Knowing your serological status to keep patients safe
There has been a revolution in the treatment and management of blood-borne viral (BBV) infections over the last two decades, where all can be prevented, managed, or cured. Safe vaccines and treatments exist for hepatitis B (HBV) to prevent infection or reduce viral loads to levels that make transmission impossible. In most cases, hepatitis C (HCV) is now a curable infection, and HIV can be managed to the point where viral loads are undetectable and risk of transmission negligible.
The College believes that it is better for registrants to know their serological status in order to keep their patients safe, and to ensure that they get the health care they need. Those who learn that they have a new BBV infection can get treatment and take the necessary measures to enable them to continue to work.
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). EPPs include surgical procedures, surgical assists, providing peripartum obstetrical care, or working in an emergency room. Risk of a health-care provider transmitting a viral infection is completely manageable, first and foremost, by knowing one’s status.
All College registrants are expected to have had the hepatitis B vaccine (if they do not have natural immunity) and to know their immune status with respect to this virus. Furthermore, College registrants who perform EPPs are expected to know their HIV and HCV status, and to get tested at least every three years, and after an exposure event (needlestick injury or other exposure). More importantly, registrants who know their status can ensure sustained good health and protect against risks associated with untreated viral hepatitis and HIV.
Registrants living with a blood borne viral infection can still practise medicine and can still perform EPPs safely.
All of this is reflected in a description of clinical best practices as outlined in the Public Health Agency of Canada publication, Guideline on the prevention of transmission of bloodborne viruses from infected healthcare workers in healthcare settings. The Blood-borne Viruses in Registrants practice standard aligns with, and originates from these guidelines.
Each year, registrants are asked on their Annual Licence Renewal Form whether they do EPPs, and if they do, they are asked if they are in compliance with the minimum testing requirements (three years) outlined by the standard. This question will continue to be asked, but the College believes that it is not just a matter of satisfying the standard—all registrants are encouraged to speak with their care provider to get tested, and to know their virologic status for their own health and safety.
Registrants who have a BBV and do EPPs have a duty to report this to the College, but they may be assured that the health monitoring department handles this information sensitively and confidentially with the utmost attention to privacy.
For more information on this, see the College website.