Preventing transmission of blood-borne infections

The College recognizes that the treatment for blood-borne agents has undergone a revolution as a result of modern antivirals and vaccination for HBV. 

For example: 

  • HIV replication can be completely controlled, leading to undetectable viral loads, and this has been shown to prevent blood-borne HIV transmission as well as sexual transmission.
  • Similarly, for HBV, antiviral therapy can control HBV replication and thereby prevent HBV transmission from blood and body fluids. In addition, the general population is now increasingly being vaccinated against HBV, and therefore protected from becoming chronically infected even if exposed.
  • For HCV, antiviral treatments can now cure >95% of those infected. Once cured, unless there are ongoing reinfection risk factors, the person will no longer be able to transmit this blood-borne infection.  

Transmission of blood-borne infections from physicians is rare and largely occurs during exposure prone procedures (EPPs) where the infected physician has sustained an injury that exposes the patient to their blood. 

Reference: SHEA guidelines Table 2, Category III   

Prior to 2016, the College required all registrants to disclose if they had been infected with a blood-borne pathogen. Now the College only requires registrants to disclose if they perform or assist in performing EPPs. 

Undergraduate medical trainees are considered to be performing EPPs during their undergraduate training. They are also considered to be performing EPPs in their first postgraduate year and throughout residency depending on their specialty. 

The current standard, Blood-borne Pathogens in Registrants, mandates that all registrants (including trainees) who perform or assist in performing EPPs and who do not have a blood-borne infection must be tested for BBPs at three year intervals.

Registrants who are shown to be infected with one of more of the agents will be allowed to continue performing EPPs if their viral loads are either undetectable (HIV), cured of HCV or have HBV viral loads that are sufficiently low as to pose a negligible risk during EPPs. Registrants’ health information is de-identified prior to being reviewed by the Blood Borne Communicable Diseases Committee expert panel.