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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 HCV, 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.
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.
For more on this story see the July 2013 issue of Hospital Employee Health