Under the Health and Safety at Work etc. Act 1974 [1] and the Control of Substances Hazardous to Health (COSHH) Regulations 2002 [2] employers are required to provide a safe place of work, protect staff and others who may be affected by their work activities, and to assess and minimise the potential health and safety risks from exposure to hazardous substances, including biological agents. Employees have a duty to co-operate with their employer to adhere to these duties (see Health and Safety Legislation and Hazardous Substances (COSHH) for further details).
The UK Health Security Agency (UKHSA) document Integrated guidance on health clearance for healthcare workers provides information on:
- the health clearance measures required to minimise the risk of transmission of infection to patients from healthcare staff.
- immunisation against infectious diseases required for the protection of staff. This includes Hepatitis B immunisation for staff whose activities place them at risk of infection with Hepatitis B.
The UKHSA, Green Book [3] recommends employee immunisation programmes as managed via Occupational Health Services (OHS). In June 2018, an NHS Scotland based Occupational Health Advice and Guidance Service for dental practice teams was introduced. These services are provided by NHS Boards and further information, including eligibility, available services and contact details were provided via a CDO letter.
Safe working practices
Adoption of safe working practices is the most effective method of reducing risks. Immunisation should never be regarded as a substitute for good practice. It is vital to emphasise to staff the importance of safe practice including an awareness of routine infection prevention and control precautions such as hand hygiene and appropriate use of PPE (gloves, aprons, masks, visors etc). This can help reduce the risks of occupational exposures to blood and body fluids, including sharps injuries such as needlestick (inoculation). Dentists and Dental Care Professionals have a legal obligation to ensure that the risks from sharps injuries are controlled and that safe sharps practice is followed as per the Health and Safety (Sharp Instruments in healthcare) Regulations (2013) [4] (also see Occupational exposure management (including sharps)).
Staff should be reminded to comply with local policies relating to infection prevention and control to protect themselves and their patients. Local policy documentation should be explained and be easily accessible, with training provided where required.
Confidentiality
Healthcare workers are entitled to the same right to confidentiality as any patient seeking or receiving medical care. OHS staff work within strict guidelines on confidentiality. Their role involves continuous revision of local procedures regarding health clearance and immunisation against infectious diseases.
OHS records are held separate from any other records such as hospital, doctor, employment. OHS staff have an ethical and professional obligation not to release this information without the informed consent of the individual. However, should patients be, or have been, at risk, it may be necessary in the public interest for the employer to have access to confidential information relating to their staff member.
Practices are required to keep records of the health clearance status of their members of staff confidential. OHS notices of fitness for clinical work (sometimes referred to as a ‘fit-slip’) do not include potentially sensitive employee health information, such as details of individuals’ vaccination history or immunity. Adopting this approach means that dental practices can avoid the need for elaborate information governance measures to maintain confidentiality.
Further information can be sourced from the Data Protection Act 2018 [5], NHS Scotland Caldicott Guardians: Principles into Practice [6] and Information Commissioner’s Office Guide to the UK General Data Protection Regulation (UK GDPR) [7].
Sources of information
- Health and Safety at Work etc. Act (1974)
- The Control of Substances Hazardous to Health Regulations (2002)
- Immunisation against infectious diseases (The Green Book) UK Health Security Agency
- Health and Safety (Sharp Instruments in Healthcare) Regulations (2013)
- Data Protection Act (2018)
- NHS Scotland Caldicott Guardian’s Principles into Practice - Scottish Government (2010)
- Guide to the UK General Data Protection Regulation (UK GDPR) - Information Commisioner’s Office