CDC guidelines call for HCV postexposure testing
December 1, 1999 2 minutes read
CDC guidelines call for HCV postexposure testing
No restrictions for HCV-positive workers
While routine screening is not recommended, employee health professionals should have protocols in place to test source patients and exposed workers for hepatitis C virus infection following needlesticks or other exposures, the Centers for Disease Control and Prevention recommends.1
"Individual institutions should establish policies and procedures for HCV testing of persons after percutaneous or permucosal exposures to blood and ensure that all personnel are familiar with these policies and procedures," the CDC guidelines on HCV recommend. Other key points of the most current CDC guidelines for HCV include:
• Health care workers who care for people exposed to HCV in the occupational setting should be knowledgeable regarding the risk for HCV infection and appropriate counseling, testing, and medical follow-up.
• Immune globulin and antiviral agents are not recommended for postexposure prophylaxis of HCV. Limited data indicate that antiviral therapy might be beneficial when started early in the course of HCV infection, but no guidelines exist for administration of therapy during the acute phase of infection. When HCV infection is identified early, the individual should be referred for medical management to a specialist knowledgeable in this area.
• Health care workers should be educated regarding risk for and prevention of bloodborne infections. Standard barrier precautions and engineering controls should be implemented to prevent exposure to blood. Protocols should be in place for reporting and follow-up of percutaneous or permucosal exposures to blood or body fluids that contain blood.
• Currently, the CDC does not recommend restricting the professional activities of health care workers with HCV infection. As recommended for all health care workers, those who are HCV-positive should follow strict aseptic technique and standard precautions, including appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments.
The risk for HCV transmission from an infected health care worker to patients appears to be very low, though there has been at least one report of transmission during performance of exposure-prone invasive procedures.2 That report, from Spain, described HCV transmission from a cardiothoracic surgeon to five patients, but did not identify factors that might have contributed to transmission. Although factors (e.g., virus titer) might be related to transmission of HCV, no methods currently exist that can reliably determine infectivity, nor do data exist to determine threshold concentration of virus required for transmission, the CDC concludes.
References
1. Centers for Disease Control and Prevention. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998; 47 (No. RR-19):1-39.
2. Esteban I, Gomez J, Martell M, et al. Transmission of hepatitis C virus by a cardiac surgeon. N Engl J Med 1996; 334:555-60.
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