Ohio Department of Ohio Department of Health Updated Health Updated

Recommendations for HIV, Recommendations for HIV, HCV, and HBV Infected HCV, and HBV Infected

Healthcare Workers, 2006Healthcare Workers, 2006

Kathleen M. Koechlin PhD, MPH, RNKathleen M. Koechlin PhD, MPH, RNHepatitis C CoordinatorHepatitis C Coordinator

Ohio Department of HealthOhio Department of HealthBureau of Infectious Disease ControlBureau of Infectious Disease Control

kathleen.koechlin@odh.ohio.govkathleen.koechlin@odh.ohio.gov614-644-2714614-644-2714

A page of acronymsA page of acronyms

ODH = Ohio Department of HealthODH = Ohio Department of Health HCW = healthcare workerHCW = healthcare worker HIV = human immunodeficiency virusHIV = human immunodeficiency virus HCV = hepatitis C virusHCV = hepatitis C virus HBV = hepatitis B virusHBV = hepatitis B virus CDC = Centers for Disease Control and CDC = Centers for Disease Control and

PreventionPrevention OSHA = Occupational Safety and Health OSHA = Occupational Safety and Health

AdministrationAdministration EPA = Environmental Protection AgencyEPA = Environmental Protection Agency JCAHO = Joint Commission on Accreditation JCAHO = Joint Commission on Accreditation

of Healthcare Organizationsof Healthcare Organizations

History – Federal History – Federal MandateMandate Section 633 of the Treasury, Section 633 of the Treasury,

Postal Service, and General Postal Service, and General Appropriations Act of 1991 Appropriations Act of 1991 mandated that all states establish mandated that all states establish recommendations for the practice recommendations for the practice of HCWs infected with a of HCWs infected with a bloodborne pathogen including bloodborne pathogen including HIV and HBVHIV and HBV

History – State History – State MandateMandate Ohio House Bill 419 passed by the 119Ohio House Bill 419 passed by the 119thth

General Assembly in 1992General Assembly in 1992– Mandated the Director of Health to create Mandated the Director of Health to create

the Task Force on the Transmission of the Task Force on the Transmission of Bloodborne Pathogens by Healthcare Bloodborne Pathogens by Healthcare ProfessionalsProfessionals

Establish and keep current guidelines/ Establish and keep current guidelines/ recommendations in accordance with the CDC recommendations in accordance with the CDC guidelinesguidelines

– Required the Ohio dental, medical, and Required the Ohio dental, medical, and nursing boards to adopt rules establishing nursing boards to adopt rules establishing that Universal Blood and Body Fluid that Universal Blood and Body Fluid Precautions be used by all persons licensed Precautions be used by all persons licensed by these boardsby these boards

CDC Recommendations CDC Recommendations - - July 12, 1991July 12, 1991 Based on the following considerations:Based on the following considerations:

– Infected HCWs who adhere to Universal Infected HCWs who adhere to Universal Precautions and do not perform invasive Precautions and do not perform invasive procedures pose no risk for transmitting HIV procedures pose no risk for transmitting HIV or HBV to patientsor HBV to patients

– Infected HCWs who adhere to Universal Infected HCWs who adhere to Universal Precautions and who perform certain Precautions and who perform certain exposure-prone procedures pose a small exposure-prone procedures pose a small risk for transmitting HBV to patientsrisk for transmitting HBV to patients

– HIV is transmitted much less readily than HIV is transmitted much less readily than HBVHBV

– Until further data are available, precautions Until further data are available, precautions must be taken to prevent HIV and HBV must be taken to prevent HIV and HBV transmission during procedures that have transmission during procedures that have been linked to HCW-to-patient HBV been linked to HCW-to-patient HBV transmission or that are considered transmission or that are considered exposure-proneexposure-prone

Background – Background – Previous Previous Infection Control Practice Infection Control Practice RecommendationsRecommendations

Universal PrecautionsUniversal Precautions Appropriately disinfected and sterilized Appropriately disinfected and sterilized

instruments and other reusable instruments and other reusable equipmentequipment

Training of HCWs on infection controlTraining of HCWs on infection control HBV vaccine for all HCWs who might be HBV vaccine for all HCWs who might be

exposed to blood in an occupational exposed to blood in an occupational settingsetting

