Blood-Borne Infections in Emergency Medicine

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Principles
HIV Recommendations
HBV Recommendations
HCV Recommendations
Copyright

[Ann Emerg Med. 2011;58:111-112.]

HIV, hepatitis, and other blood-borne infections affect increasing numbers of people, leaving emergency health care workers (HCWs) to confront a 2-fold challenge: ensuring that all individuals have access to emergency care and treatment regardless of HIV or other infectious disease status, and preventing exposure to and nosocomial transmission of those blood-borne infections. The risk of accidental transmission of HIV from infected HCWs to patients appears to be remote. However, there is greater evidence of the transmission of hepatitis B (HBV) and hepatitis C (HCV) from HCWs with active disease to patients.
In light of this challenge, the American College of Emergency Physicians (ACEP) endorses the following principles and recommendations.

•Mandatory HCV testing should not be a condition of employment for HCWs.

•Unless a practitioner is implicated in provider-to-patient HCV transmission, HCV infection per se does not constitute a basis for barring a HCW from any patient care activities, including invasive procedures.

•Decisions to restrict the practice of HCV-infected HCWs should be individualized and based on uniform and objective performance standards for competence, ability to perform routine duties, and compliance with established guidelines and procedures, not on the presence of HCV infection alone.

•All emergency HCWs with any potential for blood exposure should receive HBV vaccine unless medically contraindicated and should be tested for immunity after vaccination.

•The Centers for Disease Control and Prevention recommendations about clinical activity for HCWs who are HBsAg or HbeAg positive should be followed. HbeAg-positive HCWs should double-glove routinely and should not perform those activities that have been identified epidemiologically as associated with a risk for provider-to-patient HBV transmission despite the use of appropriate infection control procedures.

•HBV testing and postexposure prophylaxis should be discussed with victims of sexual assault at such time as the treating physician believes that such discussion would be clinically appropriate.

•HIV testing should be recommended to:

•HIV testing and postexposure prophylaxis should be discussed with victims of sexual assault at such time as the treating physician believes that such discussion would be clinically appropriate.

•HIV-positive patients should have the right to confidentiality and privacy; however, physicians should be allowed, without risk of liability, to exercise their professional discretion to confidentially inform an identified and unsuspecting third party at risk for HIV infection from the index patient.

•ACEP strongly supports the rapid HIV testing of patients who are the source of an HCW's occupational blood/body fluid exposure so as to guide rapid decisionmaking about treatment of the exposed provider.

•Mandatory HIV testing should not be a condition of employment for HCWs.

•HCWs should not be required to disclose their HIV status to employers unless their job performance is affected.

•HCWs who are HIV positive should not be:

precluded from performing any medical services according to HIV status alone; required to inform patients of their HIV status unless the patient is put at risk by exposure to the HCW's blood or body fluid; orrequired to obtain informed consent before the delivery of emergency services.

•Unless a practitioner is implicated in provider-to-patient HIV transmission, HIV infection per se does not constitute a basis for barring an HCW from any patient care activities, including invasive procedures.

•Decisions to restrict the practice of HIV-positive HCWs should be individualized and based on uniform and objective performance standards for competence, ability to perform routine duties, and compliance with established guidelines and procedures, not on the presence of an HIV infection of the HCW.

•Appropriate care should be provided to all patients who seek emergency care regardless of risk factors for or known infections with HIV or other blood-borne infections.

•Mandatory testing for HIV, HBV, or HCV should not be a condition for patients to receive emergency services. However, universal HIV screening is encouraged and may be undertaken in the emergency department or in the outpatient setting if feasible.

•Existing regulations and guidelines about infection control should be followed by emergency HCWs and institutions.

•HCWs who have been potentially exposed to infectious body fluids should have access to immediate evaluation and, when indicated, postexposure prophylaxis.

•HCWs infected with a blood-borne pathogen are encouraged to seek expert ongoing care and advice about their disease and its relation to their practice of emergency medicine.

•HCWs infected with any blood-borne pathogen who are not allowed to perform the duties of their specialty because of their serostatus should receive compensation from disability insurance policies as if they were disabled.

 Revised and approved by ACEP Board of Directors titled, “Bloodborne Infections in Emergency Medicine” October 2000; April 2004; and April 2011

 Originally approved by the ACEP Board of Directors titled, “HIV and Bloodborne Infections in Emergency Medicine” September 1996

PII: S0196-0644(11)00457-4

doi:10.1016/j.annemergmed.2011.04.026

© 2011 Published by Elsevier Inc.