Health-care professionals have a moral obligation to manage the risk of transmitting blood-borne viral infections such as human immunodeficiency virus (HIV), hepatitis C (HCV), and hepatitis B (HBV) to patients. There is a small but real risk of transmitting these viral infections if a registrant has a poorly controlled infection and performs or assists in exposure-prone procedures (EPPs) such as surgery, obstetrics or working in an emergency room. (Even medical students and postgraduate students in their first year of residency are considered to be performing EPPs.)
With the revolution in managing blood-borne viral infections, health-care professionals with a blood-borne viral (BBV) infection can practise doing EPPs safely. Safe vaccines and treatment exist for HBV to prevent infection or reduce viral loads to levels that make transmission impossible. In most cases, HCV is now a curable infection, and HIV can be managed to the point where viral loads are undetectable and risk of transmission negligible.
Recently the Public Health Agency of Canada (PHAC) published guidelines on the Prevention of Transmission of Bloodborne Viruses from Infected Healthcare Workers in Healthcare Settings for health-care professionals with a BBV doing EPPs. The document articulates the balance between reasonable expectations of the public (protection from harm), and reasonable expectations of health-care professionals (right to privacy and professional autonomy). It also sets out key recommendations for health-care professionals, health authorities, and regulators to ensure safe practice for clinicians and patients. A key message for registrants who perform EPPs is that they know their status with respect to blood-borne viral infections, and if they have a BBV to ensure it is being treated by an appropriate specialist.
The College’s practice standard Blood-borne Viruses in Registrants aligns with all of the PHAC recommendations. The standard recommends that registrants who have a BBV who perform or assist in performing EPPs get tested every three years. Each year, registrants are asked on their Annual Licence Renewal Form whether they do EPPs, and if they do, whether they have a BBV. There is a duty to report one’s self or a colleague if that registrant does EPPs and is infected.
The College’s health monitoring department handles this information sensitively and confidentially with the utmost attention to the privacy of the individual. The College Bylaws mandate the creation of a Blood Borne Communicable Disease Committee composed of experts in the field of hepatology, infectious diseases, and public health. The committee meets in camera and considers the anonymized cases of registrants in active practice who perform EPPs and have a BBV. It makes recommendations on treatment and conditions necessary for the safe return or continuation of medical practice.