Management of healthcare workers after occupational exposure to hepatitis C virus

To the Editor: The article by Charles and colleagues1 is an interesting contribution to the development of Australian protocols for healthcare workers infected with hepatitis C virus (HCV). To date, most European countries have no national policy for HCV-infected healthcare workers, and existing guidelines are advisory in nature and poorly enforced. A panel of European and American experts recently failed to reach consensus on management of HCV-infected healthcare workers who perform exposure-prone procedures, and concluded that screening for HCV infection and restricting infected healthcare workers is not justified, based on current published data.2

Today, the effectiveness of guidelines relies solely on self-assessment of HCV status from healthcare workers. However, collaboration of healthcare workers might be problematic if management criteria are not defined, and workers’ rights are not guaranteed. Issues such as practice restriction, disclosure of serological status to patients, privacy and discrimination need to be resolved. Given the risk of HCV transmission from healthcare workers to patients is not clear, the burden of uncertainty rests entirely with healthcare workers. Because of the fear of discrimination, needlestick injuries may be under-reported, and infected workers may not seek diagnosis and treatment because they have greater legal protection if they can honestly say that they did not know their serological status.3 Moreover, the largely asymptomatic nature of HCV infection may leave healthcare workers unaware of their infective status.

The results of Charles and colleagues suggest up to tenfold underreporting of occupational injuries with blood exposure in Australian healthcare workers.1 With this number of unreported exposures, there may be two or three new cases of HCV infection in healthcare workers in metropolitan hospitals in Melbourne each year — a figure similar to the prevalence of occupational HCV infection from notified injuries.

Paradoxically, the prevalence of HCV infection in healthcare workers and the transmission risk for patients cannot be assessed without compulsory testing of healthcare workers, but without risk assessment there is no reason for this compulsory testing. Overcoming this Catch-22 with well-targeted epidemiological studies may help create broad consensus about policies for HCV-infected workers.