Infected Physicians and Invasive Procedures: Safe Practice Management

Abstract

There is currently no public policy that provides guidance concerning whether and when physicians infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or human immunodeficiency virus (HIV) can safely perform invasive procedures. A committee of experts in the fields of medicine, law, and biomedical ethics and 1 community member, aided by an advisory board, was established to produce recommendations for policy reform. An extensive literature review was conducted for these 3 infectious diseases, medicine, surgery, epidemiology, law, and bioethics to gather all relevant data. Special recommendations are made regarding the management of physicians who are infected with HIV, HBV, and/or HCV. This policy proposal includes a list of exposure-prone procedures and a decision chart that indicates under what conditions infected physicians can practice beyond the need for disclosure of their serological status.

Blood-borne viruses in health care workers: Prevention and management

“…62 A few countries have proposed guidelines, including the UK 55 and the USA. 63,64 In the UK, only new HCWs who will be performing EPPs, and HCWs already involved in EPPs who have suffered an accidental needle stick, are required to undergo screening for HCV antibodies. Moreover, guidelines recommend that HCWs with HCV infection not perform EPPs.…”

Health care worker-to-patient transmission of hepatitis C virus in the health care setting: Many questions and few answers

“…In contrast, a recently published US article defines EPPs as those during which a laboratory-confirmed clinical case of viral transmission from a health care worker to a patient has occurred. 19 In that article, all health care-related procedures were classified into those with minimal risk of viral transmission, those for which viral transmission is theoretically possible but unlikely, and those for which there is definite risk of viral transmission. The latter category consists of procedures that are considered to be exposure-prone.…”

“…22 In a recently published article, the need for testing on HCV antibodies is strongly acknowledged. 19 However, concerning the second part of the question, there is consensus that testing on HCV antibodies is regarded as a sufficient method.…”

“…While the CDC proposes disclosure of the health care worker's HCV status to the patient, a recently published article considers disclosure not necessarily effective and appropriate for health care workers. 19,22 It is argued that the significance of the potential for harm is not mitigated nor remedied by disclosure and that it would be an invasion of the health care worker's privacy if the law required disclosure of the health care worker's HCV status. 19 Disclosure of the health care worker's HCV status may not improve the patient's safety but cause more harm because of the patient's anxiety and the health care worker's stigmatization.…”

Outcome of an exercise to notify patients treated by a general surgeon infected with the hepatitis C virus

“…The absence of nosocomial HCV transmissions retrospectively established in these surveys might be, consequently, interpreted as rather convincing evidence for the conclusion that the risk of provider-to-patient transmission of HCV is factually very low. Therefore, in this context patients' interests must be carefully balanced with the rights of medical personnel occupationally infected with HCV (Cockcroft, 2000;Heptonstall, 2000;Reitsma et al, 2005;Rhodes et al, 1995;Tereskerz et al, 1999;Tuboku-Metzger et al, 2005).…”