CDC Updates Hepatitis B Recommendations for Infected HCWs

From Medscape Medical News

Emma Hitt, PhD

July 6, 2012 — The US Centers for Disease Control and Prevention (CDC) has updated its 1991 recommendations for the management of hepatitis B virus (HBV)–infected healthcare providers and students to prevent HBV transmission.

The new recommendations were prepared by Scott D. Holmberg, MD, and colleagues from the CDC's Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. They were published on July 6 in the CDC's Morbidity and Mortality Weekly Report.

"The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery," Dr. Holmberg and colleagues write.

"Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures," they add.

According to the authors, as with the previous guidelines, HBV infection should not disqualify individuals from practicing medicine.

Changes to the previous recommendations include the following:

• No requirement is now needed to prenotify patients of a healthcare provider's HBV status.
• HBV DNA serum levels rather than hepatitis B e antigen status should be used to monitor infectivity.
• An HBV level of 1000 IU/mL (5000 GE/mL) or its equivalent is an appropriate threshold that determines whether a healthcare provider performing an "exposure-prone" procedure requires an expert panel oversight.
• Monitoring should be conducted with an assay that can detect levels as low as 10 to 30 IU/mL.
• For most providers and students with chronic hepatitis B who conform to current standards for infection control, HBV infection status alone does not require any curtailing of their practices or supervised learning experiences.

The guidelines address several issues, including precautions and preventive strategies that should be followed when HBV-infected healthcare providers and students treat patients. Such strategies include work practice and engineering controls. The guidelines also discuss ethical considerations.

All healthcare providers and students should receive a hepatitis B vaccine, with the 3-injection series, according to current CDC recommendations.

MMWR Morb Mortal Wkly Rep. 2012;61(RR03):1-12. Full text