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.”