Download Health- Clearance

Health Clearance
For the safety of patients, Scottish Government guidance recommends that all new staff that will
have direct clinical contact with patients are:

tested for tuberculosis disease/immunity;

offered hepatitis B immunisation and post-immunisation testing for response;

offered testing for hepatitis C;

offered testing for HIV
These standard health clearance checks are to be completed before the appointment of a new
member of staff. Note that hepatitis B and tuberculosis immunisation are a requirement for GDC
registration.
Exposure Prone Procedures
Patients may be at risk of exposure to blood borne virus (BBV) infection from healthcare workers
carrying out exposure prone procedures (EPPs). EPPs are those invasive procedures 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 worker (known as bleed-back).
Most procedures in dentistry are classed as exposure prone, with the exception of:

examination using a mouth mirror only;

taking extra-oral radiographs;

visual and digital examination of the head and neck;

visual and digital examination of the edentulous mouth;

taking impressions of edentulous patients;

The construction and fitting of full dentures.
However, taking impressions from dentate or partially dentate patients would be considered
exposure prone, as would the fitting of partial dentures and fixed or removable orthodontic
appliances, where clasps and other pieces of metal could result in injury to the dentist.
As an additional level of health clearance, new healthcare staff who will carry out exposure-prone
procedures (EPPs) must be shown to be non-infective for:

HIV (antibody negative);

hepatitis B (surface antigen negative or, if positive, e-antigen negative with a viral load of 103
genome equivalents/ml or less);

Hepatitis C (antibody negative or, if positive, negative for hepatitis C RNA).
'New staff' are classed as healthcare workers new to the NHS, returning healthcare workers who
may have been exposed to serious communicable diseases whilst away from the NHS or healthcare
workers moving to a post or training that involves EPPs for the first time in their career. These
checks must be completed before confirmation of an appointment to an EPP post and they also
apply to all healthcare workers in the independent (non-NHS) healthcare sector.
Ensure new staff who will have direct clinical contact with patients are:

tested for TB disease/immunity;

vaccinated against hepatitis B and tested for their post-immunisation response to ensure
they have the required level of antibodies;

Offered hepatitis C and HIV tests (employees are not required to undertake these tests but
they must be offered).
In addition, ensure new staff who will undertake exposure-prone procedures have been:

tested for HIV infection and shown to be antibody negative for HIV;

tested for hepatitis B infection and shown to be surface antigen negative for hepatitis B (or
be e-antigen negative with a viral load of 103geq/ml or less);

tested for hepatitis C infection and shown to be antibody negative for Hep C (or negative for
hepatitis C RNA)
Before confirmation of their appointment.
Ensure that staff are aware that if they suspect that they might have become infected with a blood
borne virus or other serious infection, such as TB, they must seek medical advice and testing
Document the practice’s policy on health clearance and ensure that staff are aware of it