‘Look-Back’ Notifications for HIV/HBV-Positive Healthcare Workers

Extract

In December 1990, the Society for Hospital Epidemiology of America (SHEA), in conjunction with the Association for Practitioners in Infection Control, published a position paper entitled, ‘The HIV-Infected Healthcare Worker,” in which we outlined our approach to the evaluation and management of such individuals. In that position paper, we wrote that we did not favor widespread or compulsory testing for human immunodeficiency virus (HIV), hepatitis B, or other bloodborne pathogens for any group of healthcare workers including those doing invasive procedures. We indicated that the vast majority of patient contacts, including most invasive procedures, could be safely carried out by healthcare workers infected with HIV or other bloodborne pathogens, provided that such individuals were familiar with and adhered to proper infection control practices including those of “Universal Blood and Body Fluid Precautions” and assuming that such individuals had no other evidence of functional impairment due to medical, emotional, or neurological disease, which could affect their capacity to carry out such procedures. We recognized, however, that a small subset of invasive procedures, principally those involving by-feel manipulation of pointed or sharp objects within body cavities (including “blind” sewing) might pose a heightened risk of accidental injury and inadvertent transmission of bloodborne pathogens. We suggested therefore that healthcare workers infected with HIV or hepatitis B virus (HBV) be counseled to avoid, voluntarily, that small subset of procedures that in the past had been linked epidemiologically to the transmission of hepatitis B virus.