Exposure-prone Procedures Research Articles

The Epidemiology of Needlestick and Sharp Injuries Among Healthcare Workers in a Secondary Care Hospital in Saudi Arabia: A Retrospective Study.

Introduction Needlestick and sharp injuries (NSI) continue to pose a significant risk for healthcare workers (HCWs) at their workplace. The incidence rate of NSI in hospitals depends on multiple risk factors. This study aimed to analyze the epidemiological characteristics of NSI among HCWs and the risk factors influencing NSI rates and to provide further direction for NSI prevention in secondary care hospitals. Methods This study included all the NSI cases reported by HCWs in King Abdul Aziz Hospital, Makkah from 2005 to 2017. All the cases were recorded in the Exposure Prevention Information Network (EPINet™)database (International Healthcare Worker Safety Center, University of Virginia, Charlottesville, USA). The study was executed by using data loaded in the EPINet™Program, the hospital electronic recording system Medica Plus, and analyzed by the StatisticalPackage for the Social Sciences program (SPSS Inc. Released 2007. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). Results During the period of study, 524 NSI cases were reported. The mean incidence rate per 100 occupied beds with 95% CI was 25.43 (22.05-28.81) and a statistically insignificant decline in NSI incidence rate was observed from 2005 to 2017. The maximal annual incidence rate (35.63 per 100 occupied beds) was registered in 2010 and the minimal value (14.84 per 100 occupied beds) in 2013. Injuries were mainly reported in patient rooms/wards (30.2%) and most frequently by nurses (56.1%). The mean of incident reporting within 24 hours was 74.0, 95% CI (67.19-80.73). This rate showed a statistically significant (p=0.01) increasing trend of 5.0% per annum. The mean of identified source patients - 83.5, 95% CI (79.13- 87.23) - possessed an annual 2.1% rise during 2005-2017 which was statistically insignificant (p=0.7). Cases occurred after the use/before disposal of items in 45.0% of cases and during the use of items in 44.7%. Hollow-bore needles caused injuries in 46.5% of incidents. Blood sample taking - 23.2% and IV or arterial line insertion/removal/manipulation (19.1%) - presented exposure-prone procedures posing the highest risk. Conclusions The results of this study revealed a high rate of NSI in the hospital. NSI rate in hospitals was impacted by a group of related risk factors, particularly, the location of risk (patient room/ward, intensive care unit (ICU), and emergency room (ER) depending on job intensity, the kind and frequency of exposure-prone procedures (blood sample taking, IV or arterial line insertion/removal/manipulation) and handling of hollow-bore and solid needle connected to the main healthcare professional group at risk (nurses). Future direction in NSI prevention requires a complex approach of continuous staff education along with the usage of devices with safety features.

Hepatitis C virus infection and anaesthesia practice: A narrative review.

This paper reviews the natural and treated history of hepatitis C virus infection, the interactions between current therapies and anaesthesia medications, and the implications of occupational exposure and infection to anaesthetists in light of significant changes in treatment. In the past decade, the introduction of new direct acting antiviral medications has seen high cure rates with a sustained viral response across all virus genotypes. These medications are well tolerated with minimal side-effects. Should a patient on these medications require anaesthesia, there are few clinically significant interactions with commonly used anaesthesia medications, and minimal perioperative investigations are required, although delaying elective surgery until after the completion of treatment regimens should be considered to maximise treatment success. As anaesthetists may practise exposure-prone procedures, regular screening for hepatitis C virus infection remains recommended to enable both patient protection and treatment of the anaesthetist prior to the development of any long-term complications of hepatitis C virus infection. Similarly, early diagnosis and treatment of occupationally acquired hepatitis C virus infection after body fluid exposure is associated with high cure rates with minimal risk of long-term liver damage. Although hepatitis C virus infection remains a significant public health issue in Australia and New Zealand, improvements in outcomes as a result of new treatment regimens have allowed the World Health Organization to target the elimination of hepatitis C virus infection as a public health threat by 2030, and public health strategies are being implemented to achieve this goal.

Clinical and occupational health management of healthcare workers living with chronic hepatitis B: UK policy and international comparisons.