Background –Background – Transmission Transmission of HBV During Invasive of HBV During Invasive ProceduresProcedures As of 1991, published reports of 20 As of 1991, published reports of 20

clusters in which a total of over 300 clusters in which a total of over 300 patients were infected with HBV in patients were infected with HBV in association with treatment by an HBV-association with treatment by an HBV-infected HCWinfected HCW– Of HCWs whose HBeAg status was determined Of HCWs whose HBeAg status was determined

(17 of 20), all were HBeAg positive(17 of 20), all were HBeAg positive– Each report indicated that the potential Each report indicated that the potential

existed for contamination of surgical wounds existed for contamination of surgical wounds or traumatized tissue, either from a major or traumatized tissue, either from a major break in standard infection-control practices break in standard infection-control practices or from unintentional injury to the infected or from unintentional injury to the infected HCW during invasive proceduresHCW during invasive procedures

Background –Background – Transmission Transmission of HIV During Invasive of HIV During Invasive ProceduresProcedures Cluster of HIV infections among patients in the Cluster of HIV infections among patients in the

practice of one dentist with AIDS (5 of 850 practice of one dentist with AIDS (5 of 850 patients evaluated through June 1991)patients evaluated through June 1991)

Two studies when patients were cared for by a Two studies when patients were cared for by a general surgeon and a surgical resident who general surgeon and a surgical resident who had AIDS, all patients tested HIV negativehad AIDS, all patients tested HIV negative

Of 143 patients treated by an HIV+ dental Of 143 patients treated by an HIV+ dental student, all were HIV-student, all were HIV-

616 patients of an HIV+ general surgeon all 616 patients of an HIV+ general surgeon all tested HIV- except for one who had a history tested HIV- except for one who had a history of injection drug useof injection drug use

Further evaluation of a substantially larger Further evaluation of a substantially larger number of patients whose exposure-prone number of patients whose exposure-prone procedures have been performed by HIV-procedures have been performed by HIV-infected HCWs is neededinfected HCWs is needed

Exposure-Prone Exposure-Prone ProceduresProcedures Certain oral, cardiothoracic, colorectal, Certain oral, cardiothoracic, colorectal,

and OB/GYN proceduresand OB/GYN procedures Characteristics of exposure-prone Characteristics of exposure-prone

procedures:procedures:– Digital palpation of a needle tip in a body Digital palpation of a needle tip in a body

cavitycavity– Simultaneous presence of the HCW’s Simultaneous presence of the HCW’s

fingers and a needle or other sharp fingers and a needle or other sharp instrument or object in a poorly visualized instrument or object in a poorly visualized or highly confined anatomic siteor highly confined anatomic site

CDC RecommendationsCDC Recommendations

All HCWs should adhere to Universal All HCWs should adhere to Universal PrecautionsPrecautions

No basis for recommendations to restrict No basis for recommendations to restrict the practice of HCWs infected with HIV or the practice of HCWs infected with HIV or HBV who perform invasive procedures HBV who perform invasive procedures not identified as exposure-prone, not identified as exposure-prone, provided they practice the recommended provided they practice the recommended surgical or dental technique and comply surgical or dental technique and comply with Universal Precautions and current with Universal Precautions and current recommendations for sterilization/ recommendations for sterilization/ disinfectiondisinfection

CDC CDC Recommendations, Recommendations, continuedcontinued Exposure-prone procedures should be Exposure-prone procedures should be

identified by medical/surgical/dental identified by medical/surgical/dental organizations and institutions at which the organizations and institutions at which the procedures are performedprocedures are performed

HCWs who perform exposure-prone HCWs who perform exposure-prone procedures should know their HIV antibody procedures should know their HIV antibody statusstatus

HCWs who perform exposure-prone HCWs who perform exposure-prone procedures and do not have serologic procedures and do not have serologic evidence of immunity to HBV from vaccination evidence of immunity to HBV from vaccination or previous infection should know their HBsAg or previous infection should know their HBsAg status and, if positive, should know their status and, if positive, should know their HBeAg statusHBeAg status

