High-Risk Work with Regard to Communicable Diseases

Essentials

• The risk of spreading infectious diseases must be considered in certain work activities.
• The aim of prevention of infectious diseases is to protect patients/clients, citizens and/or workers.
• Some of the infection prevention measures associated with high-risk work are stipulated by law and for some there are recommendations and guidelines on the websites of relevant authorities.
• There are regulations and recommendations for both health and social service professionals and for people working in other occupations, particularly in the food or agricultural fields.
• Notice that this article has been written in the Finnish context and is based on Finnish national legislation and guidance. While much of the content is generic in nature, some issues and suggested measures or details may not be applicable in all settings. Always check and follow also the local legislation, policies and recommendations.

Patient safety

• Consideration of patient safety is particularly important for people working with patients or clients who are particularly susceptible to infectious diseases.
• Authorities and departments responsible for health and social services must take systematic measures to prevent transmission of communicable diseases.
  • Patients or clients exposed to infection in health and social services units or in home care may be more susceptible to complications or other consequences of disease than the rest of the population.
  • Plans must be made to prevent infections associated with treatment.
  • The prevalence of communicable diseases and drug-resistant microbes should be monitored.
  • Measures should be taken to ensure appropriate protection and placement of patients, clients and personnel and appropriate use of antimicrobials.
• Vaccination of personnel
  • People with insufficient vaccination protection should only in exceptional circumstances work on the premises of health and social service units treating patients considered to be susceptible to serious consequences of communicable diseases.
  • Personnel must be protected against measles and chickenpox either through vaccination or by having had the disease.
  • Personnel must have been vaccinated against influenza, and those treating infants also against whooping cough.
• In certain situations, workers need to be checked to prevent transmission of tuberculosis (see below).

Protecting citizens, preventing infection

• Extensive spread of a disease from a patient to other people, i.e. epidemics, should be prevented.
• The protection of citizens against food-borne disease often requires special measures (e.g. salmonella, EHEC, see below).
• Diseases classified as dangerous are serious and have a potential for spreading, which can be prevented or limited by preventive measures. For preventing epidemics of dangerous communicable diseases, the available means may even violate an individual's basic rights.

Occupational safety

• People can be exposed to biological factors, most often communicable diseases, in many kinds of work and working environments.
• The employer has to minimize the worker's exposure to a level that is not detrimental to health. The employer must
  • inform workers about work involving risk of infection and provide them with training in correct work and risk control methods
  • keep a list of workers who have in their work been exposed to biological factors involving serious risk or causing serious disease in humans.
• A worker's health (e.g. immunodeficiency) may impact their possibilities for doing various tasks. Occupational health care can assess a worker's suitability and prerequisites for doing particular types of work.
• Examples
  • Health and social service professionals
    • Health care or laboratory workers may be exposed to communicable diseases when taking or handling samples; e.g. needlestick injuries, splashes Occupational Exposure to Blood and Body Secretions.
    • Treatment may involve direct contact with infected people.
  • Pregnant workers
    • Biological factors posing risks to pregnancy or foetal health include hepatitis and herpes viruses, HIV, cytomegalovirus, chickenpox, rubella and parvoviruses, as well as listeria bacteria and toxoplasma.
  • Agricultural work
    • Agricultural work involves many kinds of exposure, including exposure to microbes causing zoonoses, such as Cryptosporidium Cryptosporidiosis, EHEC Diarrhoeal Diseases Caused by Microbes, salmonella Diarrhoeal Diseases Caused by Microbes, MRSA Multidrug-Resistant Bacteria in Hospitals, parapoxvirus (”milker's nodules”), Erysipelothrix (erysipeloid) Erysipeloid.
    • Good hand hygiene and wearing and maintenance of garments, footwear, gloves and protection appropriate for the task are essential for infection control.
    • Whenever people working on livestock farms (pig farms, in particular) seek hospital treatment, MRSA screening should be done.

Diseases central for high-risk work