|
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
Return
to Part
1
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
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).
References
1.
Centers for Disease Control and Prevention. Updated US Public Health
Service Guidelines on the management of occupational exposures to HBV, HCV,
and HIV and recommendations for post-exposure prophylaxis.
MMWR Recomm Rep 2001; 50 (RR-11): 1-67.
2.
National Health and Medical Research Council. Australian immunisation
handbook. 7th ed. Canberra: AGPS, 2000.
3.
Case–control study of HIV seroconversion in health-care workers after
percutaneous exposure to HIV-infected blood — France, United Kingdom, and
United States, January 1988–August 1994. MMWR Morb
Mortal Wkly Rep 1995; 44: 929-933.
4.
Recommendations for prevention and control of hepatitis C virus (HCV)
infection and HCV-related chronic disease. Centers for Disease Control and
Prevention. MMWR Recomm Rep 1998; 47 (RR-19):
1-39.
5.
Batey RG. Hepatitis C: where are we at and where are we going?
Med J Aust 2002; 176: 361-362.
6.
Watson KJR. Preventing hepatitis C virus transmission in Australians
who inject drugs. Med J Aust 2000; 172: 55-56.
7.
Jaeckel E, Cornberg M, Wedemeyer H, et al. Treatment of acute
hepatitis C with interferon alfa-2b. N Engl J Med
2001; 345: 1452-1457.
8.
Dore GJ, Kaldor JM, McCaughan GW. Systematic review of role of
polymerase chain reaction in defining infectiousness among people infected
with hepatitis C virus. BMJ 1997; 315: 333-341.
9.
Recommendations for follow-up of health-care workers after
occupational exposure to hepatitis C virus. MMWR Morb
Mortal Wkly Rep 1997; 46: 603-606.
10.
Hamid SS, Farooqui B, Rizvi Q, et al. Risk of transmission and
features of hepatitis C after needlestick injuries.
Infect Control Hosp Epidemiol 1999; 20: 63-64.
11.
Mitsui T, Iwano K, Masuko K, et al. Hepatitis C virus infection in
medical personnel after needlestick accident.
Hepatology 1992; 16: 1109-1114.
12.
Osborn EHS, Papadakis MA, Gerberding JL. Occupational exposures to
body fluids among medical students: a seven-year longitudinal study.
Ann Intern Med 1999; 130: 45-51.
13.
Torres M, Campins M, Esteban JI, et al. Is it useful to perform the
RNA test for hepatitis C in health care workers after an accidental
needlestick? J Hepatol 2000; 33: 686.
14.
Lauer GM, Walker BD. Hepatitis C virus infection.
N Engl J Med 2001; 345: 41-52.
15.
Beld M, Penning M, McMorrow M, et al. Different hepatitis C virus (HCV)
RNA load profiles following seroconversion among injecting drug users
without correlation with HCV genotype and serum alanine aminotransferase
levels. J Clin Microbiol 1998; 36: 872-877.
16.
Terrault NA. Epidemiological evidence for perinatal transmission of
hepatitis C virus. Viral Hepatitis Reviews 1998;
4: 245-258.
17.
Ohto H, Terazawa S, Sasaki N, et al. Transmission of hepatitis C
virus from mothers to infants. N Engl J Med
1994; 330: 744-750.
18.
National Institutes of Health. National Institutes of Health
Consensus Development Conference Statement. Management of hepatitis C:
2002–Jun 10-12, 2002. Hepatology 2002; 36 (5
Suppl 1): S3-S20.
19.
Zaaijer HL, Cuypers HT, Reesink HW, et al. Reliability of polymerase
chain reaction for detection of hepatitis C virus infection.
Lancet 1993; 341: 722-724.
20.
Sulkowski MS, Ray SC, Thomas DL. Needlestick transmission of
hepatitis C. JAMA 2002; 287: 2406-2413.
21.
Australian Department of Health and Ageing. Medicare Benefits
Schedule, November 2002. Canberra: Commonwealth of Australia, 2002.
22.
Seeff LB. Natural history of hepatitis C.