Hepatitis B virus (HBV) is a highly infectious bloodborne virus, which remains endemic in large geographic areas and represents a major global healthcare challenge. HBV transmission from healthcare workers, who perform exposure prone procedures (EPP), to patients is a recognized transmission risk, which varies widely globally. Although the risk is small in developed countries, it increases significantly in high-prevalent, low-resource countries, representing a major challenge to these healthcare systems and underlining the necessity for robust guidance to be in place. The HBV landscape has evolved as a result of global vaccination programs, implementation of standard precautions and the advent of new generation antiviral agents (3rd generation nucleos(t)ide analogues). In light of the progress in the field, the UK Advisory Panel for Healthcare Workers Infected with Bloodborne Viruses (UKAP) recently issued updated guidance, which essentially removes past barriers, restricting healthcare workers from performing EPPs solely on the basis of HBV DNA level, regardless of hepatitis B 'e' antigen and/or treatment status. Although the current recommendations remain conservative compared to those of other developed healthcare systems, UK practice is now in line with other high-income countries, while ensuring patient safety remains paramount, without unduly restricting HCWs from clinical practice. The current article presents the latest UKAP guidance, considers its implications for HCWs and compares it with the guidance from major international scientific societies and governing bodies.

Preventing transmission of bloodborne viruses from infected healthcare workers to patients: Summary of a new Canadian Guideline.

Although it is well documented that bloodborne viruses (BBVs), including human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) have been transmitted from patients to healthcare workers (HCWs), there has also been reported transmission from HCWs to patients during the provision of health care. With remarkable progress in infection prevention, diagnosis tools, treatment regimens and major improvements in guideline development methodology, there was a need to develop an evidence-based guideline to replace the 1998 Canadian consensus document for managing HCWs infected with BBVs. This article summarizes the Canadian Guideline on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings. A Guideline Development Task Group was established and key questions developed to inform the guideline content. Systematic reviews were conducted to evaluate the risk of HCW-to-patient transmission of HIV, HCV and HBV. Environmental scans were used to provide information on Expert Review Panels, disclosure of a HCW's serologic status and lookback investigations. Federal, provincial and territorial partners and key stakeholder organizations were consulted on the Guideline. The risk of HCW-to-patient BBV transmission was found to be negligible, except during exposure-prone procedures, where there is a risk that injury to the HCW may result in exposure of a patient's open tissues to the HCW's blood. Risk of ensuing transmission and the rate of transmission varied by BBV, and were lowest with HIV and highest with HBV. The Guideline provides key content, including recommendations regarding criteria to determine if a procedure is an exposure-prone procedure, management of HCWs infected with a BBV, including considerations for the HCW's fitness for practice, Expert Review Panels, HCW disclosure obligations and right to privacy and lookback investigations. This new Guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations related to preventing HCW-to-patient transmission of BBVs during the provision of care.

1208. Preventing Transmission of Bloodborne Viruses from-Infected Healthcare Workers to Patients in Canadian Healthcare Settings: A National Guideline

BackgroundInfectious agents, such as bloodborne viruses (BBVs), can potentially be transmitted from healthcare workers (HCWs) to patients. In an effort to reduce this risk to patients, this guideline, which provides a framework for policies on the management of HCWs infected with BBVs in Canada, was developed.MethodsA total of six systematic reviews (1995–2016) were conducted to inform the risk of transmission of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) from infected HCWs to patients and the infectivity of each virus related to source serum viral load. Three environmental scans were conducted to inform sections on disclosure of HCW’s serologic status, Expert Review Panels, and lookback investigations. Government partners and key stakeholder organizations were consulted and a Task Group provided technical expertise.ResultsThe risk of HCW-to-patient BBV transmission is negligible, except during exposure-prone procedures where there is a risk of HCW injury and possible exposure of a patient’s open tissues to the HCW’s blood. Transmission rates were lowest with HIV and highest with HBV (Table 1). Rates varied with several factors including source viral load, nature of potential exposure, infection prevention and control breaches, susceptibility of exposed patient, and use of post-exposure prophylaxis where relevant. The extent of reporting bias for exposure incidents where transmission did not occur is unknown. Current antiviral therapy informed guideline recommendations, with viral load thresholds provided to assist treating physician, Expert Review Panels and regulatory authorities in determining a HCW’s fitness for practice.ConclusionRoutine Practices (or Standard Precautions) are critical to prevent HCW-to-patient transmission of infections; including BBVs. Recommendations provided in this guideline aim to further reduce the already minimal risk of HCW-to-patient transmission. The guideline provides a pan-Canadian approach for managing HCWs infected with a BBV, with recommendations directly impacting clinical practice related to preventing and controlling healthcare-associated infections. Disclosures All authors: No reported disclosures.

