Ban lifted on doctors with BBV performing exposure-prone procedures

By Michael Woodhead

31 Jan 2019

New national guidelines have lifted a ban on healthcare workers infected with blood-borne viruses performing exposure-prone procedures such as surgery.

Doctors and other healthcare workers living with HIV, hepatitis B or C virus will be allowed to return to performing exposure-prone procedures so long as they comply with criteria laid down in new guidelines from the Communicable Diseases Network of Australia (CDNA) that require them to have regular testing and treatment.

The guidelines, updated from previous ones issued in 2012, reflect the effectiveness of antiviral treatment for blood borne viruses and the lack of transmission that has been observed with healthcare workers who follow evidence-based guidelines.

To perform exposure-prone procedures such as orthopaedic surgery, dentistry and obstetric procedures, healthcare workers will need to obtain an initial health clearance and meet criteria such as being under the regular care of a specialist and undergoing regular viral load monitoring.

The guidelines note that the risks of transmission of blood-borne viruses to patients are extremely low, even in untreated healthcare workers

“Worldwide, since widespread availability of antiviral medication, there has not been a published case of transmission of a blood-borne virus from an effectively treated healthcare worker to a patient.”

Practitioners who adhere to the guidelines will not be required to divulge their status as a carrier of a blood borne virus to patients.

“Healthcare workers have the same right to confidentiality and access to confidential testing, counselling and treatment as the general population,” the guidelines state.

Doctors caring for healthcare workers with blood-borne viruses also have responsibilities to ensure that the practitioner attends regularly for testing and adheres to treatment. Patients who do not comply must be notified to AHPRA.

The guidelines state that all healthcare workers who perform exposure-prone procedures must take reasonable steps to know their blood-borne virus status, should be tested for them at least once every three years and should be vaccinated against hepatitis B.

For healthcare workers with HIV the criteria require them to be on combination antiretroviral therapy (cART) with a viral load below 200 copies/mL, measured on two occasions no less than three months apart.

HCW with hepatitis B must have viral load monitoring every three months if not on treatment or every six months if on appropriate and effective antiviral treatment, and a viral load below 200 IU/mL.

For people with hepatitis C the criteria require the healthcare worker to be HCV RNA negative if untreated or have achieved a sustained virological response (SVR) 12 weeks after treatment completion if treated with antivirals. Additional HCV RNA testing 12 months after treatment, is also required to determine if relapse or reinfection has occurred.

An exposure-prone procedure is defined as one where the healthcare worker’s hands (whether gloved or not) may be in contact with sharp instruments, needle tips or sharp tissues (spicules of bone or teeth) inside a patient’s open body cavity, wound or confined anatomical space where the hands or fingertips may not be completely visible at all times.

They include cardiothoracic, gynaecological and neurosurgery, dentistry, open surgical procedures, trauma and ENT surgery and orthopaedic procedures. Minimally invasive procedures and trauma/emergency situations are not usually considered exposure prone but have the potential to escalate to open or trauma procedures.

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