MANAGEMENT OF HEALTH-CARE WORKERS INFECTED WITH HEPATITIS-B VIRUS, HEPATITIS-C VIRUS, HUMAN-IMMUNODEFICIENCY-VIRUS, OR OTHER BLOODBORNE PATHOGENS

This article provides the current recommendations of the Society for H ealthcare Epidemiology of America (SHEA) regarding the management of h ealthcare workers infected with hepatitis B virus (HBV), hepatitis C v irus (HCV), or the human immunodeficiency virus (HIV). For the reasons cited in the article, SHEA now maintains that separate virus-specific management strategies are appropriate for healthcare workers who are infected with these unrelated viruses. SHEA emphasizes the use of appr opriate infection control procedures to minimize exposure of patients or providers to blood, emphasizes that transfers of blood from patient s to providers and from providers to patients should be avoided, and a rgues that infected healthcare workers should not be prohibited from p articipating in patient-care activities solely on the basis of their b loodborne pathogen infection. SHEA recommends that hepatitis B e-antig en-positive healthcare workers routinely should double glove and shoul d not perform those activities that have been identified epidemiologic ally as associated with a risk for provider-to-patient HBV transmissio n despite the use of appropriate infection control procedures. SHEA al so recommends that HCV- and HIV-infected providers use double gloving for procedures, but recommends that these providers not be excluded fr om any aspect of patient care unless epidemiologically incriminated in the transmission of these infections despite adequate precautions. SH EA argues for comprehensive education concerning bloodborne pathogens for all healthcare providers and trainees and against mandatory pathog en-specific educational requirements for infected providers. SHEA reco mmends against specific competence-monitoring procedures directed at t hese healthcare workers infected with bloodborne pathogens, arguing fo r managing infected providers in the context of a comprehensive approa ch to the management of all impaired providers. SHEA emphasizes the im portance of worker privacy and medical confidentiality. SHEA emphasize s the importance of offering employees who have disabilities reasonabl e accommodation for their disabilities. The article discusses exposure management in detail and, in general, recommends adherence to existin g guidelines for managing exposures to these agents. Finally, SHEA rec ommends against routine mandatory testing of providers. Specific detai ls and the rationale for these recommendations are included in the bod y of the article.