Occupational Infections: Hepatitis, Brucellosis, Tuberculosis

In which jobs do occupational infections occur?

A nurse exposed to hepatitis B after a needlestick, a slaughterhouse worker contracting brucellosis or a laboratory technician infected while working with a tuberculosis culture all fall into the same category: occupational infections arise from biological agents to which a person is exposed because of their work. What they have in common is exposure above the general risk in the community, and measures that can reduce that exposure.

Annex I of the Regulation on the Prevention of Risks Related to Exposure to Biological Agents lists the jobs where exposure to biological agents may occur as follows: food production plants, agriculture, work with animals and products of animal origin, health services and mortuaries, clinical, veterinary and diagnostic laboratories other than microbiological diagnostic laboratories, waste disposal plants, and sewage and wastewater treatment plants.

For details of the risk groups, see our article on biological agents and risk groups. This article focuses on the three most common infections and the measures they share.

Hepatitis B: a blood-borne work-related infection

The hepatitis B virus is transmitted through blood and body fluids. In healthcare workers the most common route is needlestick and sharps injury; waste collection, cleaning and laundry staff face the same risk from a needle sticking out of a bag. The regulation lists the hepatitis B virus among Group 3 agents and separately marks agents for which an effective vaccine exists.

Hepatitis B is a vaccine-preventable occupational infection. Under Annex VII of the regulation, the following principles apply to preventive vaccination:

• Workers exposed to a biological agent are vaccinated if an effective vaccine against the agent is available.
• Workers are informed of the benefits and drawbacks of both vaccination and non-vaccination.
• The cost of vaccination is not charged to the worker.
• A vaccination certificate is issued for each worker, to be shown to the authorities on request.

The workplace physician assesses the worker's vaccination and immunity status at recruitment and decides, according to the risk, whether the protective response after vaccination should be checked. There is no vaccine for hepatitis C or HIV; prevention relies on safe sharps practice and rapid assessment after exposure. For the first steps after a needlestick, see our article on sharps injuries.

Hepatitis B can be assessed as an occupational disease. In the "occupational infectious diseases" group of the list of occupational diseases, viral hepatitis appears alongside work such as hospital, dispensary, outpatient clinic and laboratory work. For the structure of the list, see our article on the list of occupational diseases.

Tuberculosis: an airborne risk for healthcare workers

Tuberculosis (TB) is transmitted by inhaling droplet nuclei released into the air when a sick person coughs or talks. For a healthcare worker, the greatest tuberculosis risk is time spent unprotected with a patient who has not yet been diagnosed: emergency departments, chest disease outpatient clinics, bronchoscopy and sputum collection stand out in this respect. Mycobacterium tuberculosis is in Group 3 in the regulation; laboratories working with tuberculosis cultures also carry a high risk.

Measures are considered in three layers:

1. Administrative: Early recognition of coughing patients, giving them a mask and moving them to a separate area; speeding up diagnosis and isolation decisions.
2. Engineering: Measures in isolation rooms in line with the principles in Annex V of the regulation, ventilation and the layout of procedure rooms.
3. Personal protection: For procedures with a risk of transmission, a tight-fitting respirator of at least FFP2 class, and users learning to put the mask on correctly. For the difference between classes, see our article on FFP1, FFP2 and FFP3 dust masks.

The legislation does not set a fixed frequency for tuberculosis screening of healthcare workers. The workplace physician plans screening at recruitment and after exposure, and sets the interval for periodic assessment according to the risk of the unit. Tuberculosis is in the same group as viral hepatitis in the list of occupational diseases.

Brucellosis: livestock farming, slaughterhouses and dairy processing

Brucellosis is the infection of livestock farms, slaughterhouses, veterinary services and areas where raw milk is handled. The bacterium is found in the abortion and birth products, blood and milk of infected animals; it is transmitted through skin wounds, the mucous membranes of the eyes and mouth, inhaled aerosols and unpasteurised dairy products. Brucella species are in Group 3 in the regulation and are also a significant transmission risk in laboratories.

