OHCP Infected with a Bloodborne Pathogen

A guideline for the management of healthcare workers who are infected with the HBV, HCV, and HIV was developed by the Society of Healthcare Epidemiology of America (SHEA).3 It recommends that infected OHCP should not be totally prohibited from patient care solely on the basis of an infection with a bloodborne pathogen and that clinical privileges be graduated according to the level of risk for transmitting a bloodborne pathogen (i.e., HBV, HCV, and HIV) in association with a procedure (Table 4) and the level of circulating viral burden of the infected OHCP.3

Table 4. Oral Healthcare-associated Procedures According to the Level of Risk for Bloodborne Pathogen Transmission.3

This strategy encourages routine voluntary, confidential testing and emphasizes that clinicians who perform Category III procedures should know their immune or infection status, i.e., their relative viral load with respect to HBV, HCV, and HIV.3 Clinicians who are institutionally based and develop one of these infections are ethically bound to report it to their institution’s occupational medicine department. Private practitioners are ethically bound to report their infectious status to the local public health department.

These recommendations take into consideration evidence that (1) the HBeAg is not a sensitive marker for HBV infectivity (2) the availability of molecular tests that measure a patient’s circulating viral burden for hepatitis B, hepatitis C, and human immunodeficiency viruses with precision, and (3) the availability of antiviral agents for the treatment of chronic HBV infection, both acute and chronic HCV infection, and HIV infection.3 Table 5 lists recommended clinical privileges for healthcare providers with HBV, HCV, and HIV infection.3

Table 5. Recommended Clinical Privileges for Healthcare Providers with HBV or HCV Infection.3
Pathogen Circulating Viral Burden Clinical Privileges
HBV and HCV <104 GE/mL Category I, II, and III procedures*
≥104 GE/mL Category I and II procedures*
HIV <5 x 102 GE/mL Category I, II, and III procedures*
≥5 x 102 GE/mL Category I and II procedures*
*Clinical privileges predicated on the infected healthcare provider meeting the following requirements:

  • No evidence of having transmitted infection to patients
  • Obtained advice from an Expert Review Panel about continued practice
  • Follow-up twice a year to determine viral burden
  • Follow-up by a personal physician who has expertise in the management of infections with HBV, HCV, and HIV and who is allowed to communicate with the Expert Review Panel about the infected provider’s clinical status
  • Consulted with an expert about optimal infection control procedures and strictly adheres to the recommended procedures
  • Routine use of double gloving and frequent glove changes during procedures (particularly when performing tasks known to compromise glove integrity) for all instances in patient care for which gloving is recommended
  • Agreed to and signs a contract or letter from the Expert Review Panel that characterizes the infected providers responsibilities