Managing risk in special circumstances

People with immune deficiencies (eg due to skin conditions, cystic fibrosis, blood-borne viruses, neutropenia, cancer treatment, HIV) are at increased risk of acquiring infections.

Management and health professionals need to decide on the type of employment that will minimise these staff members’ exposure risk.

Staff with damaged skin or weeping skin conditions (eg allergic eczema, psoriasis or exfoliating dermatitis) may be at risk of acquiring and transmitting infections.

When healthcare workers begin employment they should be screened for skin conditions (for example, by asking about any relevant skin conditions) and informed about the risk to patients and to themselves. Damaged skin must be appropriately covered before performing procedures with patients. Special gloves, hand hygiene products or moisturiser may be needed.

Cystic fibrosis may increase the risk of cross-infection between staff and patients. The degree of risk to patients depends on disease severity, frequency of coughing and respiratory pathogens present.

National guidelines³ recommend that healthcare workers with cystic fibrosis do not work with patients or other healthcare workers who also have cystic fibrosis.

All staff members with signs and symptoms of an infectious disease (eg gastroenteritis, varicella, acute respiratory illness) should be excluded from the workplace until they are no longer infectious. Specified isolation periods may apply for notifiable diseases (eg COVID-19, influenza).

If a health professional or administrative staff member has been exposed to an infectious disease they must be referred for medical advice, appropriate testing and consideration of post-exposure prophylaxis, if available.

Healthcare workers infected with a blood-borne virus (eg hepatitis B, hepatitis C or HIV) who perform procedures in which there is an increased risk of transmission to patients (exposure-prone procedures) must be under the care of a medical practitioner with relevant expertise and comply with national guidelines⁴ and relevant legislation in their jurisdiction. Depending on viral load, the health worker may need to restrict duties (refer to guidelines by The Medical Board of Australia and The Australian Health Practitioner Regulation Agency).⁵

The practice must provide appropriate infection control measures for the staff member to work safely. It should support the staff member through training and counselling, and could offer retraining/redeployment, if required.

Pregnant health professionals or administrative staff members may be at risk of contracting an infectious disease associated with special risk during pregnancy (eg influenza, rubella, varicella, cytomegalovirus or parvovirus) while at work. They should be advised to confirm their natural immunity/immunisation status for relevant infections and to take appropriate precautions as necessary.