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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Millions of people have HCV – is your surgeon one of them?

January 12th, 2015

The Centers for Disease Control and Prevention recently recommended that millions of Baby Boomers born from 1945 to 1965 get tested for hepatitis C virus so they can take advantage of new treatment options and reduce transmission of the leading cause of liver transplants.

Conspicuously absent in this important public health initiative was any mention of HCV testing of surgeons and other health care workers involved in so called “exposure prone” invasive procedures.

It is well documented in outbreaks that no doubt under-represent the true number of cases, that patients have acquired HCV and other bloodborne viruses from infected health care workers who may be asymptomatic. This can occur when the HCV-infected surgeon, for example, incurs a sharps injury or scalpel cut during the procedure and exposes the patient to infectious blood.

Of course the identification of HCV-positive health care workers raises the thorny issues of work restrictions and informing patients — much as it did when the CDC finally went to a universal HIV test recommendation in 2006. Asked about the issue, the CDC said the HCV testing recommendation applied to health care workers as well as the general public. OK, what if the health care workers test positive, should they inform their employers if they think their job may put patients of risk of infection? The CDC did not want to open this industrial-sized barrel of worms, referring inquiries to the 2010 guidelines by the Society for Healthcare Epidemiology of America (SHEA).

The SHEA guidelines are quite specific in recommending recurrent testing for HCV viral counts and applying work restrictions to HIV-positive workers who perform exposure-prone invasive procedures. The precautions to be taken range from double gloving to an outright restriction on performing certain procedures if the worker has a high HCV viral load. SHEA came out against mandatory testing, but emphasized that health care workers performing such surgical procedures are “ethically obligated” to know their status.

That’s where it stands, and we’ll go out on a limb and express doubt that many hospitals and surgical centers have adopted such measures. However, given these new CDC guidelines – which include great emphasis on the highly infective nature of HCV via blood exposure – don’t be surprised if more patients and their family members ask their surgeons, “What’s your HCV status?”