BDA position on Hepatitis B

(December 2017)

There have been various opinions put forward in recent weeks as to whether a dental nurse can work chairside before they have completed their Hepatitis B course.  Our position had been that, once dental nurses had had their first vaccination, they were able to work chairside, subject to a risk assessment being carried out and certain control measures being implemented.

We reviewed our position because other organisations adopted a stronger stance of no chairside work until the vaccination course was completed and immunity had been confirmed.  We felt it would be unhelpful for us to give members advice to act contrary to advice from their indemnity organisations and other published information. We changed our position to reflect that.

In the midst of the on-going Hepatitis B vaccine shortage, Public Health England (PHE) published Hepatitis B vaccine advice for dental professionals. We believe this PHE advice takes a pragmatic and rational approach to the issue.

It says that, “although dental nurses are normally eligible for vaccination, because of the potential for infection through their chairside assistance and instrument decontamination duties, they do not pose a threat of onward transmission to patients”. The document then offers a practical solution to the problems caused by the world-wide shortage.

It is a matter for the practice and the employees to consider the risk that an employee might contract Hepatitis B in the course of their duties, how to that risk might be controlled and whether the parties involved are willing to accept that risk.

Practices will want to take additional control measures to control the risk of staff contracting Hepatitis B. Such measures may include the avoidance of handling of needles, dismantling of burs and manual cleaning of instruments. The BDA’s view is that these measures are particularly important for the protection of unvaccinated staff.

The GDC has stated that it would “not seek to impose any restrictions on those who have been unable to get the vaccine” and this means that employers could take on new staff who have not been vaccinated, so long as they are not currently infected.

The advice goes on to reiterate the PHE point about the risks being carefully considered by both employer and employee.

In conclusion, the body of evidence from the signatories of the PHE document and the more relaxed – albeit temporary – stance by regulators, means that, subject to all parties considering and managing the risks, non- Hepatitis B immunised dental nurse can resume chairside work.

We suggest that practices discuss the matter with their employer’s liability insurance provider. Practices may find they do not have cover for injury to staff if they do not adhere to the terms of their employer’s liability insurance.

We remind practices that vaccination is only part of a suite of measures to protect staff against catching Hepatitis B. Other measures include personal protective equipment (PPE) and safe practices eg wearing thicker gloves and passing sharps using a tray etc.