Page Page 1 of 6 Policy Objective To prevent HCWs being a possible source of cross-infection to either patients or colleagues. 1. Responsibilities... 1 2. Listed symptoms / conditions / and actions to be taken by HCWs... 2 3. NHS Greater Glasgow & Clyde s Food Poisoning Exclusion & Clearance Criteria... 5 4. Evidence Base / Current Guidance... 6 See also Sickness/Absence Policy 1. RESPONSIBILITIES HCWs must: Follow this policy. Report to Occupational Health Department 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 Occupational Health Department as necessary. Infection Control must: Keep this policy up to. Give advice, as required, to Occupational Health Staff and all HCWs. Occupational Health Department must: Liase with Infection Control Staff regarding any possible infection control / return to work issues. Audit, where possible, the implementation of this policy. Virologists must: Arrange testing as required.
Page Page 2 of 6 2. LISTED SYMPTOMS / CONDITIONS / AND ACTIONS TO BE TAKEN BY HCWS Symptom / Condition Restrictions and Actions Duration Abscess (skin) contact with the patient environment and food handling. Alternative work can be considered. Chickenpox (Varicella) active Until lesions have resolved or can be covered to prevent infection spread. Until there are no new lesions and existing lesions are dry and crusted. Chickenpox post-exposure (susceptible, i.e. a person who has no history of the diease or immunisation). Occupational Health to check HCW is susceptible Conjunctivitis Dermatitis Diarrhoea / Infectious diarrhoea including norvoviruses. If exposure significant exclude from duty. 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. day 10 after 1st exposure until 21st day after last exposure (or day 28 if VZIG given). Until discharge ceases or until 48hrs after treatment commenced. Refer to Occupational Health Dept. 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 Dept. Hand Foot & 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 contact with patient s environment and food handling. Until 7 days after onset of jaundice.
Page Page 3 of 6 Symptom / Condition Restrictions and Actions Duration Hepatitis B Individual assessment. Refer to Occupational Health Dept. Hepatitis C Individual assessment. Refer to Occupational Health Dept. Herpes simplex Genital Hands herpetic whitlow Oro-facial Herpes Human immunodeficiency virus (HIV) Measles (active) Measles post-exposure (susceptible person). Occupational Health Dept. to check HCW is susceptible Mumps (active) No specific restrictions provided Standard Precautions are followed. 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. Until lesions heal. Until lesions heal. Refer to Occupational Health Dept. Until 4 days after rash appears. 7th day after 1st exposure until 21st day after last exposure and/or 4 days after rash appears. Until 9 days after onset of parotitis. Mumps Post-exposure (susceptible person). Occupational Health Dept. to check HCW is susceptible Respiratory Infection (including viral and acute) Risk assessment to exclude from care of high-risk patients during community outbreaks of RSV and influenza. Individual assessment 12th day after 1st exposure until 26th day after last exposure or until 9 days after onset of parotitis. Based on risk assessment by Occupational Health in conjunction with ICT. Parvovirus B19 Probably not infectious after onset of (Slapped cheek disease rash. Rubella (active) Until days after rash appears.
Page Page 4 of 6 Symptom / Condition Restrictions and Actions Duration Rubella Post-exposure (susceptible). Occupational Health Dept. to check HCW is susceptible. 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. 7th day after 1st exposure until 21st day after last exposure. Until treatment completed. Shingles Individual assessment. Refer to Occupational Health Dept. Staphylococcus aureus infections Staphylococcus aureus Carrier contact with the patient environment and food handling. No restriction, unless epidemiological link to transmission. Until lesions have resolved. MRSA (Methicillin resistant Staphylococcus aureus) Individual assessment. Refer to Occupational Health Dept. Streptococcal infection, Until 48 hours after start of effective group A contact with the patient antimicrobial therapy and definite environment and food handling. clinical improvement. Tuberculosis Until proven non-infectious. On Whooping Cough (Pertussis) active Whooping Cough Post-exposure (asymptomatic) No restriction or prophylaxis recommended. advice of Respiratory Physician. beginning of catarrhal stage until 3rd week after onset of paroxysms or until 5 days after start of effective antimicrobial therapy. Post-exposure (symptomatic) Exclude from duty Until 5 days after start of effective antimicrobial therapy.
Page Page 5 of 6 3. NHS GREATER GLASGOW & CLYDE S FOOD POISONING EXCLUSION & 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 1-3 days (8hrs - 7 days) Usually none but for groups A & B, discuss with CPHM Dysentery: S.boydii S.dysenteriae S.flexneri 1-3 days (8hrs - 7 days) 2 negative stool specimens for Groups A, B, C and D E.coli gastro-enteritis 12-72 hrs VTEC (E.coli O157) 2-7 days (1-14 days) 2 negative stool specimens for Groups A, B, C and D 2 negative stool specimens for Groups A, B, C and D Food Poisoning (no 1-36 hrs organism or toxin identified) Giardiasis 7-10 days (5-28 days) Hepatitis A 28 days 7 days after onset of disease - (5-50 days) Jaundice Salmonellosis (excluding typhoid & paratyphoid) 12-36 hrs (6 hrs - 7 days) 2 negative stool specimens for Groups A & B Typhoid & Paratyphoid 10-14 days (1-3 weeks) 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 gastro-enteritis 12-48 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} GROUP A: GROUP B: GROUP C: GROUP D: 3 negative stool specimens at 48 hour intervals for groups A, B, C & 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 subjected to further cooking particularly those working in Paediatric or Intensive Care Units and caring for immuno-suppressed patients.
Page Page 6 of 6 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 2004. CDC Personnel Health Guidelines AJIC 1998; 26: 3.