CDC to Baby Boomers: Get an HCV test
But what about health care workers?
The message from the Centers for Disease Control and Prevention on testing for hepatitis C is unequivocal. In the words of director Thomas Frieden, MD, MPH: “Baby boomers may not remember everything we did in the ‘60s or ‘70s, but our liver does.”
While CDC is urging everyone born between 1945 and 1965 to be tested for hepatitis C, the CDC has not altered any recommendations related to health care workers. The agency does not advise health care employers to routinely test employees for hepatitis C.
Yet hospitals are still wrestling with the question of whom to test — and when. In its guideline for management of health care workers with hepatitis B virus, hepatitis C virus and/or HIV, the Society for Healthcare Epidemiology of America (SHEA) did not recommend mandatory testing of health care workers. Employers should offer “voluntary confidential testing,” SHEA said. “A provider who conducts [exposure-prone] procedures is ethically obligated to know his or her infection status with respect to HBV, HCV and HIV,” the guideline states.
Health care workers also should be tested if a patient is exposed to a provider’s blood or body fluid, SHEA said.
Some hospitals have gone beyond those recommendations to conduct a wider screening of new employees.
Tampa (FL) General Hospital has been testing new employees for hepatitis C since the mid-1990s. Every year, about 1,000 new hires receive the test and about 20 or 25 are positive, says JoAnn Shea, MSN, ARNP, director of employee health and wellness.
“At least 75% didn’t know they had it. Most people are asymptomatic,” she says. “We get them into treatment with a hepatologist. Some of them have been able to clear the virus.”
The test is required for new hires who will be involved in exposure-prone procedures, and it is voluntary for other new hires, she says. Current employees also can be tested, if they want to know their status.
In the past 20 years, only two individuals were not hired after a positive hepatitis C test. One was a student and the other was a surgical tech who would have been involved in exposure-prone procedures. Both had high viral loads — in the millions.
Shea says she maintains confidentiality and simply reports that the person cannot be hired for that position.
“We feel like we’re supporting public health initiatives,” Shea says. “The CDC feels there needs to be more awareness about hepatitis C. We are making sure these employees are getting evaluated and treated.”
Testing of new hires also reduces the risk of a future liability for the hospital if a health care worker later discovers he or she has HCV but never reported a specific exposure, Shea says. HCV infection without other known risk factors could be presumed to be occupational.
Boomers at greatest risk
In its new awareness campaign, CDC emphasizes that:
• Baby boomers are five times more likely than other Americans to have hepatitis C.
• About 3 million Americans have hepatitis C, and
• About three-fourths of the people who have the virus don’t know it.
“Right now, there are better hepatitis C treatments available than ever and there are more treatments coming in the coming year. So confirming that someone is more infected is more important than ever,” Frieden said in a telephone news conference.
“Not everyone with hepatitis C will need treatment, but everyone with hepatitis C should be linked to care so that they can monitor how their liver is doing, determine when and if treatment is warranted, avoid things like excess alcohol which can damage their liver, and avoid medications that could also damage their liver as well as getting vaccinated against hepatitis B to protect their liver,” he said.
CDC also has another awareness campaign to prevent transmission of hepatitis C and other bloodborne pathogens. The One & Only Campaign (one needle, one syringe, only one time) promotes safe injection practices.
Sixteen outbreaks at health care facilities have been linked to at least 160 cases of hepatitis C between 2008 and 2012, most of them due to lapses in infection control.
In 2012, a traveling cardiac tech who worked in hospitals in 8 states was charged with diverting drugs for his own use and infecting patients with reused syringes. In 2008, patients were infected with hepatitis C at the Endoscopy Center of Nevada when employees reused single-dose vials on multiple patients.
Hepatitis C is the nation’s leading cause of liver cancer.