Hepatitis B virus transmission and health care workers: Epidemiology, pathogenesis and diagnosis

Abstract Hepatitis B infection is a preventable disease, infecting approximately two billion people worldwide and causing a million deaths annually. Around 2 million healthcare workers are exposed to Hepatitis B and have ten times higher risk of contracting the disease due to occupational exposure. In Asia, the seroprevalence is estimated between 15%–21%. The diagnosis of Hepatitis B is done mainly by detection of viral markers with the help of serologic tests. Nowadays molecular tests are increasingly being used both for diagnosis and management of patients. Vaccination of the healthcare worker is of utmost importance in the prevention of hepatitis B virus infection as it decreases the transmission effectively. According to CDC guidelines, an infected healthcare worker should not perform exposure prone procedures at HBV DNA levels more than 1000 IU/ml and an expert panel monitors the treatment. Seven drugs have been approved by US-FDA for treatment of HBV infection. The incidence of HBV has decreased since the advent of universal precautions and safe disposal of infected waste and sharps. Inclusion of Hepatitis B vaccination in the universal immunisation programme is also a major step in reducing the incidence of HBV infections.

A dirty little secret: stigma, shame and hepatitis C in the health setting

While recent medical innovation shows great promise in treating hepatitis C (HCV), it remains a condition associated with profound stigma. HCV is a bloodborne virus (BBV) most commonly transmitted in...

No longer 'written off' - times have changed for the BBV-infected dental professional.

There is a recognised potential risk of transmission of blood-borne viruses (BBVs) from infected healthcare workers to patients during exposure prone procedures (EPPs). The restrictions placed on performance of EPPs by infected clinicians in the UK have had a particularly significant impact on dentists because of the exposure-prone nature of most dental procedures and the difficulties in identifying alternative career pathways in the profession that do not involve EPPs. More recently, the significant positive impact of antiviral drugs on viral load, together with a re-categorisation of EPPs in dentistry have resulted in evolution of the guidance with a consequent significant improvement to the career prospects of dentists infected with BBVs. This paper provides an update for practitioners on the progress that has been made and outlines the current position with respect to practice restrictions.

Fluctuation of Viremia in Hepatitis B Virus-Infected Healthcare Workers Performing Exposure-Prone Procedures in the Netherlands.

To determine the longitudinal changes in viral load of hepatitis B virus (HBV)-infected healthcare workers (HCWs) and its consequences for exclusion of infected HCWs performing exposure-prone procedures, various HBV DNA safety thresholds, and the frequency of monitoring. Retrospective cohort study June 1, 1996-January 31, 2013. Participants In the Netherlands, chronically HBV-infected HCWs performing exposure-prone procedures are notified to the Committee for Prevention of Iatrogenic Hepatitis B. Of the 126 notified HCWs, 45 had 2 or more HBV DNA levels determined without antiviral therapy. A time-to-event analysis for HBV-infected HCWs categorized in various viremia levels surpassing a HBV DNA threshold level of 1×105 copies/mL, above which exposure-prone procedures are not allowed in the Netherlands. Fluctuations of HBV DNA in follow-up samples ranged from -5.4 to +2.2 log10 copies/mL. A high correlation was seen for each HBV DNA level with the 3 previous levels. In a time-to-event analysis, after 6 months 7.2%, 6.5%, and 14.3% of individuals had surpassed the threshold of 1×105 copies/mL for viral load categories 4.8×103 to 1.5×104; 1.5×104 to 4.0×104; and 4.0×104 to 1.0×105, respectively. We propose standard retesting every 6 months, with more frequent retesting just below the high threshold value (1×105 copies/mL), and prolonging this standard interval to 1 year after 3 consecutive levels below the threshold in policies with lower safety thresholds (1×103 or 1×104 copies/mL). Infect Control Hosp Epidemiol 2016;37:655-660.

Canadian Association of General Surgeons position statement: recommendations for surgeons with blood-borne communicable diseases.

The potential for transmission of hematogenously transmitted pathogens during exposure-prone procedures is a clinically important concern to both patients and surgeons. There is inconsistency among regulatory bodies in Canada regarding the management of infection risk among surgeons, particularly with regard to screening and the postexposure management of infected surgeons. The Canadian Association of General Surgeons commissioned a task force to review the evidence regarding the management of blood-borne pathogens and transmission risk during surgical procedures. The results of this review indicate a need for several jurisdictions to update their guidelines to reflect current evidence-based practices.

