Millions have HCV — What about surgeons?
The Centers for Disease Control and Prevention (CDC) recently recommended that millions of Baby Boomers born from 1945 to 1965 get tested for hepatitis C virus (HCV) so they can take advantage of new treatment options and reduce transmission of the leading cause of liver transplants. (To access those recommendations, see Resource, below.)
Conspicuously absent in this important public health initiative was any mention of HCV testing of surgeons and other healthcare workers involved in so-called "exposure-prone" invasive procedures.
It is well-documented in outbreaks that patients have acquired HCV and other bloodborne viruses from infected healthcare workers who might be asymptomatic. This transmission can occur when an HCV-infected surgeon, for example, incurs a sharps injury or scalpel cut during a procedure and exposes the patient to infectious blood.
The identification of HCV-positive healthcare workers raises the issues of work restrictions and informing patients, much as it did when the CDC went to a universal HIV test recommendation in 2006. Asked about the issue, the CDC said the HCV testing recommendation applied to healthcare workers as well as the general public. The CDC has been asked whether healthcare workers who test positive should inform their employers if they think their job might put patients of risk of infection. The CDC referred inquiries to the 2010 guidelines by the Society for Healthcare Epidemiology of America (SHEA).
The SHEA guidelines are specific in recommending recurrent testing for HCV viral counts and applying work restrictions to HIV-positive workers who perform exposure-prone invasive procedures. (For information on how to access those guidelines, see Resource, below.) The precautions to be taken range from double gloving to a restriction on performing certain procedures if the worker has a high HCV viral load. SHEA came out against mandatory testing, but it emphasized that healthcare workers performing such surgical procedures are "ethically obligated" to know their status. [Does your outpatient surgery program have a policy in this area? If so, contact Executive Editor Joy Daughtery Dickinson at email@example.com or (800) 688-2421.]
- "Recommendations for the Identification of Chronic Hepatitis C Virus Infection among Persons Born During 1945-1965" from the Centers for Disease Control and Prevention. Web: http://1.usa.gov/PbqdWi.
- "SHEA Guideline for Management of Healthcare Workers Who Are Infected with Hepatitis B Virus, Hepatitis C Virus, and/or Human Immunodeficiency Virus" from Infection Control and Hospital Epidemiology. Web: http://bit.ly/SbMzWt.