OCCUPATIONAL MANAGEMENT OF HEALTHCARE WORKERS WITH SYMPTOMS OF INFECTION, ACTUAL INFECTIOUS DISEASES AND FOLLOWING EXPOSURE TO

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1 AND FOLLOWING EXPOSURE TO Page 1 of 9 This Policy applies to all staff employed by NHS Greater Glasgow & Clyde and locum staff on fixed term contracts and volunteer staff. Policy Objective To prevent Healthcare Workers (HCWs) being a possible source of cross-infection to either patients of colleagues KEY CHANGES FROM THE PREVIOUS VERSION OF THIS POLICY Document Control Summary Approved by and date January Date of Publication January Developed by Infection Control Policy Sub-Group Related Documents See also NHSGGC Sickness/Absence Policy NHSGGC Standard Precautions Policy NHSGGC Hand Hygiene Policy Distribution/Availability NHSGGC Infection Prevention and Control Policy Manual and the Implications of Race Equality and other diversity duties for this document Equality and Diversity Impact Assessment Completed Lead Responsible Director Internet This policy must be implemented fairly and without prejudice whether on the grounds of ethnicity, gender, sexual orientation, religion, belief, disability or age. January Assistant Director of Nursing Infection Control Board Infection Control Manager

2 AND FOLLOWING EXPOSURE TO Page 2 of 9 CONTENTS 1. Responsibilities Listed Symptoms/ Conditions and Actions to be taken by HCWs NHSGGC Food Poisoning Exclusion and Clearance Criteria Evidence Base / Current Guidance...9

3 AND FOLLOWING EXPOSURE TO Page 3 of 9 1. Responsibilities HCWs must: Follow this policy. Report to the Occupational Health Service and Line Manager if they have any of the symptoms or conditions listed. Managers must: Ensure HCWs are aware of their responsibilities if they develop any of the listed symptoms or conditions. Advise HCWs to contact the Occupational Health Service as necessary. Infection Control must: Keep this policy up-to-date. Give advice as required to Occupational Health Staff and all HCWs. Occupational Health Service must: Liaise with Infection Control Staff regarding any possible infection / return to work issues when necessary. Audit where possible the implementation of this policy. Virologists/Microbiologist must: Arrange testing as required.

4 AND FOLLOWING EXPOSURE TO Page 4 of 9 2. Listed Symptoms/ Conditions and Actions to be taken by HCWs Symptom / Condition Restrictions and Actions Duration Abscess (skin) Restrict from patient contact, contact with the patient environment and food handling. Alternative work can be considered. Until lesions have resolved or can be covered to prevent infection spread. Chickenpox (Varicella) active Chickenpox post-exposure (susceptible, i.e. a person who has no history of the disease or immunisation) If exposure significant exclude from duty. Until there are no new lesions and existing lesions are dry and crusted. From day-10 after 1st exposure until 21st day after last exposure (or day 28 if VZIG given). Refer to Occupational Health for assessment. Conjunctivitis Dermatitis Diarrhoea / Infectious diarrhoea including noro viruses Restrict from contact with the patient and the patient environment. Dermatitis is not infectious but some skin disease can be associated with secondary infection. Individual assessment required. Until discharge ceases or until 48hrs after treatment commenced. Refer to Occupational Health For diarrhoea, where no pathogen is isolated, until symptoms have resolved for 48 hours. See Section 3 for Clearance Criteria for Specific Pathogens. Enteroviral infections Individual assessment. Refer to Occupational Health Hand Foot and Mouth Restrict from duty. Until lesions are healed Head Lice (Pediculosis) Restrict from patient contact. Until live lice are treated and HCW is observed to be free of adult and immature living lice Hepatitis A Restrict from patient contact, Until 7 days after onset of jaundice. contact with patient s environment and food handling. Hepatitis B Individual assessment. Refer to Occupational Health Hepatitis C Individual assessment. Refer to Occupational Health

5 AND FOLLOWING EXPOSURE TO Page 5 of 9 Symptom / Condition Restrictions and Actions Duration Herpes simplex (genital) No specific restrictions provided Standard Precautions are followed. herpetic whitlow (hands) Oro-facial Human Immunodeficiency Virus (HIV) Measles (active) Measles post-exposure (susceptible person) Mumps (active) Mumps Post-exposure (susceptible person) Occupational Health Service to check HCW is susceptible Respiratory Infection (including viral and acute) Parvovirus B19 (Slapped cheek disease) Rubella (active) Rubella post-exposure (susceptible). Occupational Health Service to check HCW is susceptible. Restrict from patient contact, including surgery, and contact with the patient environment. Restrict from high-risk patients including maternity services. Alternative work away from patients may be considered. Individual assessment. Risk assessment to exclude from care of high-risk patients during community outbreaks of RSV and influenza. Individual assessment. Until lesions heal. Until lesions heal. Refer to Occupational Health Until 4 days after rash appears. From 7th day after 1st exposure until 21st day after last exposure and/or 4 days after rash appears. Refer to Occupational Health for assessment Until 9 days after onset of parotitis. From 12th day after 1st exposure until 26th day after last exposure or until 9 days after onset of parotitis. Refer to Occupational Health for assessment Based on risk assessment by Occupational Health in conjunction with ICT. Probably not infectious after onset of rash. Until four days after rash appears. From 7th day after 1st exposure until 21st day after last exposure. Refer to Occupational Health for assessment.

