Management of Hcv–Infected Health Care Workers

Abstract

Alter, 1 addressing the prevention of spread of hepatitis C, confirms that there are no recommendations for restriction of professional activities for hepatitis C virus (HCV)-infected health care workers (HCWs), and indirectly excludes routine testing for HCV infection in HCWs, due to the fact that they are not at high risk for infection, and that transmission from HCV-infected HCWs to patients is rare. As opposed to this opinion, Ross et al. 2 calculate that risk for surgeon-topatient HCV transmission during a single invasive procedure is comparable with the chance of acquiring HCV by receiving a blood transfusion, so supporting the claim that medical staff in general should be tested routinely for markers of HCV infection. Guidelines on the management of HCWs often are controversial on this topic. In Italy advisory guidelines, proposed by the National Institute of Health, the Association for the Study of the Liver, and the National Institute for Infectious Diseases, claim that those HCWs who directly perform invasive procedures should undergo serologic testing and the evaluation of markers of viral infectivity (anti-HCV and HCV RNA). 3 This recommendation is enforced poorly because of the complex legal and ethical questions associated with the matter, and the lack of identification of the authority who can manage the problem effectively. An interdisciplinary group of experts from medical, bioethical, legal, and administrative disciplines, integrated with trade union and employer representatives, currently is trying to define the way to put into practice the prevention with respect to National laws and individual prerogatives. 4 The aim of the group is to safeguard both patients' and diseased workers' health, including in the term health the full range of moral, psychologic, and social factors belonging to an individual's dignity. According to the European Union Directives, the management of HCWs requires a high degree of cooperation among all the involved entities. In the absence of mandatory rules, the first mover is the employer, who has to define the strategy to deal with infected HCWs in the Document of Risk Assessment of the Health Care Unit. The Document should state clearly if priority is given to the protection of patients, or to the HCWs' rights. Policies concerning informed consent, noncompliance, confidentiality, responsibility of HCWs, disclosure of transmission risk to patients, nondiscrimination, and counseling of infected workers should be clarified. Costs and targets need to be stated, plus the means of recovering costs to ensure viability. The physician responsible for medical surveillance of workers should judge on a case-by-case basis the employee's ability to perform the job safely, with reference not only to him or herself, but also to other employees and the patients. Evidence-based ways to reduce the risk for HCV transmission, such as improvement of compliance with existing infection control measures, should be preferred to practice