CDC CDC Recommendations, Recommendations, continuedcontinued HCWs who are infected with HIV or HBV HCWs who are infected with HIV or HBV

(and are HBeAg+) should not perform (and are HBeAg+) should not perform exposure-prone procedures unless they exposure-prone procedures unless they have sought counsel from an expert have sought counsel from an expert review panel and been advised under review panel and been advised under what circumstances, if any, they may what circumstances, if any, they may continue to perform these procedures continue to perform these procedures

Mandatory testing of HCWs for HIV, Mandatory testing of HCWs for HIV, HBsAg, or HBeAg is not recommendedHBsAg, or HBeAg is not recommended

HCWs whose practices are HCWs whose practices are modified because of HIV or modified because of HIV or HBV status….HBV status….

should, whenever possible, be should, whenever possible, be provided opportunities to continue provided opportunities to continue appropriate patient-care activitiesappropriate patient-care activities

should be given career counseling and should be given career counseling and ways to retain a job so that the ways to retain a job so that the continued use of the HCW’s talents, continued use of the HCW’s talents, knowledge and skills can be knowledge and skills can be maintainedmaintained

HCWs whose practices are HCWs whose practices are modified because of HBV modified because of HBV status….status….

Should be re-evaluated Should be re-evaluated periodically to determine whether periodically to determine whether their HBeAg status changestheir HBeAg status changes

Notification of PatientsNotification of Patients

The public health benefit of notification The public health benefit of notification of patients who have had exposure-of patients who have had exposure-prone procedures performed by HCWs prone procedures performed by HCWs infected with HIV or positive for HBeAg infected with HIV or positive for HBeAg should be considered on a case-by-should be considered on a case-by-case basis, taking into consideration:case basis, taking into consideration:– Specific risksSpecific risks– Confidentiality issuesConfidentiality issues– Available resourcesAvailable resources

Additional NeedsAdditional Needs Clearer definition of the nature, frequency, and Clearer definition of the nature, frequency, and

circumstances of blood contact between circumstances of blood contact between patients and HCWs during invasive procedurespatients and HCWs during invasive procedures

Development and evaluation of new devices, Development and evaluation of new devices, protective barriers, and techniques that may protective barriers, and techniques that may prevent such blood contact without adversely prevent such blood contact without adversely affecting the quality of patient care affecting the quality of patient care

More information on the potential for HIV and More information on the potential for HIV and HBV transmission through contaminated HBV transmission through contaminated instrumentsinstruments

Improvements in sterilization and disinfection Improvements in sterilization and disinfection techniques for certain reusable equipment and techniques for certain reusable equipment and devicesdevices

Identification of factors that may influence the Identification of factors that may influence the likelihood of HIV or HBV transmission after likelihood of HIV or HBV transmission after exposure to HIV or HBV infected bloodexposure to HIV or HBV infected blood

Ohio Department of Health Updated Ohio Department of Health Updated Recommendations for HIV, HCV, and Recommendations for HIV, HCV, and HBV Infected Healthcare Workers, HBV Infected Healthcare Workers, 20062006 In the early 1990s the original document (created in In the early 1990s the original document (created in

response to the federal and state mandates) response to the federal and state mandates) developed recommendations for HCWs infected with developed recommendations for HCWs infected with HIV and HBVHIV and HBV

Developed by a committee of Ohio’s medical and Developed by a committee of Ohio’s medical and public health communities in conjunction with the public health communities in conjunction with the ODHODH– Ohio State Medical BoardOhio State Medical Board– Ohio Board of NursingOhio Board of Nursing– Ohio State Dental BoardOhio State Dental Board– Ohio Hospital AssociationOhio Hospital Association– Ohio Dental AssociationOhio Dental Association– Ohio Osteopathic AssociationOhio Osteopathic Association– Ohio State Medical AssociationOhio State Medical Association– Ohio Nurses AssociationOhio Nurses Association– Association of Ohio Health CommissionersAssociation of Ohio Health Commissioners– Physicians with expertise in HIVPhysicians with expertise in HIV

