Additionally, the panel should reinforce the need for standard precautions (e.g., double gloving, regular glove changes, use of blunt surgical needles). Members of the expert review panel may be chosen from, but not limited to, the following: persons with expertise in the provider’s specialty; infectious disease and hospital epidemiology specialists; liver disease specialists (gastroenterologists); the infected providers’ occupational health, student health, or primary care physicians; ethicists; human resource professionals; hospital or school administrators; and legal counsel. Certain constituents of the panel should be experienced in issues associated with blood-borne pathogens and their infectivity.

The CDC recommends that a threshold value of serum HBV DNA considered “safe” for practice (<1,000 international units/mL [5,000GE/mL] or its equivalent) be adopted by an expert review panel, indicating that the risk for HBV transmission is minimal and establishing when exposure-prone providers may safely perform surgical procedures. Monitoring should be conducted with an assay that can detect as low as 10–30 international units/mL, especially if the expert review panel wishes to adopt a lower threshold. Expert panel oversight by the CDC recommends that HBV-infected providers can conduct exposure-prone procedures if a low or undetectable HBV viral load is documented by regular testing at least every six months, unless higher levels require more frequent testing (e.g., as drug therapy is added or modified, or testing is repeated to determine if elevations above a threshold are transient).

The most notable change in the recommendations is that healthcare providers do not need to pre-advise their patients of their HBV seropositivity. The recommendations state that routine mandatory disclosure may be counterproductive to public health, as providers and healthcare students may believe a positive test would lead to loss of practice or educational opportunities.


Continue Reading

The CDC notes that the confidentiality of the infected provider should be respected. Certain expert review panels may elect to consider cases without knowledge of the name of the infected provider. However, awareness of the infected provider or student’s identity may be unavoidable, in which case, respect for the confidentiality of the person under review may be as it is for any other patient.The most notable change in the recommendations is that healthcare providers do not need to pre-advise their patients of their HBV seropositivity. The recommendations state that routine mandatory disclosure may be counterproductive to public health, as providers and healthcare students may believe a positive test would lead to loss of practice or educational opportunities.

The recommendations make note that most chronic HBV infected medical and dental students and healthcare providers who conform to current standards for infection control (e.g., double gloving during invasive surgery) are not curtailed in their practice or supervised learning ventures. The guidelines also reiterate the 1991 recommendation that HBV infection should not prohibit infected practitioners from surgery, dentistry, medicine, or allied health disciplines.

REFERENCES
Centers for Disease Control and Prevention. Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. MMWR 2012; 61 (No.RR-03): 1–12. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6103a1.htm?s_cid=rr6103a1_w. Accessed July 25, 2012.