It makes you sick

    Social workers often work with clients who can put them at risk
    of contracting diseases such as tuberculosis. So how do staff
    protect themselves, and are management doing enough to help? Anabel
    Unity Sale reports.

    When Jane Smith, (not her real name)a 42-year old family
    placement social worker at in outer London council, got a cough in
    November 1997 she didn’t think anything of it.

    When, in January 1998, her cough produced phlegm and she
    started wheezing loudly she went to her doctor. He diagnosed her
    with asthma and prescribed her eight courses of antibiotics over
    the next five months. By March she felt so ill she couldn’t do her
    job and resigned. “The short walk from the car park to the office
    left me out of breath,” she says.

    What Smith and her doctor did not know at the time was that she
    was suffering from tuberculosis. “Having TB never occurred to me. I
    knew I was very unwell – I had lost a quarter of my body weight.
    But I thought I had cancer and because I was afraid I didn’t voice
    it. My father had died from it the year before,” she explains.

    After a break, she started a six-month contract with a
    charity’s family centre in south London. She was there for two
    weeks before a chest x-ray and blood test at a chest clinic for her
    “asthma” diagnosed TB, even though she had her BCG immunisation as
    a teenager. Smith was immediately admitted to hospital for a week,
    seven months after first feeling ill.

    She then spent a week at home in isolation because she was
    still infectious. For six months she took antibiotics to beat the
    TB, which had destroyed the upper lobe of her left lung. “It was a
    very harsh, very toxic drug regime. I had to take eight different
    types of medication.”

    Smith is convinced, although she cannot prove it, that she
    caught TB at work. She suspects she was infected with the airborne
    disease as a result of interviewing her own clients in rooms also
    used by staff from the homeless persons unit to interview their own
    clients. “The facilities were unventilated, and they were dealing
    with people that had a high risk of having TB.”

    A TB nurse contacted Smith’s colleagues and clients at the
    council and the charity about her disease. At the centre 20
    children, 12 staff, five other clients and even social workers
    based elsewhere who had visited it were tested. At the council her
    immediate colleagues, foster carers and their birth and
    looked-after children were also tested. Even the 100 delegates at
    an annual conference she’d attended were warned to look out for any
    TB symptoms. Fortunately none had caught it. But when her close
    family had their chests x-rays she discovered her three nieces aged
    three, nine and 11 had been infected. Smith is still under the
    chest clinic and has had to reduce her working hours for another
    agency.

    She feels the council, which never made formal contact with her
    after her diagnosis, failed to take her case seriously enough. She
    says she was not offered a booster immunisation during her five
    years in their employment. “There should be regular screenings for
    infectious diseases for all frontline staff; it is another aspect
    of keeping us safe. We are as vulnerable from an assault by an
    aggressive bacteria as we are from an aggressive client,” she
    says.

    While Smith’s experience may be unusual, social care
    professionals and their employers cannot afford to ignore the risk
    of infectious diseases from clients.

    TB has been hitting the headlines recently with reports of
    potential cases in schools from Wandsworth to Manchester to
    Leicester. Any suspected cases of TB, along with 29 other
    infectious diseases including scarlet fever, viral hepatitis,
    yellow fever, rabies, food poisoning, anthrax and the plague must
    be reported to the Public Health Laboratory Service (PHLS)under the
    Public Health (Infectious Diseases) Regulations 1988. The patient’s
    doctor tells the local health authority’s consultant in
    communicable disease control of a suspected case, who then reports
    it to the PHLS.

    For the week up to 27 April 2001, a total of 154 suspected
    cases of TB and 73 suspected cases of viral hepatitis were reported
    in England and Wales to the PHLS. The largest number of suspected
    TB cases was recorded in Haringey (11), closely followed by
    Leicester with nine and Newham with eight.

    There is still a perception that TB and other infectious
    diseases are especially prominent among people with particular
    ethnic backgrounds. But anyone can get TB, explains Dr Louise
    Coole, a senior registrar in public health at Leicestershire health
    authority.