There is no brucellosis vaccine for humans; prevention relies entirely on hygiene and PPE: arm-length gloves when assisting with births, face protection, a waterproof apron, safe disposal of birth products and a rule against consuming raw milk. In the list of occupational diseases, diseases transmitted from animals to humans form a separate heading and are matched with animal care, veterinary work and work with animal materials. We described detailed measures for dairy farms on the Karacabey Plain in Bursa in our article on zoonoses and injuries in Karacabey livestock farming.

Infection in waste, wastewater treatment and cleaning work

Infection risk is not limited to healthcare and livestock. People who collect medical waste, sort on a recycling belt, or work in sewage and treatment plants may encounter blood-contaminated sharps, faecally contaminated water and rodent-borne agents. In these jobs:

• Puncture-resistant gloves and closed footwear reduce sharps injuries.
• Tetanus and hepatitis B vaccination status is assessed at recruitment.
• Wound care: Small cuts are covered, and wounds that come into contact with contaminated water are reported.
• Medical waste staff undergo a health check at least every six months under the Regulation on the Control of Medical Waste; for details see our article on medical waste worker safety.

Our article on OHS in recycling facilities complements this with the other risks in recycling plants.

Vaccination, PPE and hygiene: shared measures

Art. 10 of the Regulation on Biological Agents requires the employer to take the following measures in all work with a risk of exposure to biological agents:

• Preventing eating and drinking in areas with a risk of transmission,
• Providing suitable protective clothing or special clothing,
• Washing and toilet facilities, including eye washes and skin antiseptics,
• Storing protective equipment in a designated place, and checking and cleaning it after use,
• Removing contaminated clothing before leaving the work area, keeping it separately and having it cleaned by the employer.

The cost of these measures is not passed on to workers (Art. 10/3). Workers receive training before they start work with biological agents, and it is renewed as new risks arise (Art. 11).

Notification: occupational disease and the Ministry

When a work-related infection is suspected, the process starts with the workplace physician. The physician refers the worker to a healthcare provider authorised to diagnose occupational diseases and provides information on exposure at the workplace. For the diagnostic process, see our article on occupational disease diagnosis and notification.

The notification obligations are as follows:

1. Notification to the SGK: Under Art. 14/2 of Law No. 6331 on Occupational Health and Safety, the employer notifies the Social Security Institution (SGK) within 3 working days of learning of an occupational disease.
2. Notification to the Ministry: Every case of illness or death resulting from occupational exposure to biological agents is notified to the Ministry (Regulation on Biological Agents, Art. 16/10).
3. Information for workers: An accident or incident that could cause a serious infection is reported immediately to workers and their representatives; its causes and the measures taken are also shared as soon as possible (Art. 12/3).

At Bursa Sistemer OSGB, as part of our workplace physician service we monitor the vaccination and immunity status of exposed workers, and under health surveillance we plan the necessary tests and vaccinations with authorised laboratories and healthcare facilities. You can find our approach for hospitals, outpatient clinics and laboratories in Bursa and neighbouring provinces on our healthcare facilities page.

Frequently Asked Questions

Is hepatitis B considered an occupational disease?

It can be. In the list of occupational diseases, viral hepatitis appears in the "occupational infectious diseases" group alongside work such as hospital, dispensary, outpatient clinic and laboratory work. The link between the disease and the work is established through the assessment of an authorised healthcare provider and exposure records.

Who pays for the hepatitis B vaccine?

The employer. Under Annex VII of the Regulation on Biological Agents, the cost of vaccination is not charged to the worker; the worker is informed of the benefits and drawbacks of the vaccine and a vaccination certificate is issued for them.

How often are healthcare workers screened for tuberculosis?

The legislation does not set a fixed frequency. The workplace physician plans screening at recruitment and after unprotected contact with a tuberculosis patient, and sets the interval for periodic assessment according to the risk of the unit.

Where is an occupational infection notified?

An occupational disease is notified by the employer to the SGK within 3 working days of learning of it. Cases of illness and death resulting from occupational exposure to biological agents are also notified to the Ministry.