​Staff screening and treatment after infection outbreaks

Screening of healthcare workers as part of managing an infection outbreak may occasionally be advised by an OCT (outbreak control team). Our guidance summarises the ethical principles and legal framework that apply.

Location: UK
Audience: Occupational health doctors All doctors
Updated: Tuesday 8 September 2020
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Screening may cause understandable concern on the part of healthcare workers in relation to the occupational health and employment implications of test results.

 

Definition of infection outbreak

An infection outbreak may be defined as:

  • An incident in which two or more people experiencing a similar illness are linked in time or place
  • A greater than expected rate of infection compared with the usual background rate
  • A single case for certain rare diseases for example diphtheria, botulism, rabies and viral haemorrhagic fever
  • ​A suspected, anticipated or actual event involving microbial contamination of food or water.

 

Outbreak management

The primary objective in outbreak management is to protect public health by identifying the source of infection and implementing control measures to prevent further spread or recurrence.

Responsibility for managing outbreaks is shared by all members of the OCT. The OCT is required to give due consideration to its responsibilities in supporting investigations which may give rise to legal proceedings, for example under the Corporate Manslaughter and Corporate Homicide Act 2007, the Food Safety Act 1990 and associated regulations and the Health and Safety at Work Act 1974 and associated regulations.

 

OCT membership

The possible membership of an OCT is in appendix one. OCTs are likely to be similarly constituted to hospital infection control committees and usually includes a consultant occupational physician to advise on the occupational health aspects of any decision to screen and/or treat staff.

 

Risk assessment

All activities and decisions of the OCT should be underpinned by a suitable and sufficient risk assessment and should be evidenced-based. The risk assessment should be agreed by members of the OCT and regularly reviewed.

Occupational health practitioners must ensure that the control measures which arise from the risk assessment, and which are implemented by occupational health services, comply with the requirements of all relevant legislation in terms of confidentiality, consent and medical effectiveness and are communicated with all stakeholders.

 

Establishing a screening strategy

If, following an evidence review and risk assessment, screening and/or treatment of staff is felt to be a proportionate measure by the OCT, a screening/treatment strategy needs to be considered, agreed and communicated to affected staff.

The strategy should take the following into account:

  • Who to screen.
  • When to screen.
  • How to screen (agreed sampling method).
  • Where to screen.
  • Which test to do.
  • Who will undertake the sampling.
  • How results (both negative and positive) will be communicated to affected staff, ensuring appropriate confidentiality.
  • How outcomes will be shared with the OCT and line management.
  • How positive results are managed.

 

Legislation

The HSWA 1974 (Health and Safety at Work Act 1974) is the primary legislation covering occupational health and safety in the UK. It sets out the general duties that employers have towards employees and also to members of the public, including patients, residents and visitors. Section seven of the HSWA 1974 applies to employees.

Under the HSCA 2008 (Health and Social Care Act 2008) the Government published a specific code of practice for the prevention and control of healthcare-associated infection. One of the aims of the HSCA 2008 is to reduce healthcare associated infections.

A summary of the relevant health and safety legislation is set out in appendix two of our guidance and a summary of the HSCA 2008 code of practice relating to healthcare-associated infections is at appendix three.

Doctors and nurses have ethical obligations set out by the GMC and the NMC. Good Medical Practice states that doctors must make patient care their first concern and must protect and promote the health of patients and the public. The NMC code states that nurses must take all reasonable personal precautions to avoid any potential health risks to colleagues, people receiving care and the public.