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.
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.
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
Tuberculosis
Depending on national legislation, an employer may need to require that before starting to work in health or social service units or starting to take care of children below school age, workers must provide a reliable certificate of not having respiratory tract tuberculosis. A health check may also be required.
Find out about locally relevant regulation and guidelines.
Good food work hygiene protects consumers from food-borne infections.
High-risk work means work involving a high risk of spreading food-borne infections (e.g. salmonella, EHEC).
Workers must not perform high-risk work while they have gastroenteritis. Depending on local legislation, they may be entitled to either daily compensation for incapacity for work or to an infectious disease allowance if they have been ordered to stay at home from paid work to prevent spread of infection.
People with asymptomatic salmonella or EHEC infection performing high-risk work should, after consulting occupational health care, primarily be assigned other work tasks to avoid the risk of infection.
If this is not possible, a physician with relevant authority can order a person with disease to stay at home for a specific period.
The employer must ask the worker in specific settings for a reliable certificate of not having been infected with salmonella. These may include work
in specific food premises handling unpackaged food to be served unheated
at a dairy facility handling milk, if the facility produces milk for a dairy or for other food premises where milk is not pasteurized.
A health status certificate is based on an interview by a doctor or a nurse. In association with the interview, good food work hygiene practices should be emphasized. A laboratory test will be needed only if the employee has had diarrhoea with fever (≥ 38°C) within the past month.
A faecal nucleic acid test or salmonella culture can be done. For patients with bloody diarrhoea, nucleic acid test and culture for EHEC should also be done.
A health status certificate is required before starting employment and during employment whenever there is a justified suspicion that the employee may be a carrier of salmonella bacteria (having diarrhoea with fever, or salmonella infection in a person living in the same household, for example).
A health status certificate must also be required from trainees and other people working in equivalent areas for a minimum period defined in local regulations without an employment relationship.
The worker may return to work after 2 asymptomatic days, unless a stool sample has shown salmonella, EHEC or shigella. Carriers of the said microbes must not continue in their work until follow-up samples are negative.
In salmonellosis, the collection of follow-up specimens (salmonella culture) should be started no earlier than one week after a positive faecal culture result was obtained. Samples should be taken once a week until the first negative sample and then every two days. The person must not return to work until 3 consecutive negative samples have been obtained.
EHEC
High-risk work with regard to EHEC bacteria includes
the same tasks as for salmonella: handling of milk if milk is not pasteurized, and handling of unpackaged food served unheated
nursing on a neonatal ward, and
taking care of children below school age, elderly people or those with severe immunodeficiency, if the work involves helping with meals or other tasks predisposing the person to infection via the oral route. The doctor in charge of communicable diseases should assess the risk case by case.
EHEC follow-up samples should only be taken from people doing high-risk work or children attending day care. EHEC carriership is considered to have ended when two consecutive faecal samples taken more than 24 hours apart have been found to be PCR- or culture-negative.
References
da Silva EH, Lima E, Dos Santos TR, et al. Prevalence and incidence of tuberculosis in health workers: A systematic review of the literature. Am J Infect Control 2022;50(7):820-827 [PubMed]
Ledda C, Costantino C, Motta G, et al. SARS-CoV-2 mRNA Vaccine Breakthrough Infections in Fully Vaccinated Healthcare Personnel: A Systematic Review. Trop Med Infect Dis 2022;7(1): [PubMed]