Occupational Health & Personal Illness

All staff entering dentistry for the first time in both the NHS and private sector, or re-joining after a period of absence, are obliged to complete statutory pre-employment health checks.

Occupational Health and Personal Illness

Under current legislation and regulations outlined in the HCAI Code of Practice there is a legal duty for the Employer or Registered Provider to ensure that health care workers are free of infection and are, as far as reasonably practicable, protected from exposure to communicable infections during the course of their work.

As part of this protection against infectious diseases, employers must ensure that all members of the dental team are suitably educated in the prevention and control of health care associated infections.

Compliance can be achieved by a combination of pre-employment health checks and immunisation against vaccine-preventable diseases.

Existing staff should receive all the necessary vaccinations and boosters, post exposure needle stick assessment, treatment and follow-up.

Within the practice a nominated person should be assigned to co-ordinate the administration of staff health. It is recommended that the practice should keep a written confidential record of individual staff member’s vaccination to ensure that all members of the dental team are up to date with booster vaccinations. 

Health Clearance

Each person should be individually assessed preferably by an occupational health nurse or physician and the assessment based on their job description.

Those staff that have direct patient contact or perform exposure prone procedures (EPP) as part of their clinical duties will require “additional health checks”.

An exposure prone procedure (EPPs) is defined as a clinical treatment or procedures were there is a possibility of unrecognised bleed back into the patient’s open tissues. 

Pre-Employment Standard Health Checks 

All staff entering dentistry for the first time in both the NHS and private sector, or re-joining after a period of absence, are obliged to complete statutory pre-employment health checks to demonstrate:

  • TB immunity (evidence based on results of tuberculin skin testing (Mantoux test), interferon gamma testing or the presence of a BCG vaccine scar that has been checked by an occupational health professional).

In addition they are:

  • Offered hepatitis B immunisation, with post-immunisation testing of the immune response
  • Offered testing for hepatitis C (HCV) and HIV

Any members of the dental team for whom hepatitis B vaccination is contra-indicated on health grounds, who decline vaccination or who is a non-responders to hepatitis B vaccine:

  • Should be restricted from performing EPPs unless shown to be non-infectious (negative for hepatitis B surface antigen).
  • From then on annual testing is required to demonstrate that the person has not become hepatitis B positive.

Additional Health Checks 

Members of the dental team must be free from infection with HIV and active tuberculosis. The HIV regulations are currently under review and are likely to change.

Currently, dental personnel must be: 

  • HIV antibody negative.
  • Hepatitis B (HBV) surface antigen negative or, if positive, e-antigen negative (HbeAg) with a viral load of 103 genome equivalents/ml or less. HCWs that are Hepatitis B e-antigen positive are not allowed to perform exposure prone procedures.  
  • Hepatitis C (HCV) antibody negative, or if positive, negative for hepatitis C RNA.

Antiviral therapy is available to treat HBV and HCV. HbeAg negative infected healthcare workers can continue working whilst taking antiviral therapy, including EPPs, if their HBV DNA remains below 103 genome equivalents/ml. Those with HCV can return to work once the infection has been cleared.

Testing is a one-off and relies on the current legal, professional and ethical obligation for healthcare workers to seek confidential professional advice if they believe that they may subsequently have been exposed to HIV, HBV, HCV or tuberculosis. Failure to do so may breach the employee’s duty of care to patients under the HCAI Code of Practice and the latest GDC Standards 2013, which require registrants to make sure that they have all necessary vaccinations and follow guidance relating to blood-borne viruses.