 54.

Existing health checks

29. Health clearance recommended by this guidance should be implemented alongside existing health checks for new healthcare workers and other pre-appointment checks.

30. This guidance is supplementary to routine occupational health checks/immunisations for other infectious diseases (e.g. for rubella and varicella).