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

CATEGORIES OF NEW HEALTHCARE WORKERS

Introduction

31. This section attempts to further explain the definitions of new healthcare workers as specified in paragraphs 6 and 16, and whether standard or additional health checks may be required. It is not possible to provide a definitive list of types or specialties of healthcare workers where additional health checks would be required because individual working practices may vary between clinical settings and between workers. Annex B provides examples of EPPs.

Medical students

32. Medical students should be subject to standard health checks when they commence their course. However, the practical skills required of medical students to obtain provisional General Medical Council ( GMC) registration or of Foundation Practitioners to obtain full GMC registration do not include EPPs. Fitness for EPPs is therefore not an absolute requirement for those wishing to train as doctors. This recognises that many career paths are available to doctors which do not require the performance of EPPs.

33. However, some commonly undertaken components of the undergraduate medical curriculum may involve students in EPPs. Additional health clearance is required for those students who will be involved in EPPs. Students found to be infectious carriers of BBVs will need to comply with occupational health supervision and guidance from the responsible Head of Course to ensure they do not perform EPPs. While the appropriate Medical School is responsible for medical students during their training, NHS Boards accepting student placements should check that this guidance is being followed. Further guidance on health clearance and management of infected medical students is being prepared jointly by the Council of Heads of Medical Schools, the Association of UK University Hospitals and the Higher Education Occupational Physicians group.

Nursing Students

34. Additional health clearance is not necessary for nursing students, as performance of EPPs is not a requirement of the curriculum for pre-registration student nurse training.

Dentistry

35. Additional health clearance is recommended for all dental students before acceptance on to training courses because EPPs are performed during their training and practise. The relevant school or college will be responsible for health clearance of students during their training but NHS Boards accepting student placements should check that this guidance is being followed.

36. Additional health clearance is recommended for student dental therapists and student dental hygienists because they perform EPPs during training. The relevant school or college will be responsible for health clearance of students during their training but NHS Boards accepting student placements should check that this guidance is being followed.

37. Additional health clearance would not normally be recommended for dental nursing students (or dental nurses) or clinical dental technicians, unless a risk assessment suggested there was a need.

Other Students

38. Additional health clearance is recommended for all midwifery, paramedic, ambulance technician and podiatric surgery (but not podiatry) students before acceptance on to training courses because EPPs are performed during training and practise of these specialties. The relevant school or college will be responsible for health clearance of students during their training but NHS Boards accepting student placements should check that this guidance is being followed.

Healthcare workers who are performing EPPs for the first time

39. Healthcare workers moving into training or posts involving EPPs for the first time should also be treated as 'new' and additional health clearance is required. This will include, for instance, senior house doctors (or equivalent training grade under the modernising medical careers initiative) entering surgical or other specialities involving EPPs; qualified nurses wishing to train as midwives; and post-registration nurses moving into work in operating theatres and accident and emergency for the first time. This will not apply in future to senior house doctors (or equivalent training grades under the modernising medical careers initiative) who have already had additional health checks as medical students in the UK.

Healthcare workers who are returning to the NHS and who may have been exposed to serious communicable diseases

40. The need for additional health checks in any particular healthcare worker who is returning to work in the NHS, and who may have been exposed to serious communicable diseases while away, should be based on a risk assessment. This should be carried out by the occupational health department.

41. Some examples of healthcare workers who might be considered 'returners' include those returning from research experience (including electives spent in countries of high prevalence for TB or BBV), voluntary service with medical charities, sabbaticals (including tours of active duty in the armed forces), exchanges, locum and agency work or periods of unemployment spent outside the UK.

Healthcare workers from locum and recruitment agencies, including NHS professionals

42. Guidance on pre-employment health checks to be carried out for temporary staff is covered in NHS Circular GEN (1995) 4: Occupational Health and Safety Services for NHSScotland Staff and Towards a Safer Healthier Workplace, in relation to occupational health.

43. Occupational health checks, to the same standard as applied to NHS employees, should form part of pre-employment checks conducted by providers of temporary staff, regardless of whether they have worked previously in the NHS. Providers of temporary staff may wish to use their local NHS occupational health services to undertake health checks and clearance on their behalf. This will ensure appropriate standards are met and records kept. Health clearance appropriate to their duties should be verified before the individual undertakes any clinical work.

44. While working on NHS premises, responsibility for continuing occupational health and safety needs of temporary workers lies with the NHS employer, as covered by the Health and Safety at Work etc. Act (1974). Agencies are responsible for supplying staff fit to practise and should satisfy themselves that the staff they supply have the necessary clearances. This may include paper certification. While locum or agency staff are working on NHS premises NHS Boards should satisfy themselves that this guidance is being followed.

Healthcare workers in the independent healthcare sector

45. NHS Boards that arrange for NHS patients to be treated by non- NHS hospitals or health establishments in the UK, including independent sector treatment centres, should ensure that this guidance is followed. All healthcare workers in the independent healthcare sector are required to comply with professional codes of practice and Scottish Government Health Directorates guidelines on healthcare workers infected with BBVs.