Ohio Department of Health Updated Ohio Department of Health Updated Recommendations for HIV, HCV, and Recommendations for HIV, HCV, and HBV Infected Healthcare Workers, HBV Infected Healthcare Workers, 20062006 In 2004-2005, the ODH reviewed those In 2004-2005, the ODH reviewed those

recommendations given current science and a new recommendations given current science and a new understanding of HCV and its significanceunderstanding of HCV and its significance

The revision process solicited comments from:The revision process solicited comments from:– Ohio State Medical BoardOhio State Medical Board– Ohio Board of NursingOhio Board of Nursing– Ohio State Dental BoardOhio State Dental Board– Ohio Hospital AssociationOhio Hospital Association– Ohio Dental AssociationOhio Dental Association– Ohio Osteopathic AssociationOhio Osteopathic Association– Ohio State Medical AssociationOhio State Medical Association– Ohio Nurses AssociationOhio Nurses Association– Association of Ohio Health CommissionersAssociation of Ohio Health Commissioners– Infectious Diseases Society of OhioInfectious Diseases Society of Ohio

Principles Guiding Principles Guiding Policy DevelopmentPolicy Development Universal and/or Standard Precautions are the Universal and/or Standard Precautions are the

most effective means of preventing most effective means of preventing transmission of any bloodborne pathogen transmission of any bloodborne pathogen both to and from HCWsboth to and from HCWs

Medical practices, including Universal or Medical practices, including Universal or Standard Precautions and improved Standard Precautions and improved engineering controls, decrease the risk of engineering controls, decrease the risk of bloodborne pathogen transmissionbloodborne pathogen transmission

Mandatory HIV screening of all HCWs in Ohio Mandatory HIV screening of all HCWs in Ohio is inappropriateis inappropriate

Risk of HCV transmission from an infected Risk of HCV transmission from an infected HCW to patients appears to be very lowHCW to patients appears to be very low

There is some evidence that transmissibility There is some evidence that transmissibility of these viruses is reflected in certain of these viruses is reflected in certain biochemical markers (e.g., HBeAg, HIV-RNA biochemical markers (e.g., HBeAg, HIV-RNA viral load)viral load)

Ohio’s Policy Ohio’s Policy RecommendationsRecommendations CDC’s guidelines and OSHA’s Bloodborne CDC’s guidelines and OSHA’s Bloodborne

Pathogen Standard are the basisPathogen Standard are the basis– Universal Precautions and Standard Universal Precautions and Standard

PrecautionsPrecautions– Infection ControlInfection Control– Training and EducationTraining and Education– Hepatitis B VaccinationHepatitis B Vaccination– Counseling and TestingCounseling and Testing– Infected HCWsInfected HCWs– Review PanelsReview Panels

Universal Precautions Universal Precautions and Standard and Standard PrecautionsPrecautions All HCWs must strictly adhere to the All HCWs must strictly adhere to the

Universal Precautions set forth by the Universal Precautions set forth by the OSHAOSHA

All HCWs must follow CDC guidelines for All HCWs must follow CDC guidelines for Standard PrecautionsStandard Precautions

Ohio medical, dental, and nursing boards Ohio medical, dental, and nursing boards have mandated the use of Universal have mandated the use of Universal Precautions for license holders who Precautions for license holders who perform exposure-prone proceduresperform exposure-prone procedures

Employers must keep records of training, Employers must keep records of training, observe practices, and ensure compliance observe practices, and ensure compliance with Universal and/or Standard Precautionswith Universal and/or Standard Precautions

Infection ControlInfection Control

All HCWs must strictly adhere to All HCWs must strictly adhere to appropriate infection control procedures appropriate infection control procedures (guidelines set forth by the CDC and (guidelines set forth by the CDC and regulations of the EPA and OSHA)regulations of the EPA and OSHA)

HCWs who have exudative lesions or HCWs who have exudative lesions or weeping dermatitis should refrain from weeping dermatitis should refrain from all direct patient care and from handling all direct patient care and from handling patient care equipment and devices patient care equipment and devices used in performing invasive procedures used in performing invasive procedures until the condition resolvesuntil the condition resolves

