[Table of Contents]

Volume: 23S2 • March 1997

AN INTEGRATED PROTOCOL TO MANAGE HEALTH CARE WORKERS EXPOSED TO BLOODBORNE PATHOGENS

Introduction

In March 1996, the Division of Nosocomial and Occupational Infections, Bureau of Infectious Diseases, and the Division of HIV Epidemiology Research, Bureau of HIV/AIDS and STDs, of the Laboratory Centre for Disease Control (LCDC) hosted a meeting to develop integrated recommendations for the management and follow-up of the health care worker (HCW) with a potential occupational exposure to bloodborne pathogens. When implemented, this protocol will enable health care facilities, public health agencies, laboratories, and emergency response organizations to manage a significant occupational exposure to hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV).

LCDC has published recommendations to help minimize the HWC's risk of exposure to fluids capable of transmitting bloodborne pathogens (i.e. HBV, HCV, and HIV) in health care and other workplace situations ^(1-5). These recommendations focus on preventing exposure through administrative controls, improved instrument design, safer workplace practices, and the appropriate use of personal protective equipment. Compliance with these key preventive measures is essential in the overall management of exposure to bloodborne pathogens.

Preventive measures also include hepatitis B vaccination which is recommended for persons at increased risk of exposure to blood (including increased risk of injury from a sharp) and other body fluids capable of transmitting infection. HCW students should complete their vaccine series before possible occupational exposure to blood or body fluids capable of transmitting infection. Health care facilities may choose to make HBV immunization a condition of employment and/or a prerequisite for physician admitting privileges.

The Canadian National Advisory Committee on Immunization (NACI) regularly reviews and revises recommendations for vaccine-preventable diseases. Hepatitis B vaccination recommendations date from 1979 and were revised in 1984, 1989, and 1993 ⁽⁶⁾.

Prior work on post-exposure management for HBV, HCV, and HIV has also been done. In 1984, NACI issued recommendations for effective follow-up after a significant exposure to HBV ⁽⁷⁾. In 1990, LCDC issued guidelines for post-exposure management of the HCW exposed to HIV, including testing and possible treatment ⁽⁸⁾. In 1995, LCDC endorsed the development of a national post-exposure protocol for HCV ⁽⁹⁾. The present document replaces and updates these guidelines and recommendations.

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