Communicable disease and health protection quarterly review: July-September 2002. From the PHLS Communicable Disease Surveillance Centre.

Abstract

The Department of Health (DoH) issued new guidance on the management of hepatitis C infected health care workers (HCWs). Previous guidance from the Advisory Group on Hepatitis (AGH) recommended that HCWs infected with hepatitis C should be restricted from undertaking exposure-prone procedures (EPPs) only if they had been associated with transmission of infection to a patient. There have, however, now been five documented incidents in England and Wales in which infected health care workers have transmitted hepatitis C infection to a total of 15 patients during EPPs. As a consequence, it is now recommended that all HCWs who know they carry the hepatitis C virus (i.e. are hepatitis C virus RNA positive) should not perform EPPs. HCWs who are known to have antibodies to hepatitis C virus and who carry out EPPs should be tested for hepatitis C virus RNA. Hepatitis C infected HCWs who have received antiviral treatment and remain hepatitis C virus RNA negative 6 months after cessation of treatment may return to performing EPPs but will require a further check 6 months later to show they remain hepatitis C virus RNA negative. It is also recommended that all HCWs intending to start professional training in a career that relies upon the performance of EPPs should be tested for antibodies for hepatitis C virus before commencing training. Routine testing for hepatitis C of all HCWs who currently perform EPPs is not recommended, but HCWs who perform EPPs and who believe they may have been exposed to hepatitis C are advised to seek professional advice on whether they should be tested. Patient notification exercises are recommended whenever transmission of hepatitis C from an infected HCW to a patient has been identified. Guidance to assist in the implementation of the new arrangements is available online at http://www.doh.gov.uk/hepatitisc/healthcareworkers.htm. The DoH also released the Hepatitis C strategy for England for consultation. This strategy will form the basis of a hepatitis C action plan to be drawn up by the end of the year. The main aims of the strategy are to prevent new cases of hepatitis C infection occurring, to increase testing so as to identify those individuals with chronic infection, to ensure that those who are infected can receive specialist advice and to deliver the appropriate treatment through co-ordinated pathways of patient care. The strategy encourages the offering of hepatitis C testing in a range of clinical settings, including to those attending drug treatment centres. The importance of raising awareness of hepatitis C infection in the general population and increasing the awareness and knowledge amongst primary care health professionals is also stressed. The strategy encourages and promotes the use of Communicable Disease and Health Protection Quarterly Review: July–September 2002