Sick staff, new law: Policies should spell out work restrictions for illnesses

A reader recently wrote, "Whenever any of my fellow staff members become sick, they refuse to stay home. They then pass on their illnesses to everyone in the office. The office manager showed up today with a fever and cough. What can I do?"

Mar 13th, 2015

BY NOEL BRANDON KELSCH, RDHAP

A reader recently wrote, "Whenever any of my fellow staff members become sick, they refuse to stay home. They then pass on their illnesses to everyone in the office. The office manager showed up today with a fever and cough. What can I do?"

This concern has been voiced by many and was addressed in the Centers for Disease Control and Prevention (CDC) 2003 Guidelines for Infection Control in the Dental Setting. It states: "Dental Health Care Personnel (DHCP) are responsible for monitoring their own health status. DHCP who have acute or chronic medical conditions that render them susceptible to opportunistic infection should discuss with their personal physicians or other qualified authority whether the condition might affect their ability to safely perform their duties."1

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In essence, you have the responsibility not to come to work if you have a disease that could be passed on to staff and patients. Make your personal doctor aware that you are working in the medical setting, and have the doctor give you a directive on how long you need to stay away from work.

Many of the patients who sit in our chairs are susceptible hosts that do not have the immunity or resistance to fight off disease, and if exposed to specific diseases are likely to contract the disease. The problem is that some patients may not even know they are susceptible.

So many of the factors are varied and some are hard to track. Some of those factors include:

Age - The very young and the very old are susceptible. Specific diseases can also attach to certain age groups, such as measles and mumps that appear in childhood and adolescence.

Immunity - Natural immunity can be acquired by exposure or by having been infected. Therefore a person develops antibodies against the agent, so if it is introduced again, the antibodies can fight it off, which reduces the likelihood of the disease reoccurring. Immunization against a disease will make a person similarly protected.

Habits and customs - Local customs and mores, especially those of Third World countries, may cause an increased susceptibility to disease. Some of these may include rubbing the umbilical cord with dirt, or tattooing with the same instrument without disinfecting it first.

Physical condition - There are many areas in this category that can impact the immune system. Malnutrition, fatigue, exposure to the elements, stress, and more can all weaken the immune system.

Other factors - It has been known for a long time that a host of other factors impact resistance to disease and the immune system. These include cancer, hypertension, trauma, race, genetics, sex, occupation, socioeconomic status, and geographic location.2

Since these factors are not always clear, it is vital for everyone to stay home from work if they have a communicable disease.

THE EMPLOYER'S ROLE

The CDC goes on to state that the management/administrative team also must play a role. "However, under certain circumstances, health-care facility managers might need to exclude DHCP from work or patient contact to prevent further transmission of infection. Decisions concerning work restrictions are based on the mode of transmission and the period of infectivity of the disease (See Table 1). Exclusion policies should:

• Be written

• Include a statement of authority that defines who can exclude DHCP (for example, personal physicians)

• Be clearly communicated through education and training. Policies should also encourage DHCP to report illnesses or exposures without jeopardizing wages, benefits, or job status."

Employers should be using the table that is provided by the CDC to educate staff on the guidelines and enforce the need for employees with communicable diseases to stay home. Employers can check with their local health department on any disease that is not listed on the CDC guidelines.

Table 1

Work restrictions for various illnesses

Disease or problem

Work restriction

Duration

Conjunctivitis

Restrict from patient contact and contact with patient's environment

Until discharge ceases

Cytomegalovirus infection

No restriction

Diarrheal disease

Acute stage (diarrhea with other symptoms)

Restrict from patient contact, contact with patient's environment, and food handling

Until symptoms resolve

Diarrheal disease C

onvalescent stage,

Salmonella species

Restrict from care of patients at high risk

Until symptoms resolve; consult with local and state health authorities regarding need for negative stool cultures

Enteroviral infection

Restrict from care of infants, neonates, and immunocompromised patients and their environments

Until symptoms resolve

Hepatitis A

Restrict from patient contact, contact with patient's environment, and food handing

Until seven days after onset of jaundice

Hepatitis B

Personnel with acute or chronic hepatitis B surface antigenemia who do not perform exposure-prone procedures

No restriction; refer to state regulations; standard precautions should always be followed

Hepatitis B

Personnel with acute or chronic hepatitis B antigenemia who perform exposure-prone procedures

Do not perform exposure-prone invasive procedures until counsel from a review panel has been sought; panel should review and recommend procedures that personnel can perform, taking into account specific procedures as well as skill and technique; standard precautions should always be observed; refer to state and local regulations or recommendations

Until hepatitis B antigen is negative

Hepatitis C

No restrictions on professional activity; HCV-positive health-care personnel should follow aseptic technique and standard precautions

Herpes simplex - Genital

No restriction

Herpes simplex -Hands (herpetic whitlow)

Restrict from patient contact and contact with patient's environment

Until lesions heal

Herpes simplex - Orofacial

Evaluate need to restrict from care of patients at high risk

Human immunodeficiency virus; personnel who perform exposure-prone procedures

Do not perform exposure-prone invasive procedures until counsel from an expert review panel has been sought; panel should review and recommend procedures that personnel can perform, taking into account specific procedures as well as skill and technique Standard precautions should always be observed; refer to state and local regulations or recommendations

