SHEA recommendations for infected providers
The Society for Healthcare Epidemiology of America’s updated position statement on the management of health care workers infected with bloodborne pathogens includes the recommendations listed below.1 Infection control professionals should consult the SHEA guidelines for a complete discussion of the recommendations and more detail on the various levels of justification assigned to each. The following recommendations were assigned the initial rank of A or B, meaning, respectively, there was either "good evidence" or "moderate evidence" to support the recommendation.
• All blood and body fluids from patients and health care workers (HCWs) must be regarded as potentially infectious. Transfers of blood or other potentially infectious materials from HCWs to patients must be avoided. (A)
• Unless a practitioner is implicated in provider-to-patient HIV or hepatitis C virus (HCV) transmission, HIV or HCV infection per se does not constitute a basis for barring an HIV- or HCV-infected HCW from any patient care activity, including invasive procedures. (B)
• Health care institutions should develop comprehensive occupational health programs to manage impaired HCWs, including evaluation of workers’ fitness for duty, based on competence, ability to perform routine duties, and compliance with established guidelines and procedures. (A)
• HBV e-antigen-positive HCWs should routinely double-glove and should not perform those activities epidemiologically identified as associated with a risk for provider-to-patient HBV transmission despite the use of appropriate infection control procedures. (B)
• No special monitoring efforts are needed for HBV-, HCV-, or HIV-infected persons. However, with the HCW’s consent, the occupational health service should initiate contact with the care provider of any HCW who has a condition associated with risk for compromised competence. Contact should be made with the provider as needed to assess the progress of any of these medical conditions. (B)
• With the exception of situations in which a patient has been exposed to an HCW’s blood or other hazardous body fluid, HBV-, HCV-, and HIV-infected HCWs should not be required to disclose their infection status to patients. (B)
• A HCW who knows that he or she is the source of a significant patient exposure to blood or hazardous body fluid is obligated ethically to undergo testing for infection with bloodborne pathogens. (A)
• Health care institutions should develop specific policies to deal with such exposures and should consider establishing sanctions for source HCWs who refuse testing for bloodborne pathogens. Such policies should be formally drawn and approved by institutional attorneys and governing boards. (A)
• Exposed patients should be counseled regarding the risks for infection and the symptoms of acute HBV, HCV and HIV infection. (A) They should be offered post-exposure chemoprophylaxis or immunoprophylaxis. (B) They should be followed in a manner analogous to the existing guidelines for HCWs who sustain occupational exposures to HIV or other bloodborne pathogens. (A)
• Mandatory HBV, HCV, or HIV screening of HCWs is not warranted. (A)
Reference
1. AIDS/TB Committee for the Society for Healthcare Epidemiology of America. Management of healthcare workers infected with hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or other bloodborne pathogens. Infect Control Hosp Epidemiol 1997; 18:349-363.
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