Hepatology 1997; 26 (3 Suppl): 21S-28S.
23.
Quin JW. Interferon therapy for acute hepatitis C viral infection — a
review by meta-analysis. Aust N Z J Med 1997;
27: 611-618.
24.
Poynard T, Leroy V, Cohard M, et al. Meta-analysis of interferon
randomized trials in the treatment of viral hepatitis C: effects of dose and
duration. Hepatology 1996; 24: 778-789.
25.
Vogel W. Treatment of acute hepatitis C virus infection.
J Hepatol 1999; 31 Suppl 1: 189-192.
26.
Rosenstock L. Needlestick injuries among healthcare workers.
Statement of Linda Rosenstock, MD, MPH, Director, CDC's National Institute
for Occupational Safety and Health, before the Committee on Education and
the Workforce Subcommittee on Workforce Protections, US House of
Representatives, June 22, 2000. Available at:
http://www.cdc.gov/washington/testimony/ws062200.htm (accessed
Jun 2003).
27.
Gershon RRM, Flanagan PA, Karkashian C, et al. Health care workers’
experience with postexposure management of bloodborne pathogen exposures: a
pilot study. Am J Infect Control 2000; 28:
421-428.
28.
Fisman DN, Mittleman MA, Sorock GS, Harris AD. Willingness to pay to
avoid sharps-related injuries: a study in injured health care workers.
Am J Infect Control 2002; 30: 283-287.
29.
Kao JH, Hwang YT, Chen PJ, et al. Transmission of hepatitis C virus
between spouses: the important role of exposure duration.
Am J Gastroenterol 1996; 91: 2087-2090.
30.
Goto M, Fujiyama S, Kawano S, et al.
Intrafamilial transmission of hepatitis C virus. J
Gastroenterol Hepatol 1994; 9: 13-18.
31.
Caporaso N, Ascione A, Stroffolini T. Spread of hepatitis C virus
infection within families. Investigators of an Italian Multicenter Group.
J Viral Hepat 1998; 5: 67-72.
32.
Guadagnino V, Stroffolini T, Foca A, et al.
Hepatitis C infection in family setting. Eur J
Epidemiol 1998; 14: 229-232.
33.
Ross RS, Viazov S, Roggendorf M. Risk of hepatitis C transmission
from infected medical staff to patients: model-based calculations for
surgical settings. Arch Intern Med 2000; 160:
2313-2316.
34.
Ross RS, Viazov S, Gross T, et al. Transmission of hepatitis C virus
from a patient to an anesthesiology assistant to five patients.
N Engl J Med 2001; 343: 1851-1854.
35.
Esteban JI, Gomez J, Martell M, et al. Transmission of hepatitis C
virus by a cardiac surgeon. N Engl J Med 1996;
334: 555-560.
36.
Duckworth GJ, Heptonstall J, Aitken C. Transmission of hepatitis C
virus from a surgeon to a patient. Commun Dis Public
Health 1999; 2: 188-192.
37.
Brown P. Surgeon infects patient with hepatitis C.
BMJ 1999; 319: 1219.
38.
National Health and Medical Research Council. Infection control in
the health care setting. Guidelines for the prevention of transmission of
infectious diseases. Canberra: AGPS, 1998.
39.
Australian National Council on AIDS. Bulletin No. 16. Needlestick and
blood accidents. Canberra: AGPS, 1996.
40.
Ramsay ME. Guidance on the investigation and management of
occupational exposure to hepatitis C. Commun Dis Public
Health 1999; 2: 258-262.
41.
Health Canada. An integrated protocol to manage health care workers
exposed to bloodborne pathogens. Can Commun Dis Rep
1997; 23 Suppl 2: 1-14.
42.
Sherman M. Management of viral hepatitis: Clinical and public health
perspectives — a consensus statement. Can J
Gastroenterol 1997; 11: 407-416.
43.
Polish LB, Tong MJ, Co RL, et al. Risk factors for hepatitis C virus
infection among health care personnel in a community hospital.
Am J Infect Control 1993; 21: 196-200.
(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.
Return to Part
1
|