Training and EducationTraining and Education Proper infection control techniquesProper infection control techniques

– Comply with CDC guidelines concerning Comply with CDC guidelines concerning barrier techniques, Standard Precautions, barrier techniques, Standard Precautions, and recommendations for ongoing trainingand recommendations for ongoing training

– OSHA requires training by employers for OSHA requires training by employers for persons with occupational exposure to persons with occupational exposure to potentially infectious substancespotentially infectious substances

– Training should be required in professional Training should be required in professional and vocational schools and vocational schools

– Training is recommended as part of Training is recommended as part of continuing professional education continuing professional education programmingprogramming

– Training is encouraged to be performed in Training is encouraged to be performed in accordance with the OSHA and the JCAHO accordance with the OSHA and the JCAHO requirements but should include HCWs requirements but should include HCWs outside these employer domainsoutside these employer domains

Hepatitis B Hepatitis B VaccinationVaccination HCWs susceptible to HBV HCWs susceptible to HBV

infection and with the potential of infection and with the potential of coming into contact with blood or coming into contact with blood or other potentially infectious other potentially infectious materials while working should materials while working should receive vaccination against HBVreceive vaccination against HBV

Counseling and Counseling and TestingTesting Mandatory testing of all HCWs for HIV, HCV, or Mandatory testing of all HCWs for HIV, HCV, or

HBV is NOT recommendedHBV is NOT recommended Testing should NOT be a condition of Testing should NOT be a condition of

employment, licensure or certificationemployment, licensure or certification HCWs who perform exposure-prone invasive HCWs who perform exposure-prone invasive

procedures should know their HIV, HCV and procedures should know their HIV, HCV and HBV statusHBV status

HCWs should be acutely aware of incidents HCWs should be acutely aware of incidents that pose a risk of acquiring a bloodborne that pose a risk of acquiring a bloodborne pathogen during work duties and should pathogen during work duties and should immediately report any percutaneous or immediately report any percutaneous or mucous membrane exposure to the blood or mucous membrane exposure to the blood or other potentially infectious material of a other potentially infectious material of a patientpatient

All HIV, HCV and HBV test results are All HIV, HCV and HBV test results are protected by medical confidentiality standards protected by medical confidentiality standards and should only be released to individuals who and should only be released to individuals who have a legitimate need to knowhave a legitimate need to know

Infected HCWsInfected HCWs Infected HCWs who adhere to Universal and Infected HCWs who adhere to Universal and

Standard Precautions and do not perform Standard Precautions and do not perform invasive procedures pose no risk for invasive procedures pose no risk for transmission of a bloodborne infection to a transmission of a bloodborne infection to a patientpatient

Infected HCWs who adhere to Universal and Infected HCWs who adhere to Universal and Standard Precautions and do perform invasive Standard Precautions and do perform invasive procedures pose a small risk for transmission to procedures pose a small risk for transmission to a patienta patient

HCWs who are infected with a bloodborne HCWs who are infected with a bloodborne pathogen have an obligation to seek advice pathogen have an obligation to seek advice from their personal physician in evaluating their from their personal physician in evaluating their specific medical conditions, and to examine the specific medical conditions, and to examine the possible need for assistance from a review panelpossible need for assistance from a review panel

HCWs or their personal physician(s) should HCWs or their personal physician(s) should contact the appropriate review panel for advice contact the appropriate review panel for advice and consultation regarding a HCW’s evaluationand consultation regarding a HCW’s evaluation

