Healthcare

Healthcare workers are a key risk group because of the nature of their work. We do not have accurate data on infections and ill health in this group - but data from physician reporting schemes indicates infection rates of about 30 per 100 000 workers per year amongst nurses and about 100 per 100 000 per year amongst care givers in residential homes. Most of these infections are diarrheal diseases. However, more serious infections do sometimes occur. For example, four health workers have died after having accidentally incurred needlestick injuries during work with HIV patients. Another nine are also known to be sero-positive as a result of this kind of accident.

The control of occupational exposure to biological agents in the healthcare setting is covered by the Control of Substances Hazardous to Health Regulations 2002 (COSHH). There is detailed guidance available from the Advisory Committee on Dangerous Pathogens (ACDP) or the Department of Health on the control of various micro-organisms such as blood borne viruses (eg HIV and hepatitis B), vCJD, viral haemorrhagic fevers and TB. The HSE's Health Services Advisory Committee (HSAC) also publishes guidance on clinical waste and post-mortem rooms. ACDP are currently preparing new guidance on biological agents in the laboratory and healthcare settings.

Healthcare-associated infection (HAI) is an important cause of morbidity and mortality amongst hospital patients, especially with the increasing resistance of many human pathogens to antibiotics (eg methicillin-resistant Staphylococcus aureus: MRSA). However, the HSE do not generally deal with clinical matters as these are more appropriately dealt with elsewhere. One exception to this is where there are management failures or failures of systems of work and in such cases HSE do sometimes become involved.

The Department of Health has produced several documents covering the control of infection in hospitals. Perhaps the most important of these are as follows:

• "Getting ahead of the curve", strategy document for combating infectious diseases
• "Winning Ways", strategy document following on from "Getting ahead of the curve"
• DoH strategic guidelines for implementation of control of infection measures