Protocolo de actuación preventiva para personal sanitario infectado con VIH, VHB o VHC en el ambito hospitalario / Protocol of preventive action for healthcare workers infected with HIV, HBV or HCV

Introducción: toda la información epidemiológica de que disponemos hoy día confirma que las infecciones por virus transmitidos por sangre desde el personal sanitario a los pacientes, en la realización de procedimientos médicos, quirúrgicos y dentales, son muy infrecuentes, y que el riesgo de contagio es diferente según los virus a analizar. Protocolo: el presente protocolo recomienda lo siguiente: los derechos de los trabajadores sanitarios infectados con VIH, VHB o VHC deben respetarse en todo momento por lo que las restricciones a los mismos deben limitarse al máximo. Conclusiones: la minimización del riesgo de transmisión iatrogénica por parte del personal sanitario infectado garantiza la seguridad del paciente y es posible adoptando tanto las precauciones universales como ciertas medidas de ajuste individualizadas cuando sea preciso. La categorización según las actividades laborales que desempeña añadido al valor de carga viral en sangre, es importante para la valoración de aptitud, la cual será valorada individualmente en el Comité de Evaluación del Trabajador Sanitario (AU)

Introduction. all epidemiological information available to us today confirms that blood-borne virus infections from medical personnel to patients in medical, surgical and dental procedures are very rare, and that the risk of infection differs according to the viruses to be analyzed. Protocol: the present protocol recommends the following: the rights of health workers infected with HIV, HBV or HCV should be respected at all times and therefore the restrictions should be limited to the maximum. Conclusions: the minimization of the risk of iatrogenic transmission by health personnel infected patient guarantees the patient' s safety and it is possible to adopt both universal precautions and certain individualized adjustment measures when necessary. The categorization according to labor activities added to the value of blood viral load is important for the assessment of aptitude, which will be assessed individually in the Health Worker Evaluation Committee (AU)

Current strategies for managing providers infected with bloodborne pathogens.

BACKGROUND: In 1991 the Centers for Disease Control and Prevention issued guidelines to reduce risks for provider-to-patient transmission of bloodborne pathogens. These guidelines, unchanged since 1991, recommend management strategies for hepatitis B e antigen-positive providers and for providers infected with human immunodeficiency virus; they do not address hepatitis C virus (HCV)-infected providers. OBJECTIVE: We summarized current state practices and surveyed state health departments to determine (1) whether state policies have been modified since 1991; (2) whether state laws require prospective notification of patients and/or expert review panels to manage infected providers; (3) the frequency with which infected-providers issues come to the attention of state health departments; and (4) how state health departments intervene. METHODS: We reviewed the 50 states' laws and guidelines to determine current practices and conducted a structured telephone survey of all state health departments. RESULTS: Whereas only 19 states require infected providers to notify patients of the providers' bloodborne pathogen infection, these 19 states require notification under highly varied circumstances. Only 10 of 50 state health department officials identified these issues as requiring significant departmental effort. No state law or guideline incorporates information about providers' viral burdens as part of the risk assessment. Only 3 of 50 states have modified policies or laws since initial passage, and only 1 of 50 discusses the management of HCV-infected providers. CONCLUSIONS: These results identify a need for incorporating contemporary scientific information into guidelines and also suggest that infected-provider issues are not occurring commonly, are not being detected, or are being managed at levels below the state health department.

Health care-associated hepatitis B and C viruses: legal aspects.

The risk of hepatitis B and C transmission in health care settings has generated considerable attention within the legal system. This article begins with an overview of the relevant sources of law and then explores legal duties and liability arising from two major categories of risk: occupational risks to health care providers and health care-associated risks to patients and other third parties.

The HIV positive dentist in the United Kingdom--a legal perspective.

In 1991, the United Kingdom Advisory Panel (UKAP) was set up under the aegis of the Expert Advisory Group on AIDS (EAGA) to consider individual cases of HIV infected healthcare workers. Policy and guidance relating to HIV infected healthcare workers is set out in a Department of Health report. Although more recently the EAGA has advised that an HIV positive dentist may under certain conditions provide clinical treatment for patients who are also HIV positive, the advice from UKAP relating to exposure-prone procedures means, in effect, that dentists who become HIV positive must cease contemporary clinical dentistry. The plight of dentists who become HIV positive and face this situation has been poignantly described as '...the dental practice equivalent of clearing your desk and being escorted off the premises.'

Dentistry and the ethics of infection.

Currently, any dentist in the UK who is HIV-seropositive must stop treating patients. This is despite the fact that hepatitis B-infected dentists with a low viral load can continue to practise, and the fact that HIV is 100 times less infectious than hepatitis B. Dentists are obliged to treat HIV-positive patients, but are obliged not to treat any patients if they themselves are HIV-positive. Furthermore, prospective dental students are now screened for hepatitis B and C and HIV, and are not allowed to enrol on Bachelor of Dental Surgery degrees if they are infectious carriers of these diseases. This paper will argue that: (i) the current restriction on HIV-positive dentists is unethical, and unfair; (ii) dentists are more likely to contract HIV from patients than vice versa, and this is not reflected by the current system; (iii) the screening of dental students for HIV is also unethical; (iv) the fact that dentists can continue to practise despite hepatitis B infection, but infected prospective students are denied matriculation, is unethical; and (v) that the current Department of Health protocols, as well as being intrinsically unfair, have further unethical effects, such as the waste of valuable resources on 'lookback' exercises and the even more damaging loss of present and future dentists. Regulation in this area seems to have been driven by institutional fear of public fear of infection, rather than any scientific evidence or ethical reasoning.