A multicenter survey of factors influencing knowledge, attitude and behavior of dentists towards blood borne virus infected patients and associated infection control guidelines

Objectives: The objectives of the study were to assess the knowledge, attitude, and behavior (KAB) of dentists toward blood-borne virus (BBV) diseases, associated hazards, and infection control guidelines and to determine factors which influence KAB of dentists toward above-mentioned variables. Materials and Methods: This was a cross-sectional survey. Eighty-four dentists were provided a self-prepared, structured questionnaire. The dentists were of varying specialties and health-care sectors. Frequency distribution and Fisher's exact test were performed. Results: Most of the dentists knew the common oral manifestations of acquired immunodeficiency syndrome, but none knew all. Many dentists were not aware of mode of transmission of hepatitis D virus (HDV) (n = 42), herpes simplex virus (n = 50), and herpes zoster virus (n = 47). Over half of the dentists (n = 43) did not know that hepatitis C virus vaccine does not exist. Many dentists (n = 63) knew that interferon is used for treating hepatitis B virus infection. Knowledge of HDV transmission and infection control officer availability in dentist's clinic were influenced by a number of continued dental education (CDE) hours and workplace of dentist. Most of the dentists were not aware of National Health Service guidelines for BBV-infected dentists practicing exposure-prone procedures (EPPs). Conclusion: KAB of dentists was influenced by a number of CDE hours and workplace of dentist. We request the dental authorities to increase the number of infection control-based CDE hours, BBV educational campaign for dentists and to issue a guidelines for BBV-infected dentists practicing EPP.

Hepatitis B in healthcare workers: Transmission events and guidance for management.

Hepatitis B virus (HBV) is the most efficiently transmissible of the bloodborne viruses that are important in healthcare settings. Healthcare workers (HCWs) are at risk for exposure to HBV from infected patients and, if infected, are similarly at risk of transmitting HBV to patients. Published cases of HBV transmission from HCW to patient are relatively rare, having decreased in frequency following the introduction of standard (universal) precautions, adoption of enhanced percutaneous injury precautions such as double-gloving in surgery, and routine HBV vaccination of HCWs. Here we review published cases of HCW-to-patient transmission of HBV, details of which have helped to guide the creation of formal guidelines for the management of HBV-infected HCWs. We also compare the published guidelines for the management of HBV-infected HCWs from various governing bodies, focusing on their differences with regard to vaccination requirements, viral load limits, frequency of monitoring, and restrictions on practice. Importantly, while there are differences among the recommendations from governing bodies, no guidelines uniformly restrict HBV-infected HCWs from performing invasive or exposure-prone procedures.

Obstetrics in the time of Ebola: challenges and dilemmas in providing lifesaving care during a deadly epidemic.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 122, Issue 3 p. 284-286 Commentary Obstetrics in the time of Ebola: challenges and dilemmas in providing lifesaving care during a deadly epidemic BO Black, Corresponding Author BO Black Médecins Sans Frontières, London, UKCorrespondence: Dr BO Black, 16 Daylesford Road, Cheadle, Cheshire SK8 1LF, UK. Email [email protected]Search for more papers by this author BO Black, Corresponding Author BO Black Médecins Sans Frontières, London, UKCorrespondence: Dr BO Black, 16 Daylesford Road, Cheadle, Cheshire SK8 1LF, UK. Email [email protected]Search for more papers by this author First published: 17 December 2014 https://doi.org/10.1111/1471-0528.13232Citations: 13Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume122, Issue3February 2015Pages 284-286 RelatedInformation

Remembering the importance of preventing blood‐borne infections in the critical care setting

Remembering the importance of preventing blood‐borne infections in the critical care setting

Changing Times, Changing Landscapes: Comparing the Society for Healthcare Epidemiology of America's Infected Provider Guidelines with the Centers for Disease Control and Prevention's Guidelines for Managing Providers Infected with Hepatitis B Virus