Review PanelsReview Panels

Institutional Review PanelsInstitutional Review Panels Non-institutional review panel Non-institutional review panel

convened by the Director of the convened by the Director of the ODHODH

Institutional Review Institutional Review Panels – Composition Panels – Composition (at a (at a minimum)minimum) An infectious disease physician or an advanced An infectious disease physician or an advanced

practice nurse in infectious diseasespractice nurse in infectious diseases A HCW who holds the same license and performs A HCW who holds the same license and performs

the same procedures as the infected HCWthe same procedures as the infected HCW An infection control specialist who has expertise An infection control specialist who has expertise

in Standard Precautions and OSHA requirementsin Standard Precautions and OSHA requirements An occupational health/employee health expert An occupational health/employee health expert

from the facility where the HCW practicesfrom the facility where the HCW practices The local health commissioner or designeeThe local health commissioner or designee An attorneyAn attorney An individual with expertise in legislative An individual with expertise in legislative

mandates impacting workplace obligations mandates impacting workplace obligations toward infected HCWstoward infected HCWs

Institutional Review Institutional Review Panels – Composition, Panels – Composition, continuedcontinued The HCW’s personal physician should The HCW’s personal physician should

be consulted by the panel, after be consulted by the panel, after appropriate authorization, about the appropriate authorization, about the HCW’s current functional statusHCW’s current functional status

All institutional review panels should All institutional review panels should include at least two individuals who include at least two individuals who are from outside the institutionare from outside the institution

Institutional Review Institutional Review Panels – other Panels – other requirements:requirements:

All institutional panels making All institutional panels making recommendations regarding HIV, HCV or recommendations regarding HIV, HCV or HBV positive HCWs must receive HBV positive HCWs must receive approval from the Director of Health approval from the Director of Health before the panel acts as the review before the panel acts as the review panelpanel

Institutions should have an employee Institutions should have an employee testing policy consistent with CDC and testing policy consistent with CDC and ODH recommendations and not in ODH recommendations and not in violation of state or federal lawviolation of state or federal law

Institutional Review Institutional Review Panels – other Panels – other requirements:requirements: Any institutional panel must report to Any institutional panel must report to

the Director of Health the status of the Director of Health the status of compliance with panel compliance with panel recommendations by a HCW receiving recommendations by a HCW receiving guidance from the panelguidance from the panel– The HCW shall be identified by an assigned The HCW shall be identified by an assigned

case number for purposes of reporting to case number for purposes of reporting to the Director of Healththe Director of Health

– The HCW’s name will only be associated The HCW’s name will only be associated with the case number if any action by a with the case number if any action by a licensing board must be takenlicensing board must be taken

– The Director of Health will receive a The Director of Health will receive a timetable for the re-evaluation, progress timetable for the re-evaluation, progress and compliance of each HCW under the and compliance of each HCW under the review of an institutional panelreview of an institutional panel

Non-institutional Review Non-institutional Review Panels – Composition Panels – Composition (at a (at a minimum)minimum)

Members will be selected by the Members will be selected by the Director of Health on a case-by-case Director of Health on a case-by-case basis to ensure familiarity with the basis to ensure familiarity with the specific professional duties of the HCWspecific professional duties of the HCW

The composition of this panel must be The composition of this panel must be equivalent to the composition of the equivalent to the composition of the institutional panel with the following institutional panel with the following exceptions:exceptions:– The state epidemiologist or designee must The state epidemiologist or designee must

be includedbe included– The occupational health specialist will be The occupational health specialist will be

designated by the Director of Health if this designated by the Director of Health if this panel relates to non-institutional workers panel relates to non-institutional workers and a non-institutional panel is convenedand a non-institutional panel is convened

Review Panel DutiesReview Panel Duties

Evaluate the HCW’s medical condition Evaluate the HCW’s medical condition and ability to perform specific job dutiesand ability to perform specific job duties

Make recommendations to the Director Make recommendations to the Director of Health concerning the circumstances of Health concerning the circumstances under which the HCW may perform under which the HCW may perform exposure-prone proceduresexposure-prone procedures

Recommendations shall be based on Recommendations shall be based on the HCW’s impairment and shall the HCW’s impairment and shall consider his or her likelihood of consider his or her likelihood of performing exposure-prone proceduresperforming exposure-prone procedures

Institutional Panel Institutional Panel DutiesDuties Evaluate the HCW’s medical condition Evaluate the HCW’s medical condition

and ability to perform specific and ability to perform specific occupational dutiesoccupational duties

