Implementing Getting Ahead of the Curve: action on blood-borne viruses

http://www.doh.gov.uk/

Introduction

1. This guidance is intended to assist in implementation of Health Service Circular (HSC) 2002/010 Hepatitis C Infected Health Care Workers.

Summary of HSC 2002/010

2. This circular builds upon previous advice from the Advisory Group on Hepatitis that hepatitis C infected health care workers associated with transmission of infection to patients should no longer perform exposure prone procedures.1 It recommends that employers put arrangements in place as soon as possible so that:

• the Health Service Circular and this guidance is brought to the attention of health care workers who perform or who may perform exposure prone procedures;
• health care workers who already know that they have been infected with hepatitis C and who perform exposure prone procedures should be tested for hepatitis C virus RNA. This testing is not necessary for health care workers who are already known to be hepatitis C virus RNA positive. Those found to be carrying the virus (i.e. who are hepatitis C virus RNA positive) should not be allowed to perform exposure prone procedures;
• health care workers who are intending to undertake professional training for a career that relies upon the performance of exposure prone procedures should be tested for antibodies to hepatitis C virus, and if positive, for hepatitis C virus RNA. Those found to be hepatitis C virus RNA positive should be restricted from starting such training whilst they are carrying the virus;
• health care workers who perform exposure prone procedures and who believe that they may have been exposed to hepatitis C infection should promptly seek and follow confidential professional advice (e.g. from an occupational health physician) on whether they should be tested for hepatitis C. They should cease performing exposure prone procedures if they are carrying the virus;
• hepatitis C infected health care workers who have responded successfully to ttreatment with antiviral therapy should be allowed to resume exposure prone procedures or to start professional training for a career that relies upon the performance of exposure prone procedures. Successful response to treatment is defined as remaining hepatitis C virus RNA negative 6 months after cessation of treatment. Successfully treated health care workers will be allowed to return to performing exposure prone procedures at that time. As a further check, they should be shown still to be hepatitis C virus RNA negative 6 months later;
• staff are provided with information and training about measures to reduce the risk of occupational exposure to hepatitis C infection (e.g. safe handling and disposal of sharps and measures to reduce risks during surgical procedures).

1.       Exposure prone procedures are those where there is a risk that injury to the health care worker could result in their blood contaminating a patient's open tissues. Exposure prone procedures occur mainly in surgery (including some procedures in minor surgery carried out by GPs), obstetrics and gynaecology, dentistry and midwifery. Annex A to this guidance provides further advice. An illustrative list of exposure prone procedures is contained in Guidance on the management of HIV/AIDS infected health care workers and patient notification (issued under cover of Health Service Circular 1998/226). Revised guidance to replace this version is currently out for consultation (see http://www.doh.gov.uk/ )

AIDS/HIV infected health care workers

We are seeking comments on the above-mentioned draft guidance.

This guidance replaces the previous version published in 1998 and includes updated advice on patient notification exercises. The guidance is based on the new policy on patient notification exercises when a health care worker (HCW) is found to be infected with HIV, which was announced in November 2001. It follows expert advice from the Expert Advisory Group on AIDS (EAGA) and UK Advisory Panel for Health Care Workers infected with Blood-borne Viruses (UKAP). They advise that it is no longer necessary to notify every patient who has undergone an exposure prone procedure by an infected HCW because of the low risk of transmission and the anxiety caused to patients and the wider public.

It is recommended that the decision on whether a patient notification exercise should be undertaken should be assessed on a case-by-case basis using a criteria based framework. In line with Shifting the Balance of Power, Directors of Public Health will be responsible for deciding whether patient notification is necessary, although UKAP will be available to provide advice.

The guidance document aims to assist Directors of Public Health of Primary Care Trusts and relevant health professionals in:

• quantifying the level of risk associated with clinical procedures that are classified as exposure prone; and
• providing clear criteria to use when assessing whether a patient notification exercise is warranted, and if so, its extent.

We would welcome your comments in general on:

• the scope and content of the guidance;
• whether there are gaps in the information provided.

and in particular on:

• section 8 (When a patient notification exercise should be conducted);
• section 11 ( Guidance on notifying patients).

Any comments should be sent to
Ruth Hickson,
Department of Health, Blood and Healthcare Associated Infections Unit, Communicable Diseases Branch,
Room 631B Skipton House,
80 London Road,
London SE1 6LH
or by e-mail to Ruth.Hickson@doh.gsi.gov.uk by 18 October 2002.      

DR PAT TROOP Deputy Chief Medical Officer  

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