Abstract

Background

Infectious 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.

Methods

A 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.

Results

The 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.

Conclusion

Routine 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.

Details

Title
1208. Preventing Transmission of Bloodborne Viruses from-Infected Healthcare Workers to Patients in Canadian Healthcare Settings: A National Guideline
Author
Ogunremi, Toju 1 ; Defalco, Katherine 1 ; Johnston, B Lynn 2 ; Boucoiran, Isabelle 3 ; Cividino, Maureen 4 ; Cleghorn, Blaine 5 ; Isinger, Melody Ann 6 ; Joffe, A Mark 7 ; Mazzulli, Tony 8 ; Yves, Robert 9 ; Vearncombe, Mary 10 ; Wong, David K 11 ; Wong, Jason 12 ; Dunn, Kathy 1 ; Henry, Bonnie 13 

1  Public Health Agency of Canada, Ottawa, ON, Canada 
2  Dalhousie University, Halifax, Ottawa, ON, Canada 
3  CHU Sainte-Justine, Montreal, QC, Canada 
4  St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada 
5  Dalhousie University, Faculty of Dentistry, Halifax, NS, Canada 
6  Consultant, Ottawa, Ottawa, ON, Canada 
7  University of Alberta, Edmonton, ON, Canada 
8  Mount Sinai Hospital and University Health Network, Toronto, ON, Canada 
9  Collège des médecins du Québec, Montreal, QC, Canada 
10  Sunnybrook Health Sciences Centre, Toronto, ON, Canada 
11  Toronto General Hospital, Toronto, ON, Canada 
12  BC Centre for Disease Control, Vancouver, BC, Canada 
13  British Columbia Ministry of Health, Victoria, BC, Canada 
First page
S434
Publication year
2019
Publication date
Oct 2019
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/ofid/ofz360.1071
ProQuest document ID
3171068929
Copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.