Infection alone should not limit provider's job
Noting that hepatitis B virus and HIV are not closely related, the Society for Health Care Epidemiology of America (SHEA) recommends separate management strategies for the two categories of infected health care workers and says such workers should not be exempt from any aspect of patient care unless the procedure in question is shown to be exposure-prone.
The organization also recommends against routine mandatory testing of providers and routine patient notification of infected health care workers.
SHEA recently included its guidelines in a position paper published in its journal, Infection Control and Epidemiology.[1] Citing new studies on the risk of transmission, improved infection controls, uneven state laws, and lawsuits against infected workers, SHEA updated its guidelines, which had stated that issues facing HBV-infected health care workers were applicable to those who were HIV-infected.
'Based on accumulated evidence, SHEA now believes that the HBV model may have outlived its usefulness, at least in terms of its use in setting policies for HIV-infected providers,' the authors note.
Not only is the risk of transmission 10 to 100 times lower for HIV than it is for HBV, differences in viral burden between the two viruses make the risk of infection harder to measure for HBV. Also, HBV clusters of provider-to-patient infections continue to be reported, while reported HIV infections have been limited to two in the past seven years.
In modifying its original position on infected health care workers being allowed to practice, SHEA argues that the risk of transmission is so low that mandatory prohibition is unwarranted. The only circumstance where a provider would be barred from practice would be in the case of known provider-to-patient transmission of HIV or HBV.
At the same time, SHEA recommends that health care facilities develop comprehensive occupational health programs to manage impaired health care workers. However, infected health care workers should not be required to participate in pathogen-specific educational programs, the authors note, nor should special monitoring efforts be developed for them.
As for special procedures for internal disclosure of a health care worker's infection, SHEA argues that health care worker privacy is paramount and that 'in most situations, co-workers and supervisors do not have a need to be aware of health care workers' medical problems.'
An HIV-positive person developing opportunistic infections presents a complex set of issues. SHEA recommends that institutions prohibit all health care workers who are susceptible to varicella-zoster virus, rubella, or measles from direct patient contact. Changes in duties for immune-compromised providers should be made in collaboration with the provider and his or her primary physician.
SHEA did not change its position against patient notification, arguing that the patient's right to informed consent doesn't supersede the provider's right to privacy. The only exception is the case of exposure to a health care worker's blood or body fluids. In that situation, a patient has a right to know the health care worker's infection status. Should a patient ask a health care worker about infection status, the worker is advised to refer the patient to appropriate management personnel and provide indirect answers, such as explaining the low risk of acquired bloodborne infections.
SHEA reiterated its strong position against mandatory HIV, HBV, or HCV testing of health care workers. However, health care workers who have community or occupational exposures to HIV or HCV are encouraged to obtain follow-up testing.
Reference
[1.] AIDS/TB Committee of the Society for Healthcare Epidemiology of America. Management of health care workers infected with hepatitis B virus, hepatitis C virus, human immunodeficiency virus or other bloodborne pathogens. Infect Control Hosp Epidemiol 1997; 18:349-363.
