Infectious Diseases in the Workplace
This factsheet deals with the main infectious diseases in the workplace, their symptoms, their prevention and the main groups of workers at risk. It also covers the legal obligations of employers and the action that can be taken by workers and their representatives.
In the year 1996/7 medical consultants reported 1294 new cases of occupational infection in the UK. The main activities involved were health care, social work, farming and food handling.
Main infectious diseases at work
Hepatitis
This is a viral liver disease with three main forms, A, B and C. Those at risk include healthcare workers, sewage workers, police and emergency services, morticians and embalmers and others who come into contact with bodily fluids.
Hepatitis A is easily contracted from close contact with infected individuals or ingesting contaminated food or faeces. Symptoms can range from virtually no effect through fever, nausea, lack of appetite, diarrhoea, abdominal pain and jaundice to coma and death. Prevention is achieved by good sanitation, waste disposal and personal hygiene.
Hepatitis B is 100 times more infectious than HIV, and carried in blood, saliva, semen, urine and vaginal secretions. One third of those infected are without symptoms, and there are up to 50,000 symptomless carriers in the UK; one third suffer a mild flu-like illness and one third suffer severe illness for up to six months with nausea, vomiting, fever, pain, fatigue and jaundice. Cirrhosis or cancer of the liver can develop. Prevention can be achieved by vaccination, good personal hygiene and avoiding contact with bodily fluids.
Hepatitis C can cause chronic illness and ultimately death. It is also transmitted in body fluids though to a lesser extent than hepatitis B. There is no vaccine currently available.
HIV/AIDS
Acquired Immune Deficiency Syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). The virus may be carried for many years before symptoms appear. A breakdown of the body's defences can lead to serious infections and some cancers. Treatment with drugs can arrest the onset of symptoms. The virus is transmitted by infected blood, semen and vaginal fluid. Occupational groups at risk are health and personal care workers through needlestick injuries or contact with infected blood through skin cuts and abrasions. Prevention of exposure is achieved by good standards of cleanliness and hygiene.
Tuberculosis
Tuberculosis is a bacterial disease which mostly affects the lungs (pulmonary TB) but can affect other organs. The illness is severe and may lead to long convalescence or to permanent disability. Pulmonary tuberculosis can be transmitted by inhaling the saliva or sputum of an infected person or animal. Groups at risk are health care staff, workers in old peoples' homes, homeless hostels and drug rehabilitation centres and farm and veterinary workers. Prevention is by BCG vaccination which offers immunity for up to 15 years.
Leptospirosis (Weil's Disease)
This is a potentially lethal bacterial disease contracted from water containing mammals', predominantly rats', urine. Infection can occur through contact with the eyes and mouth or through cuts and abrasions. The human form is called Weil's disease and can lead to jaundice or meningitis. Vulnerable groups are water and sewage workers. Protection can be obtained by vaccination. Suitable protective equipment to avoid contact with contaminated water is required.
Legionnaires' disease
This is a bacterial respiratory disease which can be fatal. It is contracted by inhaling droplets of water contaminated with legionella bacteria emanating from cooling towers, air conditioning, humidifiers, showers and other water systems. Anyone in the vicinity of such systems is at risk. Control is by good design, location, maintenance and cleaning of water towers and other systems. The bacteria can be killed by biocides or raising the water temperature to over 60oC. Humidifier fever is a related disease though less virulent and caused by a variety of organisms.
Zoonoses
These are infections transmitted from animals to humans. The most severe are anthrax, bovine tuberculosis, brucellosis, hantavirus, psittacosis, Q fever, rabies, salmonellosis. A somewhat less serious group includes leptospirosis, cowpox, cryptosporidiosis, listeriosis, Newcastle disease, orf, ovine chlamydiosis, ringworm, tetanus and toxocariasis.
Infections in pregnant women
Some infections can cause miscarriages or affect a breastfeeding child: German measles, chickenpox, hepatitis, HIV, typhoid, tuberculosis, ovine chlamydia, and toxoplasma, found in infected cat and dog faeces.
Legal requirements
The Control of Substances Hazardous to Health (COSHH) Regulations apply to biological agents and there is a Biological Agents Approved Code of Practice (ACOP) in addition to the general COSHH requirements. Biological agents are classified into Groups 1-4 with Group 1 being the least and Group 4 the most dangerous. A suitable and sufficient risk assessment must be carried out for any work activity involving the deliberate use of biological agents (e.g. research, medical care) or any exposure where exposure is incidental to the activity (e.g. farm work, sewage work, social work). The assessment should cover the agents, their form, effects and hazard groups, the likelihood of exposure and disease, the possibility of substitution by a less hazardous agent, the control measures, monitoring and health surveillance. Detailed guidance is available on appropriate control measures, especially for intentional work with biological agents. The HSE must be notified of the use, storage or consignment of biological agents. Protective clothing and equipment should not itself become a means of transmitting agents. Monitoring of exposure should be carried out if a suitable technique is availab He surveillance can involve testing for immunity after vaccination. Information should be provided to employees in writing, particularly when dealing with highly infective agents.
Vaccination policy
Vaccination is recommended as a control measure by the Biological ACOP. Where a suitable vaccination procedure exists, employers should not expose non-immunised workers to an infectious agent.
Pregnant women
A particular risk assessment needs to be carried out of the hazards to pregnant or breastfeeding women or women who have given birth within the previous six months. Suitable protective or preventive measures should be provided, working conditions altered or suitable alternative work provided. If none of these can be achieved, the woman should be suspended on full pay for as long as it is necessary to avoid the risk.
Reporting (RIDDOR)
Employers are required to report to the HSE any case of an employee suffering a notifiable, occupational disease. Report should be made on Form F2508A, available from HSE Books. Self-employed people should also make a report. The infectious diseases which should be reported are listed but there is a catch-all clause requiring a report in virtually all circumstances.
Action for safety representatives
- Ensure that members are fully informed about the risks of their job and appropriate prevention and control measures including vaccination.
- Demand the employer provides suitable information and training in the avoidance of risk, including work methods, use of equipment and hygiene.
- Demand the employer carries out a comprehensive risk assessment which covers prevention, control and protection and monitoring and health surveillance.
- Where biological agents are being used, stored or transported, ensure that the correct procedures are in force, according to the Hazard Group of the agent.
- Where there is a serious and imminent risk of infection, advise members that they are entitled to withdraw their labour in order to protect themselves. If circumstances allow, seek advice from your union officials before taking this step.
- If any disease symptoms occur, ensure that members report these immediately and that a report goes to the HSE if required. Any other people who might be affected should be immediately tested for signs of illness.
Resources
- COSHH regulations: LHC factsheet, available from LHC and on www.lhc.org.uk.
- Catching animal disease: zoonoses at work. Hazards magazine no 63, July 1998, p 14-15.
- General COSHH ACOP (Control of substances hazardous to health) and Carcinogens ACOP (Control of carcinogenic substances) and Biological agents ACOP (Control of biological agents): Control of Substances Hazardous to Health Regulations 1994. HSE series L5. ISBN 0-7176-1308-9. £7.50 from HSE Books, PO Box 1999, Sudbury, Suffolk, CO10 6FS, 01787-881165, fax 01787-313995.
- LHC's HAZLIT database lists more union and official resources at www.lhc.org.uk.
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