From time to time, health care staff may develop infections which could expose some service users and colleagues to the risk of infection.
Symptoms or signs of infection can appear trivial to staff who are usually fit and well, but can cause severe problems in vulnerable service users.
Reporting
Early reporting and implementation of suitable control measures can prevent crossinfection and subsequent outbreaks of infection.
Confirmed or suspected transmissible infections in health care staff should be reported by the staff member to the Occupational Health provider. In addition, advice can be sought from the Infection Prevention & Control Advisor/local Health Protection Team if there is concern regarding spread to other staff and/or service users. The staff member’s line manager should also be informed.
Treatment
If necessary, treatment should only be undertaken by the Occupational Health provider (OH) or the individual’s General Practitioner (GP), as appropriate.
Exclusion from Work
The necessity for exclusion from work should be discussed with the Occupational Health provider / individual’s GP and in liaison with the Infection Prevention & Control Advisor/ /UKHSA/Environmental Health Officer (EHO) as necessary.
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Staff with gastro-intestinal infections who handle or prepare food in the course of their work may be required to stay off work until their stool specimens are free of microorganisms. Guidance must be sought from Occupational Health or the individual’s GP who will make the decision regarding return to work after liaising with a medical microbiologist where necessary
Although not an exhaustive list, the following table summarises the risks to service users from staff with common infectious diseases.
INFECTION SERVICE USER
BLOOD BORNE VIRUSES
(BBV) including Hepatitis B
Hepatitis C HIV
The risk of transmission of a blood borne virus from a HCW to a service user is extremely low. Not all staff will be aware of their possible infectious status therefore standard infection control practice should be applied at all times.
ADVICE TO STAFF
Staff should seek confidential advice from Occupational Health as soon as possible following diagnosis, or if concerned that they may have been exposed to a BBV.
CHICKEN POX (Varicella) And SHINGLES (Herpes Zoster)
Non-immune and immune-suppressed service users may require active protection e.g. immunisation and guidance should be sought from the service user’s Clinician/GP immediately exposure is confirmed or suspected.
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An assessment will be made regarding further clinical management, in consultation with the UKHSA HPU.
If a staff member is diagnosed with a BBV some modification of working practices may be necessary, in some defined situations.
Non-immune health care staff, i.e., those who have not had Chicken Pox the disease or vaccination, should seek advice from OH or their GP and may be medically suspended from clinical work from day 8-21 post- exposure.
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NB: Post Exposure Prophylaxis – PEP – for Chicken Pox and Shingles (Herpes Zoster) is recommended for certain people, service user and staff, who fit defined criteria. Please see the guidance available at Guidelines on post-exposure prophylaxis (PEP) for varicella or shingles (February 2025) - GOV.UK
Non-immune pregnant staff. (particularly < 20 weeks pregnant or in last 3 weeks of pregnancy) must discuss with OH or equivalent and their Obstetrician or Midwife urgently.
Immune- suppressed staff having contact with an infectious case must discuss their exposure with their clinician and / or Occupational Health provider immediately.
Symptomatic staff exclusion period is 5 days from onset of rash and until all lesions crusted over.
Caused by the herpes simplex virus, which may expose some service users who are immuno-compromised, neonates and pregnant women to particular risks. Viral encephalitis may ensue in these susceptible service users.
These are viral infections which may spread to service users and other staff.
Vaccinations against Covid-19, and RSV is recommended in line with current guidance
Depending on working environment staff may need to remain off duty until resolution of symptoms and lesions are dry. Seek OH or UKHSA guidance. Do not touch lesions, wash hands thoroughly.
DIARRHOEA and/or VOMITING
These may be symptoms of food poisoning or viral infection, which can result in cross infection causing outbreaks. Viral outbreaks spread rapidly & vulnerable service users are at particular risk, especially babies and the elderly
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Staff should remain off duty in line with current guidance. See COVID-19: managing healthcare staff with symptoms of a respiratory infectionGOV.UK (www.gov.uk)
Affected staff should remain off duty until well enough to return, (i.e. apyrexial). Covid 19 testing is only required in certain circumstances as described in the guidance above.
Vaccination for health and care staff will not be included in the autumn/winter 2025 vaccination programme in line with expert advice.
SICP with Transmission Based Precautions (TBP) are required when caring for someone with ARI.
Staff must remain off duty until 48 hours after resolution of the symptoms. Food handlers must discuss their condition with OH or HPU before returning to work. Notify the Senior Manager if more than 2 service users/staff affected.