Monitor compliance with Universal Monitor compliance with Universal Precautions, Standard Precautions and Precautions, Standard Precautions and appropriate infection control techniquesappropriate infection control techniques

Provide guidance and education to assist Provide guidance and education to assist the infected HCW in achieving strict the infected HCW in achieving strict adherence to established standardsadherence to established standards

Modification of practice Modification of practice recommendations when appropriaterecommendations when appropriate

Institutional Panel Institutional Panel Duties, Duties, continuedcontinued Render a decision regarding the HCW’s Render a decision regarding the HCW’s

ability to perform occupational dutiesability to perform occupational duties– Include a report of recommendations to be Include a report of recommendations to be

reviewed with and followed by the HCW reviewed with and followed by the HCW Copy of the report is filed with the Director of Copy of the report is filed with the Director of

HealthHealth– If HCW accepts recommendations, the panel will If HCW accepts recommendations, the panel will

establish a schedule to review the case and to re-establish a schedule to review the case and to re-evaluate the HCW’s adherence to recommendations evaluate the HCW’s adherence to recommendations and ability to continue specific occupational dutiesand ability to continue specific occupational duties

Copies of re-evaluations filed with Director of Copies of re-evaluations filed with Director of HealthHealth

Should the HCW become non-compliant with the Should the HCW become non-compliant with the panel recommendations or become unfit for duty, panel recommendations or become unfit for duty, the panel shall file a report with the Director of the panel shall file a report with the Director of Health who will notify the appropriate licensing Health who will notify the appropriate licensing boardboard

Non-institutional Panel Non-institutional Panel DutiesDuties Evaluate the HCW’s medical condition Evaluate the HCW’s medical condition

and ability to perform specific and ability to perform specific occupational dutiesoccupational duties

Monitor compliance with Universal Monitor compliance with Universal Precautions, Standard Precautions and Precautions, Standard Precautions and appropriate infection control techniquesappropriate infection control techniques

Provide guidance and education to assist Provide guidance and education to assist the infected HCW in achieving strict the infected HCW in achieving strict adherence to established standardsadherence to established standards

Modification of practice Modification of practice recommendations when appropriaterecommendations when appropriate

Non-institutional Panel Non-institutional Panel Duties, Duties, continuedcontinued A decision regarding the HCW’s ability A decision regarding the HCW’s ability

to perform occupational duties will be to perform occupational duties will be filed with the Director of Healthfiled with the Director of Health

The panel will establish a schedule for The panel will establish a schedule for periodic re-evaluation of the HCWperiodic re-evaluation of the HCW– Copies of the re-evaluation reports will be Copies of the re-evaluation reports will be

filed with the Director of Healthfiled with the Director of Health– Should the HCW become non-compliant Should the HCW become non-compliant

with the panel recommendations or with the panel recommendations or become unfit for duty, the panel shall file a become unfit for duty, the panel shall file a report with the Director of Health who will report with the Director of Health who will notify the appropriate licensing boardnotify the appropriate licensing board

ConfidentialityConfidentiality

All information obtained by a review All information obtained by a review panel regarding HIV, HCV or HBV panel regarding HIV, HCV or HBV infected HCWs shall be held in infected HCWs shall be held in confidence in accordance with all confidence in accordance with all applicable federal and state lawsapplicable federal and state laws

Members of the review panel must Members of the review panel must sign a statement of confidentiality sign a statement of confidentiality regarding the information they receive regarding the information they receive as a member of a review panelas a member of a review panel

EnforcementEnforcement

Noncompliance shall be reported Noncompliance shall be reported immediately to the Director of immediately to the Director of Health and further action will be Health and further action will be taken as necessarytaken as necessary

Enforcement, Enforcement, continuedcontinued Upon completing review of all relevant Upon completing review of all relevant

informationinformation– The panel prepares a preliminary report of The panel prepares a preliminary report of

its findings and recommendationsits findings and recommendations– A copy of this report is forwarded to the A copy of this report is forwarded to the

HCWHCW– No later than 60 days after providing the No later than 60 days after providing the

copy to the HCW, the panel convenes copy to the HCW, the panel convenes informally to review the report with the informally to review the report with the HCWHCW

