Download Reference : Health clearance for tuberculosis, hepatitis

What happens to the blood sample?
This blood sample and accompanying request form are sent
to a laboratory service for the required tests. Non current
infectivity status test results are required for HIV, hepatitis B
and hepatitis C before health clearance for the EPP post can
be given.
The occupational health department will be able to inform
new healthcare workers of the results of their tests, including
the implications for their own health and the need for referral
for specialist assessment.
NHS
East of England Ambulance Service
NHS Trust
Health clearance for tuberculosis,
hepatitis B, hepatitis C and HIV:
New healthcare workers performing EPP’s
Will these tests be repeated?
Currently, this testing is required as pre-EPP work related
placement health clearance. However, professional codes of
practice from regulatory bodies place an ongoing obligation
upon healthcare workers who may have been exposed to
infection of a serious communicable disease in whatever
circumstances to seek professional advice about the need to
be tested.
* Reference : Health clearance for tuberculosis, hepatitis B,
hepatitis C and HIV; New healthcare workers, Department of
Health, March 2007
Issued : July 2007
Occupational Health Services
Norfolk, Suffolk - 01603 422811
Essex, Hertfordshire - 01245 444437
Cambridge, Bedfordshire - 01638 718439
Introduction
What is an EPP role?
In May 2007 new guidance was issued by the Department of
Health*, placing additional requirements on employer’s to
undertake additional screening of new healthcare workers who
perform exposure-prone procedures (EPP’s).
The vast majority of emergency ambulance service duties do not
pose a risk of infection to patients provided that normal infection
control precautions are observed. However, there is a low risk of
BBV transmission during EPP’s. These include procedures
where a worker’s gloved hands maybe in contact with sharp
instruments, needle tips or sharp tissues (eg; spicules of bone or
teeth) inside a patients open body cavity, wound or confined
anatomical space where the hands or fingertips may not be
completely visible at all times, where injury may result in
exposure of the patient’s open tissues to the blood of the worker.
Standard health checks and immunisations currently in place
for employees new to the NHS and who have contact with
patients’ blood and blood stained body fluids /tissues and
clinical materials include;

immunisation against hepatitis B and tests to check their
response to immunisation including investigation of non
response.

The offer of testing for hepatitis C and HIV where
potential for previous exposure may be indicated.

A TB screen or health check or documentary evidence
of such screening taken place within previous 12
months.
New healthcare worker’s includes those new to the NHS
whose work will involve EPPs, those moving to a post or
training that involves EPP and healthcare workers returning to
a role that involves EPP’s will require additional screening.
Additional health clearance requires that you are non-infectious
for blood borne viruses (BBV’s); HIV (human immunodeficiency
virus), hepatitis B and hepatitis C. The screening procedure
should be completed before an employment offer is made /
confirmed as the healthcare worker will be ineligible for the
post if infectious or until infectivity levels fall below required
thresholds.
Such procedures occur mainly in surgery, obstetrics and
gynaecology, dentistry and some aspects of midwifery. Most
nursing duties do not involve EPP’s; exceptions include accident
and emergency and theatre nursing. It is therefore considered
that staff working on front line duties in emergency ambulance
services may be involved in EPP’s.
Healthcare workers who are infected with BBV’s are not allowed
to carry out EPP’s as injury to the worker could result in their
blood contaminating the patients open tissues.
How will the additional health clearance be done?
At the pre-employment health screening assessment these
requirements will be explained by the occupational health
department and written consent requested before the taking of a
small blood sample (approx. 6ml). The occupational health
department is responsible for taking the blood sample and
photographic identity validation will be required.
Healthcare workers who apply for a post or training which may
involve EPP’s and who decline to be tested for HIV, hepatitis B
and hepatitis C should not be cleared to perform EPP’s.