HAND, FOOT & MOUTH DISEASE
(Coxsackie virus)
Characterised by a sore throat, pyrexia and lack of appetite initially; followed by mouth ulcers and rash – red spots that develop into blisters, usually on hands and feet. Blisters can be painful. Symptoms affect both adults and children. Usually clears within 7-10 days – no antibiotic treatment effective but symptomatic relief can be effective.
Service users should ideally not be in close contact with others whilst symptomatic although isolation may be too extreme depending on care environment – seek guidance from HPU.
IMPETIGO & INFECTED SKIN CONDITIONS
i.e., psoriasis, eczema etc.
MEASLES (Rubeola), MUMPS (infectious mononucleosis) and RUBELLA (German measles)
A bacterial infection is the usual cause (although impetigo can be a mixed bacterial/viral infection), which can then be spread to service users. Particularly vulnerable service users are those with open lesions, surgical or traumatic wounds, the immuno-compromised or elderly.
Cases are highly infectious. Isolation required as follows:
• 4 days from onset of rash and recovered from symptoms (measles)
• 5 days from onset of rash and recovered from symptoms (rubella)
• 5 days from onset of swelling and recovered from symptoms (mumps)
Easily spread – often from child to adult. Airborne and faecal/oral transmission.
Infectious prior to symptoms and for first 5 days after symptoms start.
Depending on work environment, exclusion whilst symptomatic may be required, but no need to wait until blisters healed. Seek guidance from HPU. If pregnant, avoid close contact with affected person and notify GP/midwife if in contact with / affected by this infection.
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Staff suffering with these infections may be required to remain off duty until the infection has resolved unless it can be covered by an occlusive dressing. Antibiotics are often required in which case exclusion for first 48 hours of treatment is required.
Non-immune staff must inform OH or equivalent of exposure to an infectious source. Non- immune pregnant staff, i.e., those who have no history of disease and/or no positive antibody test must seek guidance from Occupational Health / GP / midwife especially in the first trimester of pregnancy.
Staff who must care for suspected or proven measles servicer users, must wear FFP3 masks, after required fit testing. See NHS England » Guidance for risk assessment and infection prevention and control measures for measles in healthcare settings
PARVOVIRUS (FIFTH DISEASE) – slapped cheek
SCABIES
SHINGLES (Herpes Zoster)
Mild, non-febrile viral disease characterized by erythema of cheeks. Most infectious prior to development of rash but not infectious thereafter.
Staff may be infected by skin-to-skin contact with service users. Scabies is often difficult to diagnose in the elderly. Service users remain contagious until 24hrs posttreatment. If > 1 service user affected, treatment will need to be undertaken simultaneously.
Also known as Varicella Zoster
Can cause foetal abnormality. Pregnant staff less than 20 weeks pregnant who have the infection or have been exposed should seek advice from their midwife.
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Staff contacts of infested service users may require treatment. If staff member is affected, family contacts will also require treatment.
Contact IPCA/HPU for further guidance. No requirement for exclusion from work once treated.
Shingles may be infectious to a non-immune person from contact with lesions. It is not transmitted by the airborne route. Staff diagnosed with shingles should seek advice from their OH provider or GP on returning to work.
See also Chicken Pox above
SORE THROATS
TUBERCULOSIS
These may have many causes but are usually viral. Bacterial causes e.g. streptococcal infections, can cause severe infections in vulnerable service users.
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Physical isolation is only required for those who are pulmonary smear positive for AFBs (acid fast bacilli). Isolation should continue until at least 14 days after commencing appropriate anti-tuberculosis therapy and/or until advised by TB specialist/team.
Staff should remain off duty until resolution of symptoms, if unwell and with a severe sore throat associated with pyrexia.
Notify the IPCA and the OH provider if more than one member of staff is affected
Staff should remain off duty until resolution of symptoms, if unwell and with a severe sore throat associated with pyrexia, in accordance with specialist advice.
Notify the IPCA/HPU and the OH provider if more than one member of staff is affected.
WHOOPING COUGH (pertussis)
May occur in older service users as result of diminished immunity. Isolation for first 48 hours of antibiotic treatment; may remain infectious for 21days without treatment. Non-infectious cough may persist for weeks. Preventable by vaccination. Management/exclusion same as service user and seek fitness to work advice from GP/OH if antibiotics not prescribed.
