The ongoing talks about the screening of healthcare workers are coming to a close. Theresa Judgelooks at the likely outcome.
Agreement on the introduction of a programme of compulsory screening of certain healthcare workers for blood-borne diseases is expected within months.
Talks have been ongoing for some time between the HSE and trade unions representing doctors, nurses and dentists on the introduction of screening and it is believed that the groups are now close to agreement.
Under the agreement all new and existing workers who perform procedures where there is a risk of viruses being transmitted from the healthcare worker to the patient will be screened. While the talks' initial focus is on introducing screening for Hepatitis B, agreement will then be sought for similar screening for Hepatitis C and HIV.
Meanwhile, HIV tests are continuing on former patients of a Dublin-based dentist who was diagnosed with HIV. Two weeks ago the HSE confirmed it was recalling 66 of the dentist's patients for tests but it stressed that the possibility of any of the patients being infected was "extremely remote".
The HSE has now said that of the 66 patients - most of whom are children - 54 have been tested and all were clear. Another six have test dates set or are in the process of arranging them, while the remainder are deciding if they want to be tested.
The HSE has said that all 66 were offered immediate blood tests with a guarantee of results being returned within 24 hours.
It is believed that a large sum of money has been paid to a private organisation to carry out the tests as the HSE wanted them to be conducted independently. The dentist worked in the public dental service from September 2005 up until October 2006 when the HIV diagnosis was made but only those patients who had open wounds in their mouths as a result of treatment were recalled for blood tests.
Both doctors and dentists stress that existing infection-control procedures offer a very high degree of protection to the public and the chances of a patient being infected are very, very low. It is pointed out that there have been only two documented cases worldwide of healthcare workers transmitting HIV to their patients.
However, doctors, dentists and nurses face a greater risk from patients depending on those they are treating and the procedures they are performing.
Irish Medical Organisation (IMO) president Paula Gilvarry says that Hepatitis B is more of a concern because it is more easily transmitted. However, people can be vaccinated against it.
"All doctors and healthcare workers in the State should be vaccinated because it is more likely to be passed from a patient to the doctor than from the doctor to a patient, and if the healthcare worker is vaccinated they can't get it to pass it on," she says.
The biggest risk to healthcare workers is from needle stick injuries when they are in the course of treating infected patients. "Needle stick injuries are not uncommon - over the course of their career practically every doctor would have managed to stab themselves with a needle at least once," Gilvarry says.
The HSE is now in the process of implementing new national guidelines published early last year in a Department of Health report Prevention of Transmission of Blood-Borne Diseases in the Healthcare Setting.
The report deals with the three main blood-borne viruses - Hepatitis B, Hepatitis C and HIV.
The report concludes that "provided infection-control procedures are adhered to, contact between healthcare workers and patients carries little or no risk of transmission of blood-borne pathogens".
It also details the procedures to be followed when a healthcare worker is found to be infected, such as the setting up of a local expert group to advise on the steps that need to be taken.
The recall of the patients of the HIV-infected dentist resulted from such a procedure and the HSE rejected criticisms of the delay from the time of the diagnosis last October to when patients were informed two weeks ago.
The report also recommends tightening regulations to minimise the risks of transmission and the implementation of these regulations have been the subject of ongoing negotiations between the HSE and representative bodies - the IMO, the Irish Hospital Consultants Association (IHCA), the Irish Dental Association (IDA) and the Irish Nurses Organisation (INO).
Unions were resisting the introduction of compulsory screening until there were agreed safeguards for healthcare workers found to be infected. The report recommends retraining and redeployment of such staff if necessary.
Having a blood-borne virus would be an issue only for workers engaged in what are termed "exposure prone procedures" (EPPs) defined as "a procedure where there is a risk that injury to the healthcare worker may result in exposure of the patient's open tissues to the blood of the worker". These would include anybody involved in surgery or procedures where there is the possibility of open wounds.
The report states that Hepatitis B prevention should be based on the screening and vaccination of workers not already immune to the infection.
"The immune status of healthcare workers involved in healthcare must be established and then vaccination performed as appropriate," it states.
Hepatitis C prevention, it says, "should likewise be based on the screening of all healthcare workers who undertake EPPs". It recommends that the screening process be introduced on an incremental basis.
On HIV it states: "Screening of healthcare workers for HIV is not considered a desirable option but this will be kept under review. There are currently no vaccines available for Hepatitis C or HIV. Prevention of transmission of these viruses relies on good infection-control procedures."
However, it appears now that the authorities are determined to introduce screening for all three infections. The IHCA was angered when the chief medical officer of the public appointments service recently insisted that new consultants provide evidence that they were free of the infections. IHCA spokesman Donal Duffy says it is felt that this "diktat" is unnecessary given that agreement is close on introducing general screening for both new and existing staff.
While the recent case may have highlighted the issue for patients, the IDA stresses that dental surgeons in Ireland "work within a very high standard of infection-control practices and effective risk management policies".
IDA spokesman Gerry Cleary outlines the very thorough precautions that are taken when a person known to be infected with a blood-borne virus is treated at his surgery.
These include wrapping the chair and all equipment in protective covers before treatment and complete decontamination afterwards.
"For this reason, these patients are usually treated at the end of the day to allow more time to prepare and to clean up afterwards," he says.
Cleary believes there is a very high level of adherence to the strict infection-control regulations laid down by the Dental Council of Ireland, pointing out that dentists could face charges of professional misconduct for breaches.
"If a patient feels procedures are not being followed - somebody not wearing gloves, for example, could be a cause for suspicion - they can ask questions and complain to the fitness to practice committee of the IDA. They can also protect themselves by voting with their feet," he adds.