In March 2010, the Society for Healthcare Epidemiology of America (SHEA) published revised and updated guidelines for the management of healthcare workers infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or human immunodeficiency virus (HIV); in July 2012, the Centers for Disease Control and Prevention (CDC) published updated recommendations for managing HBV-infected healthcare providers and students. The purpose of this commentary is both to underscore the significance of the major modifications of recommendations in the CDC and SHEA revised guidelines and to highlight points of similarities and differences between them. The optimal management of healthcare providers infected with bloodborne pathogens has long been the focus of controversy. In 1991, the CDC issued guidelines recommending that healthcare workers who are infected with HBV and have circulating hepatitis B e antigen (HBeAg) who perform the types of invasive surgical and dental procedures that previously had been implicated in the transmission of HBV from healthcare workers to patients (referred to as “exposure-prone invasive procedures”) can conduct such procedures only after both notifying the patient of the healthcare provider’s infection and consulting an expert review panel. These guidelines make similar recommendations for providers infected with HIV. Once the expert review panel has evaluated the provider and his or her clinical performance and planned procedures, the panel could grant permission for the provider to conduct the procedures. Specifically, the guidelines state, “Healthcare workers who are infected with HIV or HBV and are ‘e’ antigen positive should not perform exposure-prone procedures unless they have sought the counsel of an expert review panel and have been advised under what circumstances, if any, they may continue to perform these procedures. Such circumstances would include notifying prospective patients of the healthcare worker’s seropositivity before they undergo exposure-prone invasive procedures.” These guidelines were issued as an immediate response to a cluster of 6 patients whose HIV infections were linked epidemiologically as well as through DNA sequencing to a dentist who had AIDS. The precise mechanisms by which HIV was transmitted in this dentist’s practice were never defined, and the extraordinarily high rate of transmission in the dentist’s practice remains unexplained. Several instances of iatrogenic transmission of HBV had been documented in the 1980s (summarized in Bell et al). Similarly, provider-to-patient transmission of HCV, although uncommon, has been subsequently documented definitively. Nonetheless, the landscape of management strategies for bloodborne pathogen infections in the healthcare setting has been altered dramatically in the more than 20 years that have intervened since the 1991 CDC guidelines were issued. Numerous strategies have been introduced into the healthcare workplace to decrease occupational risks for parenteral exposures (and, therefore, for infections, both from patient to provider and from provider to patient). For example, the introductions of universal/standard precautions, safer medical and surgical devices, modifications of intrinsically risky work practices, routine double-gloving for invasive procedures, and use of blunt-tipped surgical needles have all contributed to a reduction in risk for occupational exposures. Another major change in the past 2 decades is the fact that HCV has emerged as an increasingly important bloodborne pathogen that also has been associated with iatrogenic risks. In the intervening 2 decades, other countries and professional societies have issued more contemporaneous guidelines about the management of providers infected with bloodborne pathogens. Perhaps most significantly, substantial

The systems approach to error reduction: factors influencing inoculation injury reporting in the operating theatre

To examine the frequency of, and factors influencing, reporting of mucocutaneous and percutaneous injuries in operating theatres. Surgeons and peri-operative nurses risk acquiring blood-borne viral infections during surgical procedures. Appropriate first-aid and prophylactic treatment after an injury can significantly reduce the risk of infection. However, studies indicate that injuries often go unreported. The 'systems approach' to error reduction relies on reporting incidents and near misses. Failure to report will compromise safety. A postal survey of all surgeons and peri-operative nurses engaged in exposure prone procedures in nine Welsh hospitals, face-to-face interviews with selected participants and telephone interviews with Infection Control Nurses. The response rate was 51.47% (315/612). Most respondents reported one or more percutaneous (183/315, 58.1%) and/or mucocutaneous injuries (68/315, 21.6%) in the 5 years preceding the study. Only 54.9% (112/204) reported every injury. Surgeons were poorer at reporting: 70/133 (52.6%) reported all or >50% of their injuries compared with 65/71 nurses (91.5%). Injuries are frequently under-reported, possibly compromising safety in operating theatres. A significant number of inoculation injuries are not reported. Factors influencing under-reporting were identified. This knowledge can assist managers in improving reporting and encouraging a robust safety culture within operating departments.

HIV and employment

According to 2009 statistics, the human immunodeficiency virus (HIV) infected an estimated 86,500 individuals within the UK, although around one-quarter were unaware of their infection. In the majority of cases, it is now considered a long-term controllable but incurable infection. Indeed, most HIV-positive individuals are able to work. Employment is across most, if not all, workforce sectors and protection against workplace discrimination is provided by the Equality Act 2010. Issues including confidentiality, workplace adjustments, vaccinations and travel restrictions may be relevant to the occupational health of HIV-positive workers. There are special considerations concerning HIV-infected health care workers, including avoidance of performing exposure-prone procedures. Prevention of HIV acquisition in the workplace is relevant to a diverse range of occupational environments, and HIV post-exposure prophylaxis should be considered after potential HIV exposure incidents. If a worker contracts HIV by occupational means, financial help may be available.

