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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

  

Management of healthcare workers after occupational exposure to hepatitis C virus

Patrick G P Charles, Peter W Angus, Joseph J Sasadeusz and M Lindsay Grayson

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We believe that our proposed post-needlestick injury HCV investigation protocol provides a practical approach for assessing injured healthcare workers in the current therapeutic and legal contexts of HCV management in Australia. We encourage the development and acceptance of a common protocol for use in all Australian hospitals.

1: Blood and body fluid exposures among healthcare workers at major metropolitan hospitals in Victoria

Hospital

Months of assessment (dates)

Blood and body-fluid exposures

HCV exposures*


 

Total (% of all exposures)

Annualised no.


 

1

29 (1/99–5/01)

335

36 (11%)

15

2

16 (1/00–4/01)

205

26 (13%)

19

3

  5 (1/01–5/01)

  34

  6 (18%)

14

4

  24 (1/99–12/00)

468

25 (5%)  

12

5

29 (1/99–5/01)

363

40 (11%)

17

6

    8 (4/00–11/00)

  45

  5 (11%)

  7

Total

111

1450  

138 (9.9%)  

84


  

* Patient was positive for antibodies to hepatitis C virus. † 60%–85% were needlestick injuries.

2: Proposed management plan to reduce needlestick injuries and their risk among healthcare workers

1. Reduction in the risk of needlestick injuries and other exposures through:

§   Adequate education of healthcare workers about phlebotomy and intravenous cannula insertion, with credentialling of knowledge and performance.

§   Systems management

·   Availability of suitable sharps-disposal containers

·   Introduction of safety cannulas

·   Rationalisation/avoidance of unnecessary procedures

·   Appropriate healthcare worker workload and adequate staff–patient ratios (excessive tiredness and work-related stress are clearly associated with higher rates of needlestick injury).

2. Appropriate health management and follow-up systems for staff, including appropriate counselling about hepatitis B and C virus and HIV infection.

3. Appropriate vaccination program for healthcare workers, especially hepatitis B vaccination, to prevent bloodborne diseases.

3: Proposed protocol for follow-up of healthcare workers after needlestick injury involving a patient with hepatitis C virus infection

 

HCV Ab = antibody to hepatitis C virus. PCR = polymerase chain reaction.
* Renal dialysis patients may have false-negative HCV Ab results and should be screened for HCV infection with both HCV Ab and PCR testing.
† “High transmitter risk” healthcare workers comprise surgeons, operating room nurses, interventional radiologists and their assistants, and emergency department and intensive care staff.
‡ “Low transmitter risk” healthcare workers comprise all others.
§ PCR done to allow early treatment if infected, to assess potential for healthcare worker-to-patient transmission and for legal reasons.
¶ PCR done for healthcare worker mental health and sexual advice.
** For possible retrospective PCR if HCV Ab seroconversion occurs.

Competing interests

  

None identified.

Acknowledgements

Many of the proposals in this protocol are the result of a meeting of clinicians held in Melbourne, Victoria, in 2001 to discuss a standardised approach to nosocomial HCV transmission. We acknowledge the input of these clincians and also the assistance of the infection control practitioners who helped obtain data: Ms Rhea Martin (Austin and Repatriation Medical Centre), Ms Fiona Wilson (Western General Hospital), Ms Joanne Cocks (St Vincent’s Hospital), Mr Richard Bartolo (Mercy Hospital), Associate Professor Denis Spelman (Alfred Hospital) and Dr Alan Street (Royal Melbourne Hospital).

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(Received 31 Mar 2003, accepted 2 Jun 2003)

Department of Infectious Diseases, Austin and Repatriation Medical Centre, Heidelberg, VIC.

Patrick GP Charles, MB BS, Registrar; M Lindsay Grayson, MD, FRACP, FAFPHM, Director, and Professor, Department of Medicine, University of Melbourne, and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.

Department of Gastroenterology, Austin and Repatriation Medical Centre, Heidelberg, VIC.

Peter W Angus, MD, FRACP, Director of Gastroenterology and Hepatology, and Professor of Medicine, Department of Medicine, University of Melbourne, Parkville, VIC.

Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC.

Joseph J Sasadeusz, PhD, FRACP, Infectious Diseases Physician.

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