SHEA lists guidelines for infected HCWs

The position paper recently issued by the Society for Healthcare Epidemiology of America (SHEA) outlines updated recommendations for managing health care workers infected with hepatitis B, hepatitis C, and HIV.1

Highlights of those recommendations follow, but employee health professionals are urged to consult the SHEA guidelines for additional recommendations and complete, detailed discussions of each recommendation’s background and rationale. Recommendations are categorized by strength and quality as follows: A — good evidence to support the recommendation; B — moderate evidence to support the recommendation.

• All blood and body fluids from patients and HCWs must be regarded as potentially infectious. Transfers of blood or other potentially infectious materials from HCWs to patients must be avoided. (A)

• Infected HCWs should not be prohibited from participating in patient care activities solely on the basis of their bloodborne pathogen infection. Unless a practitioner is implicated in provider-to-patient HIV or HCV transmission, HIV or HCV infection per se does not constitute a basis for barring an infected HCW from any patient care activity, including invasive procedures. (B)

• With the exception of situations in which a patient clearly has been exposed to an HCW’s blood or other hazardous body fluid, HBV-, HCV-, and HIV-infected HCWs should not be required to disclose their infection status to any patient. (B)

• HCWs who know they are the source of a significant patient exposure to blood or hazardous body fluid are obligated ethically to undergo testing for infection with bloodborne pathogens. (A)

• Mandatory HBV, HCV, or HIV screening of HCWs is not warranted.

• HCWs who perform invasive procedures that have been linked epidemiologically to provider-to-patient HBV transmission should know their HBV serologic status; those found to be HBsAg-positive should determine their HBeAg status. Those who are HBeAg-positive should not perform procedures that have been linked epidemiologically to instances of provider-to-patient HBV transmission. (B)

• Health care institutions should develop comprehensive occupational health programs to manage impaired HCWs, including evaluation of workers’ fitness for duty, based on competence, ability to perform routine duties, and compliance with established guidelines and procedures. (A)

• HBV e-antigen-positive HCWs should double-glove routinely and should not perform those activities that have been identified epidemiologically as associated with a risk for provider-to-patient HBV transmission despite the use of appropriate infection control procedures. (B)

• Required participation of HBV-, HCV-, or HIV-infected HCWs in pathogen-specific educational programs is not justified. (B)

• All HCWs should receive comprehensive education about techniques useful in avoiding HCW-to-patient blood exposures. (A)

• No specific monitoring is needed for HBV-, HCV-, or HIV-infected people; however, with the HCW’s consent, the occupational health service should initiate contact with the care provider of any HCW who has a condition associated with risk for compromised competence. Contact should be made with the provider as needed to assess the progress of any of these medical conditions. (B)

• Health care institutions, workers’ compensation programs, and insurers must undertake special efforts to maximize HCWs’ privacy and confidentiality. Every effort must be made to segregate infected HCWs’ occupational health records from routine hospital medical records, including excluding information about the HCW’s condition from the institutional computer system. (A)

• Institutional policy should specify explicitly which personnel, if any, need to be aware of an HCW’s medical problems. Institutional personnel should not disclose specific information about numbers of HCWs infected with bloodborne pathogens because that may lead to inadvertent confidentiality breaches. (A)

• Institutional policy should prohibit all HCWs who are susceptible to varicella zoster virus (VZV), rubella, or measles from providing direct patient care to patients who have active VZV, rubella, or measles. HCWs who have signs or symptoms consistent with pulmonary tuberculosis should be evaluated for active TB. For all HCWs known to have impaired cellular immunity, occupational medicine personnel should maintain an increased index of suspicion for opportunistic infections, especially for tuberculosis, in settings where the prevalence of those infections are high.

Reference

1. AIDS/TB Committee of the Society for Healthcare Epidemiology of America. Management of healthcare workers infected with hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or other bloodborne pathogens. Infect Control Hosp Epidemiol 1997; 18:349-363.