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4. The duties and obligations of health care workers who are or may be infected with HIV

4.1 The current statements of the General Medical Council, General Dental Council and the Nursing and Midwifery Council about the ethical responsibilities of health care workers towards their patients are set out at Annex B. These responsibilities are equally applicable to all other professional groups not covered by these regulatory bodies.

4.2 All doctors, dentists, nurses, midwives, health visitors and other health care professionals who have direct clinical care of patients, have a duty to keep themselves informed and updated on the codes of professional conduct and guidelines on HIV infection laid down by their regulatory bodies and any relevant guidance issued by the Department of Health.

4.3 In addition, students should be made aware of the implications of these statements and of the contents of this guidance (see also Paragraphs 1.1 and 5.5).

4.4 All health care workers are under ethical and legal duties to protect the health and safety of their patients. Under the Health and Safety at Work etc. Act 1974, and associated regulations, such as the Control of Substances Hazardous to Health (COSHH) Regulations 2002, health care workers who are employees have a legal duty to take reasonable care for the health and safety of themselves and of others, such as colleagues and patients, and to co-operate with their employer in health and safety matters.

4.5 Self-employed health care workers have general duties to conduct their work so that they and others are not exposed to health and safety risks. The Employment Medical Advisory Service of the Health and Safety Executive (HSE) is able to act as a liaison point between health care employers and their employees, and HSE. It may also be approached by infected health care workers wishing to seek advice on health and safety issues.

4.6 HIV infected health care workers must not rely on their own assessment of the risk they pose to patients.

4.7 A health care worker who has any reason to believe they may have been exposed to infection with HIV, in whatever circumstances, must promptly seek and follow confidential professional advice on whether they should be tested for HIV. Failure to do so may breach the duty of care to patients.

4.8 Examples of how a health care worker may have been exposed to HIV infection include if they have:

  • engaged in unprotected sexual intercourse between men;
  • had unprotected intercourse in, or with a person who had been exposed in, a country where transmission of HIV through sexual intercourse between men and women is common;
  • shared injecting equipment whilst misusing drugs;
  • had a significant occupational exposure to HIV infected material in any circumstances;
  • engaged in invasive medical, surgical, dental or midwifery procedures, either as a practitioner or patient, in parts of the world where infection control precautions may have been inadequate, or with populations with a high prevalence of HIV infection.

Additionally, a person who has had unprotected sexual intercourse with someone in any of the above categories may also have been exposed to HIV infection.

4.9 HIV infected health care workers must promptly seek and follow appropriate expert medical and occupational health advice. If there is no occupational health physician available locally, all possible effort must be made to contact one elsewhere. Those who perform, or who may perform, exposure prone procedures must obtain further expert advice about modification or limitation of their working practices to avoid exposure prone procedures. Procedures which are thought to be exposure prone must not be performed whilst expert advice is sought (see Section 6).

4.10 If there is uncertainty whether an HIV infected worker has performed exposure prone procedures, a detailed occupational health assessment should be arranged. UKAP can be consulted by the occupational health physician, the health care worker or a physician on their behalf. The health care worker's identity should not be disclosed to UKAP (any correspondence must be anonymised or pseudonyms used).

4.11 If it is believed that any exposure prone procedures have been performed by an infected health care worker, then the infected health care worker or their chosen representative (e.g. the occupational health physician or the HIV physician) should, without delay inform the Director of Public Health (DPH) of the relevant PCT on a strictly confidential basis.

4.12 The DPH will in turn make an appraisal of the situation to decide whether a patient notification exercise is warranted, consulting the Consultant in Communicable Disease Control (CCDC), Regional Epidemiologists, Regional Directors of Public Health, and UKAP, as necessary. The medical director of an employing trust should also be informed in confidence at this stage (see Section 8). The health care worker, the occupational health physician or the HIV physician should not make the decision about whether a patient notification exercise needs to be considered.

4.13 HIV infected health care workers who do not perform exposure prone procedures, but who continue to provide clinical care to patients, must remain under regular medical and occupational health supervision. They should follow appropriate occupational health advice, especially if their circumstances change (see Section 6).

4.14 Once any health care worker has symptomatic HIV disease, closer and more frequent occupational health supervision is necessary. As well as providing support to the worker, the aim of this is to detect at the earliest opportunity any physical or psychological impairment which may render a worker unfit to practise, or may place their health at risk.

4.15 HIV infected health care workers applying for new posts should complete health questionnaires honestly. HIV infection is a medical condition about which an occupational health physician should be informed, verbally if preferred. Details will remain confidential to the occupational health department, as for other medical conditions disclosed in confidence to occupational health practitioners (see Paragraphs 6.7-6.9).

4.16 Health care workers who know or have good reason to believe (having taken steps to confirm the facts as far as practicable) that an HIV infected worker is performing exposure prone procedures or has done so in the past, must inform an appropriate person in the health care worker's employing authority (e.g. an occupational health physician) or, where appropriate, the relevant regulatory body. The DPH should also be informed in confidence. UKAP can be asked to advise when the need for such notification is unclear. Such cases are likely to arise very rarely. Wherever possible, the health care worker should be informed before information is passed to an employer or regulatory body.

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