Volume 180 - Issue 4
Management of healthcare workers after occupational exposure to hepatitis C virus
Authors: Patrick G P Charles, M Lindsay Grayson, Peter W Angus and Joseph J Sasadeusz
Med J Aust 2004; 180 (4): 195-196. || doi: 10.5694/j.1326-5377.2004.tb05870.x
Published online: 16 February 2004
Published online: 16 February 2004
Patrick G P Charles,* M Lindsay Grayson,† Peter W Angus,‡ Joseph J Sasadeusz§
* Registrar, Department of Infectious Diseases, † Director, Infectious Diseases and Clinical Epidemiology, ‡ Director, Gastroenterology and Hepatology, Austin and Repatriation Medical Centre, Studley Road, Heidelberg, VIC 3084; § Director, and Infectious Diseases Physician, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC. patrick.charlesATmh.org.au
In reply: Magnavita correctly points out the need for a national policy on the management of healthcare workers who are either infected with or occupationally exposed to hepatitis C virus (HCV).
Compulsory testing of healthcare workers is neither practical, logical nor fair in the current Australian healthcare environment. Firstly, most healthcare institutions do not currently have adequate staff health systems in place to ensure that staff are appropriately vaccinated against readily preventable diseases, such as hepatitis B, measles and varicella, let alone to test all staff for a disease such as hepatitis C, for which there is no vaccine. Secondly, awareness about important issues, such as healthcare worker transmission-risk assessment is embryonic (at best) in most institutions. The risk of HCV transmission from infected healthcare workers to their patients is generally considered to be extremely low, but probably depends on a number of factors, including the nature of the patient’s procedure and the healthcare worker’s injury and level of viraemia at the time. Simplistic legal opinions about such matters rarely help. Finally, we agree that the rights of healthcare workers are often neglected in this era of litigation-driven medicine. If these rights are not considered, and infected or exposed healthcare workers are simply excluded from all types of work without any appropriate risk assessment or compensation, then compliance with any form of postinjury testing is unlikely. However, rather than ignoring this important workplace issue, as we believe many Australian institutions currently do, a logical assessment of potential transmission risk is possible that is both fair to the patient and the infected worker. Stratification of healthcare workers according to their level of HCV viraemia and whether they are involved in exposure-prone procedures is a logical start — this we have attempted in our proposed guidelines.1
Some healthcare workers may avoid being tested so that they can have the protection of not knowing their serological status.2 However, recent studies suggesting the efficacy of early treatment of acute HCV infection3 mean that it will actually be in healthcare workers’ interest to know if they have recently acquired HCV infection — as long as they are treated in a manner that protects their health and workplace rights, while also protecting the rights of their patients.
References
- Charles PGP, Angus PW, Sasadeusz JJ, Grayson ML. Management of healthcare workers after occupational exposure to hepatitis C virus. Med J Aust 2003; 179: 153-157. <eMJA full text>
- Gostin LO. A proposed national policy on health care workers living with HIV/AIDS and other blood-borne pathogens. JAMA 2000; 284: 1965–1970.
- Jaeckel E, Cornberg M, Wedemeyer H, et al. Treatment of acute hepatitis C with interferon alfa–2b. N Engl J Med 2001; 345: 1452–1457. CBBJFADB