What is it?

Sometimes employees will have or develop conditions that make them more susceptible to infections.  Facilities need to assist employees who experience circumstances that place them at greater risk of infection by developing management plans that ensure their well-being. Where a healthcare worker is known to be particularly susceptible to HAIs, work duties need to be assessed to ensure that the welfare of that person, residents, and other healthcare workers is safeguarded. 

This may involve appropriate work placements, adjustments or restrictions, or deployment to a role involving less risk.  

Skin Conditions

Skin integrity is the ultimate barrier to the transmission of infectious agents. Damaged skin or weeping skin conditions e.g., allergic eczema, psoriasis, exfoliating dermatitis, etc., can be readily colonised by healthcare-associated micro-organisms. Healthcare workers with these conditions may not be harmed by these micro-organisms but may spread them widely to residents or other employees. It's essential to apply standard precautions.

Healthcare workers with skin conditions should be identified by personal history screening when they start employment and need to be informed of the risk they may pose to residents

Damaged skin must be appropriately covered before carrying out procedures

Appropriate PPE, such as specific types of gloves, hand hygiene products, and moisturising lotion should be used

Employees who have physical contact or potential exposure to blood or body substances should be assessed by the Infection Prevention and Control Lead, manager, or nurse manager on site. If necessary, medical advice should be sought. Temporary redeployment may be required based on the advice given.

Being Immunocompromised

Employees with immune deficiency conditions are more at risk of acquiring infections. Examples of these conditions include neutropenia, disseminated malignancy, and infections that produce immunodeficiency e.g., HIV.  The type of employment they can undertake should only include duties that will minimise their exposure to infections. 

Pregnancy and Infection

Information on the risks associated with pregnancy should be provided to pregnant employees and they should be assisted to avoid infectious circumstances that may present a risk to them or the baby. It is their responsibility to advise their doctor and employer of their pregnancy and this information must remain confidential.

All pregnant healthcare workers should adhere to standard and transmission-based precautions and ensure that they are appropriately vaccinated. However, pregnant healthcare workers should be given the opportunity to avoid residents with specific infections.

Two viral infections that are of concern to the pregnant woman and her foetus are varicella zoster (chicken pox) and primary CMV (cytomegalovirus) disease.

The risks to pregnant women are likely to be greatest when managing residents with chickenpox or shingles. Pregnant or potentially pregnant women without a history of varicella zoster infection or vaccination should be aware of the risks associated with their susceptibility and should arrange with their supervisor to work elsewhere within the facility. 

CMV infection is of particular concern to pregnant women because of the possibility of foetal damage if this infection is acquired for the first time during pregnancy. CMV may be shed into blood, urine, saliva, semen, breast milk, tears, and faeces. However, the likelihood of transmission of infection is very low as long as standard procedures are strictly observed. 

Pregnant staff members may wish to have their susceptibility to CMV determined by their local general practitioner, lead maternity carer, or specialist.

Bloodborne Pathogens

Bloodborne pathogens are microorganisms that are carried in the blood and can cause diseases in people. There are many different bloodborne pathogens, including malaria, syphilis, and brucellosis, and most notably, Hepatitis B (HBV), Hepatitis C (HCV), and the Human Immunodeficiency Virus (HIV).

Healthcare workers with a bloodborne virus are not excluded from employment or functions, they can safely perform under policies in place in the facility. However, employees should have a clear responsibility to know their infectious status, follow treatment recommended by medical practitioners, and modify their involvement in direct resident care to eliminate exposure-prone procedures.

Healthcare workers infected with a bloodborne virus should consult with their Doctor regarding their continued involvement in direct resident care. The Doctor should also determine and make recommendations to the employer about the healthcare worker's ability to perform to the accepted professional standards without compromising the safety of others or themselves in the workplace and continue to comply with relevant health regulations.

For more information see Healthcare Workers with Bloodborne Viruses.