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Health Clearance for Tuberculosis, Hepatitis B, Hepatitis C and HIV for New Healthcare Workers with Direct Clinical Contact with Patient

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ANNEX C

REGULATORY BODIES' STATEMENTS ON PROFESSIONAL RESPONSIBILITIES

1. General Medical Council ( GMC)

Extracts from Serious Communicable Diseases (1997).

The GMC Statement, HIV Infection and AIDS: the Ethical Considerations, was first sent to all registered medical practitioners in August 1988, and in April 1991 was sent to those who had obtained full registration since 1988. A revised version was sent in June 1993, and this was re-circulated to doctors as part of the series of booklets Duties of a Doctor in 1995.

In 1997, it was superseded by the booklet Serious Communicable Diseases. This term applies to any disease which may be transmitted from human to human and which may result in death or serious illness. It particularly concerns, but is not limited to, infections such as HIV, tuberculosis and hepatitis B and C.

Responsibilities of doctors who have been exposed to a serious communicable disease

29. If you have any reason to believe that you have been exposed to a serious communicable disease you must seek and follow professional advice without delay on whether you should undergo testing and, if so, which tests are appropriate. Further guidance on your responsibilities if your health may put patients at risk is included in our booklet Good Medical Practice.

30. If you acquire a serious communicable disease you must promptly seek and follow advice from a suitably qualified colleague - such as a consultant in occupational health, infectious diseases or public health on:

  • Whether, and in what ways, you should modify your professional practice;
  • Whether you should inform your current employer, your previous employers or any prospective employer, about your condition.

31. You must not rely on your own assessment of the risks you pose to patients.

32. If you have a serious communicable disease and continue in professional practice, you must have appropriate medical supervision.

33. If you apply for a new post, you must complete health questionnaires honestly and fully.

Treating colleagues with serious communicable diseases

34. If you are treating a doctor or other healthcare worker with a serious communicable disease, you must provide the confidentiality and support to which every patient is entitled.

35. If you know, or have good reason to believe, that a medical colleague or healthcare worker who has, or may have, a serious communicable disease, is practising, or has practised, in a way which places patients at risk, you must inform an appropriate person in the healthcare worker's employing authority, for example an occupational health physician, or where appropriate the relevant regulatory body. Such cases are likely to arise very rarely. Wherever possible you should inform the healthcare worker concerned before passing information to an employer or regulatory body.

2. General Dental Council

Extract from Maintaining Standards Guidance to dentists on professional and personal conduct (November 1997)

This guidance was sent to all registered dental practitioners in December 1997 and replaces the guidance entitled Professional Conduct and Fitness to Practise.

Dealing with Cross-Infection

4.1 There has always existed the risk of cross-infection in dental treatment. Therefore, a dentist has a duty to take appropriate precautions to protect patients and other members of the dental team from that risk. The publicity surrounding the spread of HIV infection has served to highlight the precautions which a dentist should already have been taking and which are now more important than ever. Detailed guidance on cross-infection control has been issued by the Health Departments and the British Dental Association, and is endorsed by the Council.

It is unethical for a dentist to refuse to treat a patient solely on the grounds that the person has a blood borne virus or any other transmissible disease or infection.

Failure to employ adequate methods of cross-infection control would almost certainly render a dentist liable to a charge of serious professional misconduct.

Dealing with Transmissible Disease

4.2 A dentist who is aware of being infected with a blood borne virus or any other transmissible disease or infection which might jeopardise the wellbeing of patients and takes no action is behaving unethically. The Council would take the same view if a dentist took no action when having reason to believe that such infection may be present.

It is the responsibility of a dentist in either situation to obtain medical advice which may result in appropriate testing and, if a dentist is found to be infected, regular medical supervision. The medical advice may include the necessity to cease the practice of dentistry altogether, to exclude exposure-prone procedures or to modify practice in some other way.

Failure to obtain such advice or to act upon it would almost certainly lead to a charge of serious professional misconduct.

3. Nursing and Midwifery Council -

Extract from: Registrar's Letter 4/1994, Annex 1: ACQUIRED IMMUNE DEFICIENCY SYNDROME AND HUMAN IMMUNO-DEFICIENCY VIRUS INFECTION ( AIDS AND HIV INFECTION) The Council's Position Statement

The Council's Code of Professional Conduct

2. The 'Code of Professional Conduct for the Nurse, Midwife and Health Visitor' is a statement to the profession of the primacy of the interests of patients and clients. Its introductory paragraph states the requirement that each registered nurse, midwife and health visitor safeguard the interest of individual patients and clients. It goes on to indicate to all persons on the register maintained by the Council that, in the exercise of their personal professional accountability, they must 'act always in such a manner as to promote and safeguard the interests and well-being of patients and clients'.

The Responsibility of Individual Practitioners with HIV Infection

13. Although the risk of transmission of HIV infection from a practitioner to a patient is remote, and, on the available evidence much less than the risk of patient to practitioner transmission, the risk must be taken seriously. The Department of Health in England have commissioned a study to evaluate this risk. It is incumbent on the person who is HIV positive to ensure that she or he is assessed regularly by her or his medical advisers and complies with the advice received.

14. Similarly, a nurse, midwife or health visitor who believes that she or he may have been exposed to infection with HIV, in whatever circumstances, should seek specialist medical advice and diagnostic testing, if applicable. She or he must then adhere to the specialist medical advice received. Each practitioner must consider very carefully their personal accountability as defined in the Code of Professional Conduct and remember that she or he has an overriding ethical duty of care to patients.

The Nursing and Midwifery Council advice sheet on Bloodborne viruses, which sets out professional responsibilities for registrants, is available at:
http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1555

NMC guidelines are available at:
http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1555.

Health Professions Council

The standards of conduct, performance and ethics for registrants of the Health Professions Council are available at:
http://www.hpc-uk.org/assets/documents/10001BFBSCPEs-cfw.pdf


1 http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/HealthClearance/fs/en

2 http://www.dh.gov.uk/Consultations/ClosedConsultations/ClosedConsultationsArticle/fs/en?CONTENT_ID=4016880&chk=MX34eS

3 Exposure-prone procedures are those invasive procedures where there is a risk that injury to the worker may result in exposure of the patient's open tissues to the blood of the worker. These include procedures where the worker's gloved hands may be in contact with sharp instruments, needle tips or sharp tissues (e.g. spicules of bone or teeth) inside a patient's open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times. Such procedures occur mainly in surgery obstetrics and gynaecology, dentistry and some aspects of midwifery. Most nursing duties do not involve EPPs; exceptions include A&E and theatre nursing. Further guidance and examples of EPPs can be found in Annex B.

4 Tomorrow's Doctors (February 2003)
http://www.gmc-uk.org/med_ed/tomdoc.pdf

5. The New Doctor (January 2005)
http://www.gmc-uk.org/med_ed/default.htm

6. http://www.mmc.scot.nhs.uk

7 NICE(2006) Clinical diagnosis and management of tuberculosis, and measures for its prevention and control
http://www.nice.org.uk/page.aspx?o=CG033&c=infections

8 Serious communicable diseases. General Medical Council 1997
http://www.gmc-.uk.org/guidance/library/serious_communicable_diseases.asp.
The NIMC Code of Professional Conduct: standards for conduct, performance and ethics:Nursing and Midwifery Council, 2004
http://www.nmc-.uk.org/aFramedisplay.aspx?documentD=201

9. See DH (2002) Good practice guidelines for renal dialysis/transplantation units: prevention and control of blood-borne virus infection
http://www.dh-gov.uk/assetRoot/04/05/95/11/04059511.pdf