According to the Health and Safety Executive (HSE, 2017) there are numerous occupations where staff are potentially at risk of incidental exposure to micro-organisms such as viruses and bacteria. However, two occupations are mentioned as being particularly at risk, namely healthcare and laboratories. For those working in a microbiology laboratory, the risk of coming into contact with infections at work is high given that these staff intentionally work with micro-organisms. Conversely, for other healthcare workers and, arguably, for social care workers, the risk is due to the fact that the exposure “is incidental to the purpose of work” (HSE, 2017).
The nature of healthcare professionals’ work indicates that they are one of the key groups exposed to risks of infection in the workplace. Available data as quoted by the HSE (2017) indicates that infection rates are high among this group: 30/100,000 yearly for nurses and 100/100,000 yearly for caregivers who work in residential homes. Although most common infections reported are diarrhoeal diseases, cases were also reported of more serious infections such as those due to needlestick injuries which occurred when healthcare professionals attended to human immunodeficiency virus (HIV) patients (HSE, 2017).
The risk of infection in the healthcare workplace is acknowledged and there are regulations in place to help manage it. One such regulation is the Control of Substances Hazardous to Health Regulations 2002 (HSE, 2013). Guidance aiming to support the control of occupational exposure to infections is provided by the Advisory Committee on Dangerous Pathogens (ACDP) or the Department of Health (DH). Both these institutions refer to effective means to control infections due to harmful micro-organisms, such as HIV, hepatitis B, tuberculosis (TB) etc. Attention should be paid to proper management of clinical waste and post-mortem rooms; provisions supporting this are published by the HSE's Health Services Advisory Committee (HSE, 2003; HSE, 2011). In order to reduce the risk of self-exposure as well as that of exposing others to infections, healthcare professionals should be aware of the general provisions of these regulations.
A report published by the DH (2002) considers how infections can be controlled in hospitals, with one section dedicated to highlighting some of the most significant risks. Prior to describing these risks specifically, one general statement is made: “The problem of infectious diseases is never static.” (DH, 2002:9). This is important because it draws attention to associated risk factors which contribute to raising the risk for infectious disease; healthcare professionals should carefully consider and be aware of these in order to engage properly in the process of preventing infections. These factors are not necessarily directly connected to the workplace environment, but they draw attention to circumstances in which such risks are increased and should therefore also be considered: world-wide travel and trade, technological advancement, and the adaptation of micro-organisms to increased resistance to treatment. Simultaneously, there is a higher number of people with weak immune systems (e.g. due to the increased incidence of cancer), along with modifications regarding how land is used and the environment managed (DH, 2002).
The DH (2002) refers to the following circumstances which directly increase the risk of infectious disease: the emergence of new diseases or diseases which had not been previously recognised, the existence of animal diseases that can be transmitted to humans, poor hygiene, disease control measures which are not sufficiently strict and poor standards of medical care.
The ACDP (2003) indicates that the process of infection may be regarded as a chain of three main elements: the source, transmission and the host. This representation can support professionals to acquire better control of the infection process. Breaking any link of the chain, at any point, will provide control over the process. As such knowing the specific characteristics of all three types of links is essential.
The source. Four main sources of infection should be considered in the workplace: (1) blood and other body fluids as well as the sources for these (e.g. bodies, raw meat etc.); (2) waste products from humans or animals (e.g. faeces, vomit etc.); (3) respiratory discharge (e.g. sneezing) and (4) skin (ACDP, 2003).
Transmission. As indicated by the ACDP (2003), for infection to occur, micro-organisms must follow a route which allows them to move from the source to the host. Acknowledging the common conditions in which transmission occurs is essential for preventing this from happening. Consequently, it is important for employees to know how infections are transmitted for them to act so as to prevent their own infection as well as others’. The following are indicated as common means of facilitating transmission: (1) putting contaminated items (e.g. hands, objects) into the mouth, nose or eyes, (2) allowing infectious aerosols/droplets (e.g. respiratory discharge) to enter one’s body (e.g. by breathing them in), (3) allowing blood or other body fluids to contact mucous membranes (e.g. eyes, nose etc.), (4) allowing micro-organisms or contaminated items to contact broken skin, (5) allowing micro-organisms to enter the body via a skin-penetrating injury (e.g. needle, animal bite etc.).
The host. The previous section indicated some of the transmission routes employees should be aware of when considering the risk of infection. It becomes evident that broken skin and mucous membranes are very susceptible to infections. Those exposed to a high risk of infection in their working environments should consider protecting themselves and others by applying special precautions relating to the indicated areas (e.g. covering the mouth, covering open wounds, proper handwashing etc.). Following these methods of protection, one’s immune system is the next barrier against infections; therefore, provisions should be made to strengthen the immune system of those who are exposed to the risk of infection (ACDP, 2003).
These general considerations are relevant for mitigating the risk of infections in the workplace. The World Health Organisation (WHO, 2004) refers to a series of infection prevention and control practices which are directly connected with existing risks of infection. It groups these according to the following categories:
(1) standard precautions: handwashing and antisepsis, use of personal protective equipment and management of (healthcare) waste,
(2) additional precautions which are transmission-based: airborne, droplet and contact precautions.
Other risks, as indicated by the WHO (2004), may derive from how patient placement and transportation are managed (e.g. spacing between beds) and from how the environment is managed. The latter includes the management of premises/ buildings, air (e.g. ventilation quality), water, waste management (e.g. methods of disposal) etc.
As observed, the potential risks of infection in the workplace are related to both direct and indirect associated factors. Awareness of these can help professionals to conduct their activity in a safe manner which ensures infection prevention.
Advisory Committee on Dangerous Pathogens. (2003). Infection at work: Controlling the risks A guide for employers and the self-employed on identifying, assessing and controlling the risks of infection in the workplace. [Online] Available at: http://www.hse.gov.uk/pubns/infection.pdf. [Accessed 25 July 2017].
Department of Health. (2002). Getting Ahead of the Curve A strategy for combating infectious diseases (including other aspects of health protection). [Online] Available at: http://webarchive.nationalarchives.gov.uk/20121206050457/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4060875.pdf. [Accessed 25 July 2017].
Health and Safety Executive. (2003). Safe working and the prevention of infection in the mortuary and post-mortem room. [Online] Available at: http://www.hse.gov.uk/pUbns/priced/mortuary-infection.pdf. [Accessed 25 July 2017].
Health and Safety Executive. (2011). Safe management of healthcare waste Version 1.0. [Online] Available at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_126348.pdf. [Accessed 25 July 2017].
Health and Safety Executive. (2013). Control of Substances Hazardous to Health. The Control of Substances Hazardous to Health Regulations 2002 (as amended) Approved Code of Practice and guidance. [Online] Available at: http://www.hse.gov.uk/pUbns/priced/l5.pdf. [Accessed 25 July 2017].
Health and Safety Executive. (2017). Infections at work. [Online]. Available at: http://www.hse.gov.uk/biosafety/infection.htm. [Accessed 25 July 2017]
World Health Organisation. (2004). Practical Guidelines for Infection Control in Health Care Facilities. [Online]. Available at: http://www.wpro.who.int/publications/docs/practical_guidelines_infection_control.pdf. [Accessed 25 July 2017].