    She says: “People must remember TB isn’t a disease that infects
    people defined by their race. When people have it here it might be
    related to poverty, housing conditions or other health
    issues.”

    She says the recent outbreaks in Leicester were not related to
    people going overseas and bringing TB back into the UK. However,
    she admits some countries are more prone to it than others: “We do
    acknowledge that some countries have a higher incident of TB,
    including the Indian sub-continent, some eastern European and
    African countries.”

    A spokesperson for Haringey Council, which has a multiracial
    population, says: “Statistical evidence has consistently pointed to
    an increase in the incidence of tropical diseases because of two
    factors: the wider availability of travelling packages to countries
    with a high risk of catching tropical disease, combined with areas
    of social deprivation in Britain where people are more susceptible
    to being infected.”

    While it is highly unusual for social workers to be stuck down
    by the plague, no matter what some tabloids may hope, what are
    councils doing to protect staff from infectious diseases?

    Most local authorities’ occupational health departments conduct
    risk assessments, as part of their health and safety procedures, to
    identify what their social workers might be at risk from in the
    line of duty. Haringey Council’s risk assessment looks at all staff
    whose work may expose them to hepatitis B and TB.

    It encourages residential and day care employees in learning
    difficulty and mental health establishments and family centre
    employees to be immunised against hepatitis B. And testing for TB
    is offered to staff working in children’s homes, day centres and
    nurseries; all domiciliary care staff; all care and cleaning
    employees working in homes for older people and those with clients
    who have Aids, are alcoholics or who are undernourished.

    Staff at Leicester Council also have risk assessments. David
    Simms, health and safety officer at Leicester Council’s social
    services department, believes prevention is better than cure.
    “Infection control is an important factor in maintaining the health
    and safety of staff and client groups; however immunisation is not
    an alternative to good infection control and practice,” he
    comments.

    Unison members working for Newham Council, where people are
    responsible for getting themselves immunised, want the council to
    take more preventive measures. After two students at a local
    college contracted TB, Newham Unison plans to meet with director of
    social services Kathryn Hudson to call for a council-led
    immunisation programme.

    Newham Unison chair Michael Gavan says: “All frontline staff
    who deal with people in residential homes and in their own homes,
    including social workers and care workers, should be screened for
    infectious diseases and offered free vaccinations on site.”

    Unison believes providing relevant details about a client’s
    medical condition would also go a long way to protecting staff from
    contracting infectious diseases.

    A Unison survey conducted among home care workers earlier this
    year revealed that 70 per cent occasionally took responsibility for
    a client without adequate information about their health. And a
    third of respondents were frequently faced with this
    situation.

    A spokesperson says this arrangement is not good enough: “In
    order to give the right level of professional care to their
    clients, relevant health information should be available to staff
    before they visit. Staff need to be offered all the care and
    protection they need in order to carry out their job
    effectively.

    “Some of the situations social care workers face in clients’
    homes would not be acceptable in the workplace. Within the
    workplace employers are much more aware of health and safety
    concerns.”

    Anthony Douglas, chairperson of the Association of Directors of
    Social Services London region, also believes councils should take a
    more active role in protecting their staff from infectious
    diseases.

    He says: “Social care is full of unprotected and potentially
    dangerous encounters, [which are] often unpredictable. It goes with
    the territory.”

    He adds: “The responsibility and the potential liability is the
    employer’s, not the individual member of staff’s. A council must
    carry out a risk assessment of a task where infection is a risk,
    and if there is evidence that immunisation reduces the risk the
    obligation is to advise or even insist on immunisation.”

    So the message for councils is clear. Offering detailed risk
    assessments, and in some cases providing free immunisation for all
    appropriate staff, is vital to protect them from possible
    infections. As Smith says: “Even if councils only want to protect
    themselves from litigation from clients who have been
    cross-infected by their social worker, they need to take this
    threat seriously.”

    More from Community Care

    Comments are closed.