6 AND FOLLOWING EXPOSURE TO Page 6 of 9 Symptom / Condition Restrictions and Actions Duration Scabies Restrict from patient contact. Refer to Occupational Health where there is doubt about the diagnosis or if there is more than one staff infected. Until treatment completed Shingles Individual assessment. Refer to Occupational Health Staphylococcus aureus infections Staphylococcus aureus carrier MRSA (Meticillin resistant Staphylococcus aureus) Streptococcal infection, group A Restrict from patient contact, contact with the patient environment and food handling. No restriction, unless epidemiological link to transmission. Individual assessment. Restrict from patient contact, contact with the patient environment and food handling. Until lesions have resolved. Refer to Occupational Health Until 48 hours after start of effective antimicrobial therapy and definite clinical improvement. Tuberculosis Until proven non-infectious. On advice of Respiratory Physician. Whooping Cough (Pertussis) active Whooping Cough post-exposure asymptomatic post-exposure symptomatic No restriction or prophylaxis recommended. From beginning of catarrhal stage until 3rd week after onset of paroxysms or until 5 days after start of effective antimicrobial therapy. Until 5 days after start of effective antimicrobial therapy.

7 AND FOLLOWING EXPOSURE TO Page 7 of 9 3. NHSGGC Food Poisoning Exclusion and Clearance Criteria Infection Incubation CRITERIA OF CLEARANCE Range SYMPTOM FREE CASE SYMPTOMLESS CONTACT Aeromonas 1-2 days (1-7 days) Campylobacter 3-4 days (1-10 days) Cholera 2-3 days 2 negative stool specimens for (3hrs - 5 days) Groups A, B, C and D Cryptosporidiosis 7-14 days (1-21 days) Dysentery: amoebic 2-4 weeks after treatment Dysentery: S.sonnei Dysentery: S.boydii S.dysenteriae S.flexneri 1-3 days (8hrs - 7 days) 1-3 days (8hrs - 7 days) Usually none but for groups A & B, discuss with CPHM 2 negative stool specimens for Groups A, B, C and D E.coli gastroenteritis hrs VTEC (E.coli O157) Food Poisoning (no organism or toxin identified) Giardiasis Hepatitis A Salmonellosis (excluding typhoid and paratyphoid) Typhoid and Paratyphoid 2-7 days 2 negative stool specimens for 2 negative stool specimens for (1-14 days) Groups A, B, C and D Groups A, B, C and D 1-36 hrs 7-10 days (5-28 days) 28 days (5-50 days) hrs (6 hrs - 7 days) days (1-3 weeks) 7 days after onset of disease - Jaundice 2 negative stool specimens for Groups A & B 6 negative stool specimens at two weekly intervals for group C; 3 negative at weekly intervals for groups A, B & D Until asymptomatic for 48 hours A. B. C & D. Viral gastroenteritis hrs (12 hrs - 10 days) Yersiniosis 3-7 days Bacillus cereus 1-16 hrs) C. perfringens 8-22 hrs) V.parahaemolyticus 2-48 hrs) S. aureus 1-7 hrs) 3 negative stool specimens at 48-hour intervals for groups A, B, C & D.

8 AND FOLLOWING EXPOSURE TO Page 8 of 9 GROUP A: GROUP B: GROUP C: GROUP D: Any person of doubtful hygiene or with unsatisfactory toilet, hand-washing or hand drying facilities at home, work or school. Pre-school children. Food workers whose work involves preparing or serving unwrapped foods not subject to further heating. Health care and nursing staff handling food not subject to further cooking particularly those working in Paediatric or Intensive Care Units and caring for immunosuppressed patients.

9 AND FOLLOWING EXPOSURE TO Page 9 of 9 4. Evidence Base / Current Guidance Ayliffe G A, Lowbury EJL, et al Control of Hospital Infection, 3rd edn. Chapman and Hall, London (November 2000). Heymann D.L. Control of Communicable Diseases in Man Manual. 18 th Edition CDC Personnel Health Guidelines AJIC 1998; 26: 3. Immunisation against infectious disease Green Book (2006). Department of Health. DH_079917