The Society for Healthcare Epidemiology of America (SHEA) has released new guidelines regarding the management of healthcare providers who are infected with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) calling for each to be handled differently in light of advances in clinical knowledge and the evolution of the science in infection prevention measures.
SHEA recommends that infected providers not be strictly prohibited from participating in patient-care activities solely on the basis of a bloodborne pathogen infection because the use of appropriate infection prevention procedures makes the risk of exposure and transmission exceedingly small.
“SHEA recommends a comprehensive approach to managing healthcare providers who are infected with any of these diseases to ensure that assessment of the provider-to-patient transmission risks are considered in the appropriate context and perspective,” says Neil Fishman, MD, president of SHEA and director of the Department of Healthcare Epidemiology and Infection Control at the University of Pennsylvania Health System.
Because HBV, HCV and HIV are most readily transmitted either parenterally or across mucous membranes, experts widely agree that the risk for transmission from an infected provider to a patient during the provision of routine healthcare is near zero. The guideline recommends both enhanced precautions (e.g., double-gloving) for patient care procedures and also addresses viral load thresholds at which an infected provider should refrain from conducting any Category III invasive procedures (procedures with a definite risk of transmission).
SHEA offered different recommendations for HBV, HCV, and HIV because different viral loads of each pathogen require different surveillance measures and have different levels of risk (see below).
SHEA previously issued these guidelines in 1990 and then 1997, and Fishman noted that the updated guidelines reflect the evolution of both research and practice.