INFECTIOUS DISEASES IN THE WORKPLACE
Infectious diseases can occur in any place where people spend time together. Occasionally, an employer or employee may need to know how to respond to an infectious disease in the workplace.
Who to contact for advice
The General Practitioner
The GP should always be the first contact if a member of staff / colleague is unwell in order to make a diagnosis. GPs can also give advice on preventing infectious diseases when travelling abroad.
Consultant for Communicable Disease Control
Formerly the Medical Officer for Environmental Health, this is a doctor employed by the local Health Authority in the Department of Public Health, who works in collaboration with Environmental Health Officers. They provide advice on infectious diseases matters and outbreaks of infectious disease in the community, schools and workplaces and can advise on the need for exclusion of an individual with an infectious disease from the workplace.
Environmental Health Officers
These are local authority officers who, among other things, investigate outbreaks of food poisoning in the community. They will arrange for tests of affected people if necessary, and in collaboration with the CCDC, will advise on exclusion from work of affected individuals.
Some infectious diseases that may occur in the workplace
Meningitis is inflammation of the membrane covering the brain and spinal cord. It can be caused by a variety of infections both viral and bacterial. Viral Meningitis tends to be a milder form of the disease. This can occur in ‘outbreaks’ although it would be unusual to have several cases occurring in one school.
Bacterial Meningitis can be caused by several organisms. Specific advice is only given in respect of meningococcal meningitis which can occur in epidemics and can have a sudden onset. In adults, fever, intense headache, nausea, vomiting, pain/aversion to bright lights, stiff neck and sometimes a sudden rash are described as the classical signs.
Exclusion from work
There is no specific exclusion period, patients are usually very ill but can return to work when they have recovered. Contacts of patients do not need to be excluded from the workplace and do not pose a risk to other workers.
Household contacts and “kissing” contacts are given prophylactic antibiotic treatment. The investigation and prophylactic treatment of work colleagues of a case would rarely be required, and then only on the advice of the Consultant in Public Health Medicine.
In the majority of cases there is no effective vaccine available to help prevent further spread. A small number of cases are caused by a strain of meningococcus for which there is a vaccine and this will be offered by the consultant in Public Health Medicine when appropriate. In epidemics, many people can be shown to have the organism present in their nose/throat without any illness. Most cases are sporadic, and unrelated to other cases.
It is important to remember that the risk of developing the illness in the contact of a case of meningitis is very small, but the anxiety generated by the illness is very great.
Tuberculosis remains fairly uncommon, but recent reports suggest an increase in the number of people affected in the UK. If infected, the patient will be excluded from work until the Chest Specialist and Consultant in Public Health Medicine are satisfied they are non-infectious (may be as little as one week after treatment started). Some people may receive preventative treatment for tuberculosis if they have been in contact with a case. These individuals do not have the infection and are not infectious.
The importance of both personal hygiene and of hygienic practices when serving, preparing and eating food cannot be over-emphasised. Workers should be aware of the need for good hygiene as these diseases can spread in the workplace.
Staff should always be encouraged to wash their hands with soap and water after going to the toilet and before handling or eating food. Paper towels or machine roller towels should be used. Toilet bowls, seats and flush handles, along with any other surfaces that may have been touched by contaminated hands (i.e. door handles, tap handles etc.) should be disinfected as often as possible. A simple solution of a disinfectant is all that is required. The wash hand basins in toilet blocks should not be used for drinking water.
Salmonella infection is usually acquired from infected foodstuffs. The food usually needs conditions to allow the bacteria to multiply (that is, a small dose of bacteria may not lead to infection).
Staff with diarrhoea should be excluded from work until the diarrhoea stops. The risk of spreading infection when diarrhoea has resolved is low. Special conditions apply to people working in certain conditions such as food handlers and people working in hospitals and nursing homes. Advice in such cases should be sought from Environmental Health Officer.
A bacterial infection causing abdominal pain and often bloody diarrhoea acquired from infected food or animals (especially puppies and kittens). Advice on exclusion from work should be obtained from the Environmental Health Officer or Consultant in Public Health Medicine.
E. coli (VTEC)
E. coli (VTEC) also known as E. coli 0157, is a relatively new cause of bloody diarrhoea. It causes more severe illness in young children and the elderly and can lead to large outbreaks. Control is based around the guidelines for enteric diseases and will be handled by the Consultant in Public Health Medicine and the Environmental Health Officer. All cases must be excluded from work until symptom free. All decisions on exclusion will be undertaken by the Consultant in Public Health Medicine.
Hepatitis A is a highly infectious disease of the liver, also called yellow jaundice or viral hepatitis. The most common symptoms are raised temperature, a feeling of sickness, diarrhoea, loss of appetite, stomach pains and jaundice (yellow skin colour). The urine often becomes dark in colour and the stools quite pale. Not everybody gets all of these symptoms. Some people may feel off colour but not become jaundiced.
The incubation period – the time from becoming infected to developing symptoms – is usually about four weeks, but can be as long as six weeks. The illness lasts 1-2 weeks. It is usually mild in children, but more severe in adults. Complete recovery, without complications or recurrence, can be expected. Patients are at their most infectious to other people in the two weeks before the jaundice appears. They can return to work seven days after the appearance of jaundice as they cease to be infectious by then.
Hepatitis A is spread by hand-to-mouth contact if personal hygiene (especially handwashing after toilet and before eating) is inadequate. The virus is present in the stools of infected persons. Toilet seats, flush handles, toilet door handles, etc, may become contaminated. If another person touches a contaminated surface they may eventually transfer the virus into their mouth, for example when eating food.
Exclusion from Work for Diarrhoeal Disease and Food Poisoning
A. Most common food poisoning agents such as viruses, salmonella enteritidis, campylobacter
Return to work once symptom free
People in high-risk groups return to work 48 hours (2 days) after becoming symptom free. No need for negative stool samples.
B. High risk diseases such as E. coli 0157, Salmonella typhi and paratyphi
Return to work once symptom free.
High-risk groups – contact EHO or CCDC for advice
High risk groups:
Food handlers working with unwrapped foods consumed raw (eg salads) or without further cooking (eg cold meats).
Healthcare staff working with susceptible patients.
Children under 5 attending nurseries, playgroups, pre-schools etc.
Anyone with unreliable personal hygiene due to learning difficulties or other special needs.
Always contact the EHO or CCDC for advice on all exclusions from work.