Enforcement, Enforcement, continuedcontinued At the informal review:At the informal review:

– The HCW may appear in person, with, or by The HCW may appear in person, with, or by such other representative as the HCW feels such other representative as the HCW feels is appropriateis appropriate

– The HCW may, in advance of or at the The HCW may, in advance of or at the informal review, present additional relevant informal review, present additional relevant information and his or her positions, information and his or her positions, arguments, or contentions in writing or arguments, or contentions in writing or verballyverbally

– The panel may adopt, reverse, or modify The panel may adopt, reverse, or modify the preliminary report and notify the HCW the preliminary report and notify the HCW within 30 days of the informal review in the within 30 days of the informal review in the panel’s final report and recommendationpanel’s final report and recommendation

Enforcement, Enforcement, continuedcontinued After the panel’s final report:After the panel’s final report:

– The HCW may, within 30 days, request the The HCW may, within 30 days, request the Director of Health review the panel’s final Director of Health review the panel’s final report and recommendationsreport and recommendations

– The HCW may include written objections to The HCW may include written objections to the panel’s final report and the panel’s final report and recommendations along with the request for recommendations along with the request for the Director’s reviewthe Director’s review

– The Director of Health may request such The Director of Health may request such additional information the Director feels is additional information the Director feels is appropriate to conduct the requested reviewappropriate to conduct the requested review

– The Director shall affirm, reverse, or modify The Director shall affirm, reverse, or modify the panel’s final report and the panel’s final report and recommendationsrecommendations

– The decision of the Director to affirm, The decision of the Director to affirm, reverse, or modify the panel’s report and reverse, or modify the panel’s report and recommendations is final and not subject to recommendations is final and not subject to appealappeal

Articles of InterestArticles of Interest

Harpaz R, Von Seidlein L, Averhoff FM, et al. Harpaz R, Von Seidlein L, Averhoff FM, et al. Transmission of hepatitis B virus to multiple Transmission of hepatitis B virus to multiple patients from a surgeon without evidence of patients from a surgeon without evidence of inadequate infection control. N Engl J Med inadequate infection control. N Engl J Med 1996;334:549-54.1996;334:549-54.

AIDS/TB Committee of the Society for AIDS/TB Committee of the Society for Healthcare Epidemiology of America. Healthcare Epidemiology of America. Management of healthcare workers infected Management of healthcare workers infected with hepatitis B virus, hepatitis C virus, with hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or other human immunodeficiency virus, or other bloodborne pathogens. Infect Control Hosp bloodborne pathogens. Infect Control Hosp Epidemiol 1997;18:349-63.Epidemiol 1997;18:349-63.

Articles of InterestArticles of Interest

Reitsma AM, Closen ML, Cunningham Reitsma AM, Closen ML, Cunningham M, et al. Infected physicians and M, et al. Infected physicians and invasive procedures: Safe practice invasive procedures: Safe practice management. Clinical Infectious management. Clinical Infectious Diseases 2005;40:1665-72.Diseases 2005;40:1665-72.

Perry JL, Pearson RD, Jagger J. Infected Perry JL, Pearson RD, Jagger J. Infected health care workers and patient health care workers and patient safety: A double standard. Am J Infect safety: A double standard. Am J Infect Control 2006;34:313-9.Control 2006;34:313-9.

ReferencesReferences

Recommendations for Preventing Recommendations for Preventing Transmission of Human Immunodeficiency Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures. During Exposure-Prone Invasive Procedures. MMWR 40(RR08); 1-9. MMWR 40(RR08); 1-9. http://www.cdc.gov/mmwr/preview/mmwrhthttp://www.cdc.gov/mmwr/preview/mmwrhtml/00014845.htmml/00014845.htm

Ohio Department of Health Updated Ohio Department of Health Updated Recommendations for HIV, HCV, and HBV Recommendations for HIV, HCV, and HBV Infected Healthcare Workers, 2006.Infected Healthcare Workers, 2006.

http://www.odh.ohio.gov/alerts/alerts.aspxhttp://www.odh.ohio.gov/alerts/alerts.aspx