Measles active

Exclude from duty

Until seven days after rash appears

Measles postexposure (susceptible personnel)

Exclude from duty

From 5th day after first exposure through 21st day after last exposure, or four days after rash appears

Meningococcal infection

Exclude from duty

Until 24 hours after start of effective therapy

Mumps active

Exclude from duty

Until nine days after onset of parotitis

Mumps postexposure (susceptible personnel)

Exclude from duty

From 12th day after first exposure through 26th day after last exposure, or until nine days after onset of parotitis

Pediculosis

Restrict from patient contact

Until treated and observed to be free of adult and immature lice

Pertussis active

Exclude from duty

From beginning of catarrhal stage through 3rd week after onset of paroxysms, or until five days after start of effective antibiotic therapy

Pertussis postexposure (asymptomatic personnel)

No restriction, prophylaxis recommended

Until five days after start of effective antibiotic therapy

Pertussis postexposure (symptomatic personnel)

Exclude from duty

Rubella active

Exclude from duty

Until five days after rash appears

Rubella postexposure (susceptible personnel)

Exclude from duty

From 7th day after first exposure through 21st day after last exposure

Staphylococcus aureus infection active, draining skin lesions

Restrict from contact with patients and patient's environment or food handling

Until lesions have resolved

Staphylococcus aureus infection carrier state

No restriction unless personnel are epidemiologically linked to transmission of the organism

Streptococcal infection, group A

Restrict from patient care, contact with patient's environment, and food handling.

Until 24 hours after adequate treatment started

Tuberculosis active disease

Exclude from duty

Until proven noninfectious

Tuberculosis PPD converter

No restriction

Varicella (chicken pox) active

Exclude from duty

Until all lesions dry and crust

Varicella (chicken pox) postexposure (susceptible personnel)

Exclude from duty

Until all lesions dry and crust

Zoster (shingles) localized, in healthy person

Cover lesions, restrict from care of patients at high risk Restrict from patient contact

Until all lesions dry and crust

Zoster (shingles) generalized or localized in immunosuppressed person postexposure (susceptible personnel)

Restrict from patient contact

From 10th day after first exposure through 21st day (28th day if VZIG administered) after last exposure; or, if varicella occurs, when lesions crust and dry

Viral respiratory infection, acute febrile

Consider excluding from the care of patients at high risk or contact with such patients' environments during community outbreak of respiratory syncytial virus and influenza

Until acute symptoms resolve

A good example of employer responsibility that is not listed on Table 1 is influenza. One of the most important things that anyone working in the health care field can do if they have symptoms of the flu is to isolate themselves. That means they should stay home and get well. A person can pass the flu on to someone else before symptoms appear. That's why vaccinations are so important. After developing symptoms of the flu a person is contagious for five to seven days. Some people, especially young children and people with weakened immune systems, might infect others for an even longer time. The CDC states that employees with symptoms of influenza should:

• Be instructed not to report to work, or if at work, to stop patient care activities, don a facemask, and promptly notify their supervisor and infection control personnel/occupational health before leaving work.

• Be excluded from work until at least 24 hours after they no longer have a fever (without the use of fever-reducing medicines such as acetaminophen). Those with ongoing respiratory symptoms should be considered for evaluation by occupational health to determine appropriateness of contact with patients.3

New laws on sick leave

The state of California has instituted a new law that should be in all states. As of July 1, 2015, under the Healthy Workplaces, Healthy Families Act of 2014, all California employers must provide their California employees with at least three days (24 hours) of paid sick leave per year. Unlike several other California leave laws, there is no exemption for small employers. The new law applies to employees (exempt and nonexempt) who work in California 30 days or more in a year. It does not matter if someone is full-time or part-time.

This is something that is really needed and should be pursued legislatively in other states. Currently, there are no federal legal requirements for paid sick leave.4 This law could significantly impact the rate of sick employees reporting to work.

Employees and employers have responsibilities for protecting staff and patients against communicable diseases. Efforts can and do impact the community. RDH

References

1. http://www.cdc.gov/oralhealth/infectioncontrol/guidelines/. Accessed 12.14.14. pages, 7-9

2. Tortora GJ, Funke BR, Case CL. Microbiology: An Introduction (11 Edition).

3. http://www.cdc.gov/flu/professionals/infectioncontrol/healthcaresettings.htm

4. http://www.dol.gov/dol/topic/workhours/sickleave.htm Accessed 12.14.14


NOEL BRANDON KELSCH, RDHAP, is a syndicated columnist, writer, speaker, and cartoonist. She serves on the editorial review committee for the Organization for Safety, Asepsis and Prevention newsletter and has received many national awards. Kelsch owns her dental hygiene practice that focuses on access to care for all and helps facilitate the Simi Valley Free Dental Clinic. She has devoted much of her 35 years in dentistry to educating people about the devastating effects of methamphetamines and drug use. She is a past president of the California Dental Hygienists' Association.

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