National Hepatitis C Testing Policy May 2007
3. Transmission and infection control in the healthcare setting
- Hepatitis C testing of health care workers should be conducted in accordance with the general principles set out in this document with regard to privacy, confidentiality and access to appropriate health care and support services.
- Hepatitis C testing of all health care workers is not recommended.
- Health care workers who perform exposure prone procedures (EPPs) must undergo hepatitis C testing so that they are aware of their HCV status.
- Health care workers who test positive for HCV RNA must not perform EPPs.
- Testing should be considered for health care workers following occupational exposure to blood or body substances, for example through needlestick injury.
The health care system must support health care workers to minimise the risk of transmission by creating safe work environments, including appropriate training in infection control techniques and personal protective equipment.
In view of the general low risk of transmission of HCV in health care settings, routine testing of all health care workers is not recommended, as testing cannot ensure that at any point in time health care workers or patients are not potentially infectious.
In view of the documented risk of transmission of the HCV from a HCV RNA positive health care worker to a patient during the performance of EPPs, health care workers who perform EPPs must undergo regular testing for HCV in accordance with the general principles for testing set out in this document with regard to privacy, confidentiality and access to appropriate information and health care. Health care workers who are found to be HCV antibody positive must also undergo HCV RNA testing, and where they are found to be HCV RNA positive they must not perform EPPs.
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In order to ensure compliance with this recommendation it is essential that appropriate support is available to health care workers who test positive for HCV RNA given the potential psychological, social and economic costs to the individual.
In view of the risk, albeit low, of transmission of HCV from infected health care workers to patients during the performance of EPPs, health care workers who perform EPPs, or are about to commence performing EPPs, must know their HCV status by seeking serologic testing if untested. Serologic testing is also indicated for health care workers who perform EPPs, where:
it is 12 months or longer since their last test;
they have experienced a significant occupational exposure; or
non-occupational exposure has been identified, including needle sharing with a person infected with or at increased risk of hepatitis C.
Guidance regarding the management and monitoring of health care workers who have cleared hepatitis C infection (with or without treatment) and are negative for HCV RNA should be sought from a medical practitioner with expertise in the management of hepatitis C.
In cases of either patient or healthcare worker exposure to blood or body fluids (for example, through needlestick injury) during the provision of health care, consent for testing of the source individual – either a patient or a health care worker - should be obtained in accordance with the guiding principles of this policy. Protocols for post-exposure management are included in Australian Infection Control Guidelines for the Prevention of Transmission of Infectious Diseases in the Health Care Setting January 2004 (http://www.health.gov.au/internet/main/publishing.nsf/content/icg-guidelines-index.htm)
4Australian Government Department of Health and Ageing. Australian Infection Control Guidelines for the Prevention of Transmission of Infectious Diseases in the Health Care Setting January 2004.