Inter-professional differences in compliance with standard precautions in operating theatres: A multi-site, mixed methods study

BackgroundOccupational acquisition of blood-borne infections has been reported following exposure to blood or body fluids. Consistent adherence to standard precautions will reduce the risk of infection. ObjectivesTo identify: the frequency of self-reported adverse exposure to blood and body fluids among surgeons and scrub nurses during surgical procedures; contributory factors to such injuries; the extent of compliance with standard precautions; and factors influencing compliance with precautions. DesignA multi-site mixed methods study incorporating a cross-sectional survey and interviews. SettingsSix NHS trusts in Wales between January 2006 and August 2008. ParticipantsSurgeons and scrub nurses and Senior Infection Control Nurses. MethodsA postal survey to all surgeons and scrub nurses, who engaged in exposure prone procedures, followed by face to face interviews with surgeons and scrub nurses, and telephone interviews with Infection Control Nurses. ResultsResponse rate was 51.47% (315/612). Most 219/315 (69.5%) respondents reported sustaining an inoculation injury in the last five years: 183/315 (58.1%) reported sharps’ injuries and 40/315 (12.7%) splashes. Being a surgeon and believing injuries to be an occupational hazard were significantly associated with increased risk of sharps’ injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04–2.88 and adjusted odds ratio 2.0, 1.11–3.5, respectively). Compliance was incomplete: 31/315 (10%) respondents always complied with all available precautions, 1/315 (0.003%) claimed never to comply with any precautions; 64/293 (21.8%) always used safety devices, 141/310 (45.5%) eye protection, 72 (23.2%) double gloves, and 259/307 (84.4%) avoided passing sharps from hand to hand. Others selected precautions according to their own assessment of risk. Surgeons were less likely to adopt eye protection (adjusted odds ratio 0.28, 0.11–0.71) and to attend training sessions (odds ratio 0.111, 0.061–0.19). The professions viewed the risks associated with their roles differently, with nurses being more willing to follow protocols. ConclusionInter-professional differences in experiencing adverse exposures must be addressed to improve safety and reduce infection risks. This requires new training initiatives to alter risk perception and promote compliance with policies and procedures.

Hepatitis C virus infection among transmission-prone medical personnel.

Hepatitis C virus (HCV)-infected physicians have been reported to infect some of their patients during exposure-prone procedures (EPPs). There is no European consensus on the policy for the prevention of this transmission. To help define an appropriate preventive policy, we determined the prevalence of HCV infection among EPP-performing medical personnel in the Academic Medical Center in Amsterdam, the Netherlands. The prevalence of HCV infection was studied among 729 EPP-performing health care workers. Serum samples, stored after post-hepatitis B virus (HBV) vaccination testing in the years 2000–2009, were tested for HCV antibodies. Repeat reactive samples were confirmed by immunoblot assay and the detection of HCV RNA. The average age of the 729 health care workers was 39 years (range 18–66), suggesting a considerable cumulative occupational exposure to the blood. Nevertheless, only one of the 729 workers (0.14%; 95% confidence interval [CI]: <0.01% to 0.85%) was tested and confirmed to be positive for anti-HCV and positive for HCV RNA, which is comparable to the prevalence of HCV among Amsterdam citizens. Against this background, for the protection of personnel and patients, careful follow-up after needlestick injuries may be sufficient. If a zero-risk approach is desirable and costs are less relevant, the recurrent screening of EPP-performing personnel for HCV is superior to the follow-up of reported occupational exposures.

Hepatitis B and the surgeon

Hepatitis B virus is the most transmissible virus and is very resistant to heat and chemicals, because of its unique structure. Blood has the maximum concentration of the virus among all the body fluids and the risk of transmission is related to the presence of HBeAg and the Hepatitis B virus DNA level in the blood. In India, about 1-10% of the healthcare workers are HBsAg positive. Healthcare workers, especially surgeons, and laboratory technicians are at a high risk of developing Hepatitis B infection. Transmission from Hepatitis B positive surgeons to patients has been well-documented. However, the risk of transmission from a patient to a surgeon is higher - about 30% - following a needle stick injury from an HBeAg positive individual. In India, there is low awareness among healthcare personnel about Hepatitis B vaccination and its related issues, and there is no health policy in this regard. In relation to the healthcare workers, there is an urgent need to formulate guidelines on HBsAg testing, hepatitis B vaccination, restriction of exposure-prone procedures that have to be performed, the extent to which their serological status can be revealed to patients, implementation of universal precautions, and post-exposure prophylaxis.