- This document updates the "Society for Healthcare Epidemiology of America (SHEA) Guideline for Management of Healthcare Workers Who Are Infected With Hepatitis B Virus, Hepatitis C virus, and/or Human Immunodeficiency Virus" published in 2010.
- Since 2010, only 5 instances of healthcare personnel (HCP)-to-patient transmission of hepatitis B virus (HBV) (n = 2), hepatitis C virus (HCV) (n = 3), or human immunodeficiency virus (HIV) (n = 0) have occurred, underscoring the low risk for these events.
- In addition, interventions have been developed to reduce risks for occupational exposures and injuries, rendering the healthcare environment less risky for both patients and HCP. Effective antiretroviral therapy can now fully suppress HIV, rendering the person noninfectious to others, even through sexual contact.
- This document addresses Category III/exposure-prone procedures and notes that institutions are encouraged to individualize their own processes to address local circumstances, including state and local statutes.
Table 1. Factors Contributing to the Pathogenesis and Transmission Risk for HBV, HCV, and HIV
Table 2. 2020 Viral Load Thresholds for Any Restrictions on HCP Practice
|Note: The issue of viral nucleic acid quantification for HBV, HCV, and HIV remains challenging because different assay methodologies provide differing results. No uniform agreement exists about the conversions of genome equivalents per milliliter (GE/mL) to international units for HBV, HCV, or HIV.|
Table 3. Categorization of Healthcare-Associated Procedures According to Level of Risk for Bloodborne Pathogen Transmission
Procedures with negligible risk of bloodborne virus transmission
Procedures for which bloodborne virus transmission is theoretically possible but unlikely
Procedures for which there is definite risk of bloodborne virus transmission or that have been classified previously as “exposure-prone”
Note: Modified from Reitsma et al. Clin Infect Dis 2005; 40:1665–1672.
a Does not include subgingival scaling with hand instrumentation.
b If done emergently (e.g., during acute trauma or resuscitation efforts), peripheral phlebotomy is classified as Category III.
c If there is no risk present of biting or of otherwise violent patients.
d Use of an ultrasonic device for scaling and root planing would greatly reduce or eliminate the risk for percutaneous injury to the provider. If significant physical force with hand instrumentation is anticipated to be necessary, scaling and root planing and other Class II procedures could be reasonably classified as Category III.
e Making and suturing an episiotomy is classified as Category III.
f If unexpected circumstances require moving to an open procedure (e.g., laparotomy or thoracotomy), some of these procedures will be classified as Category III.
g If moving to an open procedure is required, these procedures will be classified as Category III.
h If opening a joint is indicated and/or use of power instruments (e.g., drills) is necessary, this procedure is classified as Category III.
i A procedure involving bones, major vasculature, and/or deep body cavities will be classified as Category III.
j Removal of an erupted or non-erupted tooth requiring elevation of a mucoperiosteal flap, removal of bone, or sectioning of tooth and suturing if needed.